Predictores de fragilidad en usuarios mayores de Atención Primaria de Salud

estudio descriptivo y correlacional, realizado en una muestra de conveniencia con 136 ancianos de la comunidad. Los datos fueron recolectados a través de un cuestionario sociodemográfico, clínico y de fenotipo de fragilidad. Para el análisis de los datos se utilizaron la prueba t de Student o la prueba U-Mann-Whitney, chi-cuadrado y regresión logística binaria.

Resultados:

la prevalencia de fragilidad fue del 26,5% (n=36). Los ancianos frágiles eran mayores (p=0,011), peor autoevaluación de la salud (p=0,001) y menos capaces físicamente (p <0,001). En la regresión multivariante, se observó que los ancianos frágiles eran mayores (Odds Ratio=1,111; Intervalo de confianza del 95%=1,026-1,203) y peor capacidad física (Odds Ratio=0,673; Intervalo de confianza del 95%=0,508-0,893).

Conclusiones:

la prevalencia de fragilidad en ancianos en Atención Primaria de Salud fue considerable. La edad avanzada y la peor capacidad física fueron los predictores más relevantes de fragilidad en el anciano

Descriptores:
Anciano; Salud del Anciano; Fragilidad; Prevalencia; Atención Primaria de Salud

Frailty phenotype	Adjusted Model
Weight loss - Unintentional weight loss in the last year, less than 5% of body weight	Nutritional disorders - Have you lost or gained weight for no apparent reason in the past 6 months? Have you been eating worse from lack of appetite? Phenotype quotation: No=0/ Yes =1
Resistance/exhaustion - Depression Scale (CES-D) a) I felt that all I did was an effort and b) I couldn’t keep going	Geriatric Depression Scale (GDS) - Do you feel full of energy? Phenotype quotation: No=0/ Yes =1
Physical activity/energy expenditure - Minnesota Activity and Leisure Quiz	Time Occupancy Scale - Do you usually practice sports activities (swimming, cycling, walking, gymnastics, fitness)? Phenotype quotation: No=1/ Yes =0
Slowness/walking time - walking time, 15 steps, sex and height stratification	Timed Up and Go (TUG) test - <10 seconds=independent ≥ 10 seconds=some dependency Phenotype quotation: No=0/Yes =1
Weakness/hand strength - Handgrip strength stratified by sex and body mass index (BMI) quartiles	Handgrip Strength - Stratified by Sex (Men ≥ 31 Women ≥ 18 Kilogram (kg), - cut-offs A) Phenotype quotation: No=0/ Yes =1

Dimensions	Phenotype n (%)
Weight loss	No	Yes
D1	136 (100)	0 (0)
Resistance	Yes	No
D2	123 (90.4)	13 (9.6)
Physical activity	Yes	No
D3	60 (44.1)	76 (55.9)
Slowness	< 10	≥ 10
D4	48 (35.3)	88 (64.7)
TUG (M±SD)	11.6±5.0
Weakness	No	Yes
D5	84 (62.2)	51 (37.8)
Total score (M±SD)	1.7±1.2

Dimension	Cut-off		Phenotype n(%)
Dimension	Cut-off		Non-frail	Frail
Weaknesses	A	<18 kg (Female)	100 (73.5)	36(26.5)
	A	<31 kg (Male)	100 (73.5)	36(26.5)
	B	<16 kg (Female)	109(80.1)	27 (19.9)
	B	<27 kg (Male)	109(80.1)	27 (19.9)
	C	<16 kg (Female)	109(80.1)	27 (19.9)
	C	<26 kg (Male)	109(80.1)	27 (19.9)

	Non-frail (n=100)	Frail (n=36)	Statistical test
Qualitative variables	n(%)	n(%)
Sex
Male	51(77.3)	15(2.7)	χ2(1)=0.9 p=0.337
Female	49(70.0)	21(30.0)	χ2(1)=0.9 p=0.337
Age (years)
65-74	64(83.1)	13 (16.9)	χ2(2)=9.0 p=0.011
75-84	32 (62.7)	19 (37.3)
≥85	4 (50.0)	4 (50.0)
Marital status
Married	78 (75.0)	26 (25.0)	χ2(1)=0.5 p=0.483
Not married	22 (68.8)	10 (31.3)	χ2(1)=0.5 p=0.483
BMI (kg/m2)
≤ 21.9	12 (80.0)	3 (20.0)	χ2(2)=0.5 p=0.766
22-26.9	41 (74.5)	14 (25.5)
≥27	47(71.2)	19 (28.8)
Clinical history
Hypercholesterolemia
No	36 (83.7)	7 (16.3)	χ2(1)=3.4 p=0.067
Yes	64 (68.8)	29 (31.2)	χ2(1)=3.4 p=0.067
Diabetes
No	72 (78.3)	20 (21.7)	χ2(1)=3.3 p=0.071
Yes	28 (63.6)	16 (36.4)	χ2(1)=3.3 p=0.071
Hypertension
No	29 (76.3)	9 (23.7)	χ2(1)=0.2 p=0.646
Yes	71 (72.4)	27 (27.6)	χ2(1)=0.2 p=0.646
Self-rated health
Very good/good	67 (82.7)	14 (17.3)	χ2(2)=14.6 p=0.001
Acceptance	31 (66.0)	16 (34.0)
Weak/very weak	2 (25.0)	6 (75.0)
Quantitative variables	M±DP	M±DP
Age (years)	72.6±5.8	77.8±6.0	U=943.0 p<0.001
BMI (kg/m2)	26.9±4.1	27.7±5.4	t(134)=-0.9 p=0.357
No of people living in the same house	2.2±1.0	2.3±1.3	U=1744.5 p=0.975
Physical capacity	7.8±1.7	5.8±2.2	U=831.0 p<0.001

	Univariable		Multivariate
	Odds Ratio	95%CI	Odds Ratio	95%CI
Qualitative variables
Sex
Male	1	--
Female	1.457	0.675-3.147
Categorized age (years)			n.a.
65-74	1	--
75-84	2.923^* * p<0.05;	1.283-6.658
≥85	4.923^* * p<0.05;	1.089-22.257
Marital status
Married	1	--
Not married	1.364	0.572-3.253
BMI (Lipschitz) (kg/m2)
≤ 21.9	1	--
22-26.9	1.366	0.336-5.556
27	1.617	0.410-6.381
Clinical history
Hypercholesterolemia
Yes	2.330	0.928-5.853
No	1	--
Diabetes
Yes	2.057	0.934-4.529
No	1	--
Hypertension
Yes	1.225	0.514-2.923
No	1	--
Self-rated health
Very good/good	1	--	1	--
Acceptance	2.470^* * p<0.05;	1.073-5.688	0.825	0.284-2.397
Weak/very weak	14.357^ p<0.01; p<0.001; n.a.: not applied because in the multivariate model the quantitative variable age is used instead of the qualitative variable categorized age.	2.621-78.653	4.020	0.597-27.059
Quantitative variables
Age (years)	1.155^ p<0.01; p<0.001; n.a.: not applied because in the multivariate model the quantitative variable age is used instead of the qualitative variable categorized age. ^* * p<0.05;	1.077-1.239	1.111^ p<0.01; p<0.001; n.a.: not applied because in the multivariate model the quantitative variable age is used instead of the qualitative variable categorized age.	1.026-1.203
BMI (kg/m2)	1.040	0.957-1.131
No of people living in the same house	1.094	0.780-1.536
Physical capacity	0.591^ p<0.01; p<0.001; n.a.: not applied because in the multivariate model the quantitative variable age is used instead of the qualitative variable categorized age. ^* * p<0.05;	0.465-0.752	0.673^ p<0.01; p<0.001; n.a.: not applied because in the multivariate model the quantitative variable age is used instead of the qualitative variable categorized age.	0.508-0.839

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[1] Corresponding author: João Tavares E-mail: joaoptavares@ua.pt