DOI: 10.1111/ajag.12184
Research How common is frailty in older Australians? Imaina Widagdo and Nicole Pratt Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
Mary Russell School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
Elizabeth Roughead Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
Aim: To determine the prevalence of frailty in a cohort of older Australians. Methods: Frailty status of the 2087 participants of the Australian Longitudinal Study of Ageing was assessed based on the questionnaire responses at the baseline interview. Frailty status and prevalence were assessed using four measures: two unidimensional measures (the Frailty Phenotype and Simplified Frailty Phenotype) and two multidimensional measures (Frailty Index and Prognostic Frailty Score). Agreement between the four measures was determined. Results: The multidimensional measures identified more people as frail (17.5 and 49.4%) than did the unidimensional (2 and 8.8%). There was little agreement between the measures; only 0.5% of the participants were identified as frail by all four measures. Conclusions: The apparent prevalence of frailty varied when different measures were used. It is important for clinicians and researchers to be aware that different frailty measures may identify different groups of older people as frail. Key words: Australia, frailty, frailty measure, older people, prevalence.
Introduction Frailty has been defined as ‘a multidimensional syndrome characterised by decreased reserve and diminished resistance to stressors’ [1]. Being frail has been associated with an increased risk of adverse health outcomes, including mortality, hospitalisation, nursing home admission, falling and medicine-related problems [2–9]. Identifying frail individuals is increasingly recognised as important in mitigating adverse outcomes [10,11].
Correspondence to: Ms Imaina Widagdo, University of South Australia. Email: [email protected] Australasian Journal on Ageing, Vol 34 No 4 December 2015, 247–251 © 2015 AJA Inc.
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At least 21 measures to identify frailty have been developed; however, there is no consensus on the elements that contribute to frailty status [1,10,12,13]. The existing frailty measures can be categorised into two broad types: unidimensional and multidimensional. Unidimensional measures assess a range of physical characteristics to determine frailty, such as physical activity, muscle weakness or nutritional status. There is an overlap between methods for identifying frailty and those for identifying sarcopenia, with both including assessment of muscle mass, strength and function [14]. Accordingly, the unidimensional measures can be referred to as ‘sarcopenic’ frailty measures. Multidimensional measures assess a combination of physical characteristics and psychological, social, environmental or medical factors, in line with the expert consensus that ‘frailty is multidimensional and may involve psychological, social, emotional and spiritual aspects in addition to physical components’ [1]. Frailty measures also vary in how they classify frailty status. Some measures classify frailty status dichotomously (non-frail or frail), whereas other measures classify frailty status using three categories: non-frail, pre-frail and frail. Estimates of the prevalence of frailty vary. A systematic review found estimates ranging from 4 to 59% depending on the frailty measure used [15]. Studies comparing different frailty measures in the same population have also shown that the apparent prevalence of frailty varies according to the measure used [4,5,16]. In Australia, there have been few studies on the prevalence of frailty. However, studies have been conducted in specific patient populations such as hospitalised patients [17,18] and men [19]. An Australian study that used a unidimensional frailty measure estimated that 66% of hospitalised older patients were frail [17], and another such study estimated that 9% of older men were frail [18]. Another study using a multidimensional measure estimated that the prevalence of frailty among older men was 15% [19]. The prevalence of frailty among the wider population of older Australians has not been reported. This study aimed to determine the prevalence of frailty among older Australians.
Methods Study population This study used the baseline data of a longitudinal survey, the Australian Longitudinal Study of Ageing (ALSA) [20]. The study population included 2087 older persons aged 70 years or more who were resident in Adelaide, South Australia, together with their spouses aged 65 years or more. Participants were recruited by random sampling from the South 247
W i d a g d o
I ,
P r a t t
N ,
R u s s e l l
M
e t
a l .
Table 1: Application of Frailty Phenotype to the ALSA dataset Frailty Phenotype item
ALSA dataset item
Unintentional weight loss ≥4.5 kg or ≥5% within one year (self-report) Low grip strength In the lowest 20% at baseline (adjusted for sex and BMI) Self-rated exhaustion (CES-D scale) Feel that everything was an effort or could not get going for ≥3 days in the last week
BMI 4.5 kg in last year (self-report) Unable to rise from chair five times without use of arms Low energy level (CES-D scale) Could not get going for ≥3 days in the last week
BMI
Research How common is frailty in older Australians? Imaina Widagdo and Nicole Pratt Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
Mary Russell School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
Elizabeth Roughead Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
Aim: To determine the prevalence of frailty in a cohort of older Australians. Methods: Frailty status of the 2087 participants of the Australian Longitudinal Study of Ageing was assessed based on the questionnaire responses at the baseline interview. Frailty status and prevalence were assessed using four measures: two unidimensional measures (the Frailty Phenotype and Simplified Frailty Phenotype) and two multidimensional measures (Frailty Index and Prognostic Frailty Score). Agreement between the four measures was determined. Results: The multidimensional measures identified more people as frail (17.5 and 49.4%) than did the unidimensional (2 and 8.8%). There was little agreement between the measures; only 0.5% of the participants were identified as frail by all four measures. Conclusions: The apparent prevalence of frailty varied when different measures were used. It is important for clinicians and researchers to be aware that different frailty measures may identify different groups of older people as frail. Key words: Australia, frailty, frailty measure, older people, prevalence.
Introduction Frailty has been defined as ‘a multidimensional syndrome characterised by decreased reserve and diminished resistance to stressors’ [1]. Being frail has been associated with an increased risk of adverse health outcomes, including mortality, hospitalisation, nursing home admission, falling and medicine-related problems [2–9]. Identifying frail individuals is increasingly recognised as important in mitigating adverse outcomes [10,11].
Correspondence to: Ms Imaina Widagdo, University of South Australia. Email: [email protected] Australasian Journal on Ageing, Vol 34 No 4 December 2015, 247–251 © 2015 AJA Inc.
bs_bs_banner
At least 21 measures to identify frailty have been developed; however, there is no consensus on the elements that contribute to frailty status [1,10,12,13]. The existing frailty measures can be categorised into two broad types: unidimensional and multidimensional. Unidimensional measures assess a range of physical characteristics to determine frailty, such as physical activity, muscle weakness or nutritional status. There is an overlap between methods for identifying frailty and those for identifying sarcopenia, with both including assessment of muscle mass, strength and function [14]. Accordingly, the unidimensional measures can be referred to as ‘sarcopenic’ frailty measures. Multidimensional measures assess a combination of physical characteristics and psychological, social, environmental or medical factors, in line with the expert consensus that ‘frailty is multidimensional and may involve psychological, social, emotional and spiritual aspects in addition to physical components’ [1]. Frailty measures also vary in how they classify frailty status. Some measures classify frailty status dichotomously (non-frail or frail), whereas other measures classify frailty status using three categories: non-frail, pre-frail and frail. Estimates of the prevalence of frailty vary. A systematic review found estimates ranging from 4 to 59% depending on the frailty measure used [15]. Studies comparing different frailty measures in the same population have also shown that the apparent prevalence of frailty varies according to the measure used [4,5,16]. In Australia, there have been few studies on the prevalence of frailty. However, studies have been conducted in specific patient populations such as hospitalised patients [17,18] and men [19]. An Australian study that used a unidimensional frailty measure estimated that 66% of hospitalised older patients were frail [17], and another such study estimated that 9% of older men were frail [18]. Another study using a multidimensional measure estimated that the prevalence of frailty among older men was 15% [19]. The prevalence of frailty among the wider population of older Australians has not been reported. This study aimed to determine the prevalence of frailty among older Australians.
Methods Study population This study used the baseline data of a longitudinal survey, the Australian Longitudinal Study of Ageing (ALSA) [20]. The study population included 2087 older persons aged 70 years or more who were resident in Adelaide, South Australia, together with their spouses aged 65 years or more. Participants were recruited by random sampling from the South 247
W i d a g d o
I ,
P r a t t
N ,
R u s s e l l
M
e t
a l .
Table 1: Application of Frailty Phenotype to the ALSA dataset Frailty Phenotype item
ALSA dataset item
Unintentional weight loss ≥4.5 kg or ≥5% within one year (self-report) Low grip strength In the lowest 20% at baseline (adjusted for sex and BMI) Self-rated exhaustion (CES-D scale) Feel that everything was an effort or could not get going for ≥3 days in the last week
BMI 4.5 kg in last year (self-report) Unable to rise from chair five times without use of arms Low energy level (CES-D scale) Could not get going for ≥3 days in the last week
BMI
