Frailty prevalence and related factors in older adults from southern Brazil: A cross-sectional observational study

Melo Filho, Jarbas; Moreira, Natália Boneti; Vojciechowski, Audrin Said; Biesek, Simone; Bento, Paulo Cesar Barauce; Gomes, Anna Raquel Silveira

doi:10.6061/clinics/2020/e1694

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ORIGINAL ARTICLE • Clinics 75 • 2020 • https://doi.org/10.6061/clinics/2020/e1694 copy

Frailty prevalence and related factors in older adults from southern Brazil: A cross-sectional observational study

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

To determine the prevalence of frailty and the association of sociodemographic characteristics, clinical aspects, and functional capacity with the frailty status of community-dwelling older adults from Curitiba, Southern Brazil.

METHODS:

This cross-sectional observational study included 1,716 participants aged ≥60 years. Frailty was assessed using the Fried phenotype indicators of weakness, exhaustion, low activity, slowness, and weight loss. Sociodemographic characteristics, clinical aspects, and functional capacity and functionality were evaluated and compared between the sexes and the different frailty statuses (non-frail, prefrail, and frail). Multinomial logistic regression models were used to identify associations (p<0.05).

RESULTS:

A high prevalence of frailty (15.8%) and prefrailty (65.3%) were observed, and both were higher in female than in male individuals. The most predominant frailty criterion was weakness, followed by exhaustion. Compared with the non-frail elderly, the prefrail and frail elderly were older in age and presented more health problems, greater dependency for basic and instrumental activities of daily living, and reduced lower extremity strength performance and functional mobility. The highest proportion of illiterate individuals, individuals with 1-4 years of education, widowed individuals, polypharmacy, and possible cognition problems and diseases were seen in the frail elderly group. Moreover, the risk of being prefrail and frail was higher in those who were older and had more health problems, higher body mass index, and reduced lower extremity strength performance. Greater calf circumference and independence in activities of daily living were protective factors for prefrailty and frailty. Furthermore, lower functional mobility increased the chances of being frail.

CONCLUSIONS:

The prevalence of frailty was more pronounced in female than in male individuals, mainly because of a decline in force. Prefrailty was 4 times more prevalent than frailty, and the presence of health problems and reduced functional capacity increased the chances of being prefrail and frail.

Frail Elderly; Prevalence; Evaluation

Frailty criteria	Cutoffs
^a a The values are 20th percentile of the total sample. Low activity (Minnesota, kcals/week) Stratified by sex	Males: <206
	Females: <440
^a a The values are 20th percentile of the total sample. Weakness (HGS, kgf) Stratified by sex and BMI quartiles (kg/m²)	Males	Females
	BMI≤24.5; HGS≤21.0	BMI≤24.5; HGS≤21.3
	BMI>24.5≤27; HGS≤25	BMI>24.5≤27.5; HGS≤25.1
	BMI>27.5≤30; HGS≤27.7	BMI>27.5≤31.4; HGS≤28.1
	BMI>30; HGS≤30.9	BMI>31.4; HGS≤32.5
^b b The values are 80th percentile of the total sample. Slowness (GS, seconds)Stratified by sex and medium height (cm)	Males	Females
	Heights ≤168; GS≥4.5	Heights ≤155 cm; GS≥4.6
	Heights >168; GS≥4.2	Heights >155 cm. GS≥4.2

Continuous variables	Total(n=1,716)	Females(n=1,299)	Males(n=417)
	Mean (SD)	Mean (SD)	Mean (SD)
Sociodemographic and clinical aspects
Age (years)	71.0 (7.3)	70.8 (7.3)	71.5 (7.3)
Health problems (n)	2.3 (1.4)	2.5 (1.4)^ p<0.01.	1.7 (1.3)
Cognition screening (score)	24.4 (4.5)	24.5 (4.3)	24.0 (5.0)
BMI (kg/m²)	28.1 (5.1)	28.3 (5.3)^* * p<0.05;	27.5 (4.3)
CC (cm)	35.9 (4.1)	35.9 (4.2)	36.1 (3.8)
Functional capacity and functionality
ADL (score)	5.6 (0.8)	5.5 (0.8)	5.7 (0.7)^ p<0.01.
IADL (score)	18.7 (3.2)	19.0 (2.8)^ p<0.01.	17.8 (3.9)
Handgrip strength (kgf)	24.6 (8.3)	21.8 (5.5)	33.4 (9.3)^ p<0.01.
Lower extremity strength performance (seconds)	12.4 (4.9)	12.4 (4.9)	12.3 (4.8)
Functional mobility (seconds)	10.1 (4.5)	10.1 (4.6)	10.1 (4.5)
Gait speed (seconds)	3.9 (2.0)	3.9 (2.1)	3.8 (1.7)

Categorical variables	Total	Females	Males
	n (%)	n (%)	n (%)
Education level
Illiterate	145 (8.4)	108 (8.3)	37 (8.9)
1 to 4 years	702 (40.9)	555 (42.7)^* * p<0.05;	147 (35.3)
5 to 8 years	288 (16.8)	216 (16.6)	72 (17.3)
>8 years	581 (33.9)	420 (32.3)	161 (38.6)^* * p<0.05;
Marital status
Single	161 (9.4)	125 (9.6)	36 (8.6)
Married	735 (42.8)	468 (36.0)	267 (64.0)^ p<0.01.
Widowed	596 (34.7)	547 (42.1)^ p<0.01.	49 (11.8)
Separated and Divorced	224 (13,1)	159 (12,2)	65 (15,6)
Polypharmacy
No	1059 (61.7)	771 (59.4)	288 (69.1)^ p<0.01.
Yes	657 (38.3)	528 (40.6)^ p<0.01.	129 (30.9)
Frailty States
Non-frail	325 (18.9)	158 (12.2)	167 (40.0)^ p<0.01.
Prefrail	1120 (65.3)	900 (69.3)^ p<0.01.	220 (52.8)
Frail	271 (15.8)	241 (18.6)^ p<0.01.	30 (7.2)
Frailty criteria
Exhaustion	351 (20.5)	282 (21.7)^* * p<0.05;	69 (16.5)
Low activity	342 (19.9)	259 (19.9)	83 (19.9)
Weight loss	245 (14.3)	194 (14.9)	51 (12.2)
Weakness	1128 (65.7)	1036 (70.8)^ p<0.01.	92 (22.1)
Slowness	347 (20.2)	267 (20.6)	80 (19.2)

Continuous variables	Non-frail(n=731)	Prefrail(n=875)	Frail(n=110)
	Mean (SD)	Mean (SD)	Mean (SD)
Sociodemographic and clinical aspects
Age (years)	68.8 (6.4)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	71.0 (7.1)^c c Compared to prefrail and frail;	73.3 (8.3)
Health problems (n)	1.9 (1.3)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	2.4 (1.4)^c c Compared to prefrail and frail;	2.6 (1.5)
Cognition screening (score)	25.7 (4.0)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	24.6 (4.3)^c c Compared to prefrail and frail;	22.1 (5.2)
BMI (kg/m²)	26.4 (3.9)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	28.4 (5.0)	29.0 (6.2)
CC (cm)	35.9 (3.7)	36.1 (4.0)^c c Compared to prefrail and frail;	35.4 (4.9)
Functional capacity and Functionality
ADL (score)	5.8 (0.7)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	5.6 (0.7)^c c Compared to prefrail and frail;	5.2 (1.1)
IADL (score)	19.6 (2.3)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	19.0 (2.8)^c c Compared to prefrail and frail;	16.5 (4.3)
Lower extremity strength performance (seconds)	10.4 (3.4)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	12.0 (4.1)^c c Compared to prefrail and frail;	16.3 (6.8)
Functional mobility (seconds)	8.4 (2.8)^a a Compared to non-frail and prefrail; ,^b b Compared to non-frail and frail;	9.6 (3.3)^c c Compared to prefrail and frail;	14.0 (7.5)

Categorical variables	Non-frail	Prefrail	Frail
	n (%)	n (%)	n (%)
Educational level
Illiterate	20.0 (6.2)	92.0 (8.2)	33.0 (12.2)^* * p<0.05, based on adjusted residuals of the chi-square test.
1 to 4 years	98.0 (30.2)	479.0 (42.8)^* * p<0.05, based on adjusted residuals of the chi-square test.	125.0 (46.1)^* * p<0.05, based on adjusted residuals of the chi-square test.
5 to 8 years	56.0 (17.2)	191.0 (17.1)	41.0 (15.1)
>8 years	151 (46.5)^* * p<0.05, based on adjusted residuals of the chi-square test.	358 (32.0)	72 (26.6.)
Marital status
Single	29.0 (8.9)	108.0 (9.6)	24.0 (8.9)
Married	185.0 (56.9)^* * p<0.05, based on adjusted residuals of the chi-square test.	467.0 (41.7)	83.0 (30.6)
Widowed	67.0 (20.6)	402.0 (35.9)	127.0 (46.9)^* * p<0.05, based on adjusted residuals of the chi-square test.
Separated and Divorced	44.0 (13.5)	143.0 (12.7)	37.0 (13.7)
Polypharmacy
No	236 (72.6)^* * p<0.05, based on adjusted residuals of the chi-square test.	693 (61.9)	130 (48.0)
Yes	89 (27.4)	427 (38.1)	141 (52.0)^* * p<0.05, based on adjusted residuals of the chi-square test.
Health problems
None	50.0 (15.4)^* * p<0.05, based on adjusted residuals of the chi-square test.	91.0 (8.1)	21.0 (7.7)
Hypertension	185.0 (56.9)	690.0 (61.6)	190.0 (70.1)^* * p<0.05, based on adjusted residuals of the chi-square test.
Diabetes	71.0 (21.8)	321.0 (28.7)	92.0 (33.9)^* * p<0.05, based on adjusted residuals of the chi-square test.
Osteoarthritis	88.0 (27.1)	510.0 (45.5)^* * p<0.05, based on adjusted residuals of the chi-square test.	125.0 (46.1)
Osteoporosis	39.0 (12.0)	163.0 (14.6)	50.0 (18.5)
Depression	10.0 (3.1)	113.0 (10.1)	36.0 (13.3)^* * p<0.05, based on adjusted residuals of the chi-square test.
Dementia	7.0 (2.2)	11.0 (1.0)	13.0 (4.8)^* * p<0.05, based on adjusted residuals of the chi-square test.
Parkinsonism	0 (0)	8 (0.7)	6 (2.2)^* * p<0.05, based on adjusted residuals of the chi-square test.
Other diseases	68.0 (20.9)	273.0 (24.4)	78.0 (28.8)

Variables	Non-frail	Prefrail	Frail
	OR (95% CI)	OR (95% CI)	OR (95% CI)
Sociodemographic and clinical aspects
Age (years)	1.00	1.04 (1.01-1.06)^ p<0.01.	1.04 (1.01-1.07)^ p<0.01.
Health problems (n)	1.00	1.14 (1.02-1.26)^* * p<0.05;	1.21 (1.06-1.40)^ p<0.01.
BMI (kg/m²)	1.00	1.17 (1.12-1.23)^ p<0.01.	1.28 (1.20-1.35)^ p<0.01.
CC (cm)	1.00	0.89 (0.85-0.94)^ p<0.01.	0.82 (0.76-0.87)^ p<0.01.
Functional capacity
ADL (score)	1.00	0.74 (0.57-0.96)^* * p<0.05;	0.68 (0.49-0.92)^* * p<0.05;
IADL (score)	1.00	1.01 (0.95-1.07)	0.94 (0.87-1.02)
Lower extremity strength performance (seconds)	1.00	1.09 (1.04-1.15)^ p<0.01.	1.19 (1.12-1.26)^ p<0.01.
Functional mobility (seconds)	1.00	1.07 (0.99-1.15)	1.15 (1.06-1.25)^ p<0.01.

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[1] *Corresponding author. E-mail: jarbasmf@hotmail.com