Prevalence of frailty and associated factors in a community-dwelling older people cohort living in Juiz de Fora, Minas Gerais, Brazil: Fibra-JF Study

Lourenço, Roberto Alves; Moreira, Virgílio Garcia; Banhato, Eliane Ferreira Carvalho; Guedes, Danielle Viveiros; Silva, Kelly Cristina Atalaia da; Delgado, Francisco Eduardo da Fonseca; Marmora, Cláudia Helena Cerqueira

doi:10.1590/1413-81232018241.29542016

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Article • Ciênc. saúde colet. 24 (1) • Jan 2019 • https://doi.org/10.1590/1413-81232018241.29542016 copy

Prevalence of frailty and associated factors in a community-dwelling older people cohort living in Juiz de Fora, Minas Gerais, Brazil: Fibra-JF Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Frailty is a state of multisystem physiological vulnerability related to aging and an increased risk of adverse outcomes. This study aimed to evaluate the prevalence and associated factors of frailty in the Fibra-JF Study, Minas Gerais, Brazil. We selected a random sample of 461 individuals aged 65 years or more stratified by territorial unit, gender and age. The frailty syndrome was established by the presence of three or more of five items: a feeling of exhaustion, low handgrip strength, slow gait speed, weight loss, and low caloric expenditure. The mean age was 74.4 (SD ± 6.8) years, 69.6% were women and 71.9% white. The prevalence of frailty was 5.2%; 49.9% was from pre-frail subjects. Advanced age (OR: 6.4; CI 1.76-23.8), impairment of the basic activities of daily living (OR: 5.2, CI 1.1-23.1) and self-perception of poor health (OR: 0.13, CI 0.03-0.4) were associated with frailty. In this study, a substantial number of individuals was classified as frail, while half of the sample was at risk of progression towards this condition, suggesting that it is urgent to adopt public health measures focused on frailty prevention and reduction of associated adverse health outcomes.

Key words
Prevalence; Frailty; Elderly; Older people; Vulnerability

Item	Measure
Weight loss	For verification of weight loss, those with self-reported unintentional loss of more than 4.5 kg in the year were considered positive. At follow-up, the body mass index (BMI) was measured and when the corresponding result for the previous year for weight was ≥ 0.05 by the formula below, without report of intentional loss, it was also considered positive for weight loss. (Weight in the previous year - Current Weight / Weight in the previous year).
Muscle strength	A manual dynamometer was used in the dominant upper limb to measure muscle strength, requiring the participant to exercise the highest possible force three times. Those in the first quintile, after adjusting the result for gender and body mass index, were considered positive for the item muscle weakness.
Feeling of exhaustion	Two questions of the Center for Epidemiological Study Center Scale (CES-D) were used to verify the feeling of exhaustion, namely, items seven and 20. “I feel tired in everything I do” and “I cannot continue this way”. Those who answered “yes” to any of the two questions were considered positive for the feeling of exhaustion question.
Slowing of gait score	The time spent to walk a 4.6m course in a straight line was evaluated to verify slowing of gait score and, after adjustment for height and gender, those of the first quintile were considered positive for the slowing of gait score.
Decreased physical activity	The Minnesota Leisure Time Activities (MLTA) questionnaire was used to verify the decreased physical activity and the weekly caloric expenditure was calculated for each activity performed by the individual. Those of the first quintile were considered positive for decreased physical activity.

		Classification of Frailty						Total
		Robust		Pre-frail		Frail		Total
		n	%	n	%	n	%	n	%
Gender	Male	64	33.3	59	27.7	7	31.8	130	30.4
	Female	128	66.7	154	72.3	15	68.2	297	69.6
Age	65-74	137	71.4	93	43.7	5	22.7	235	55
	> 75	55	28.6	120	56.3	17	77.3	192	45
Ethnicity	White	138	71.9	153	72.2	15	68.2	306	71.8
	Non-white	54	28.1	59	27.8	7	31.8	120	28.2
Schooling	0-4	114	59.4	137	64.3	15	68.2	266	62.3
	5-8	30	15.6	33	15.5	2	9.1	65	15.2
	>9	48	25	43	20.2	5	22.7	96	22.5
Marital status	Married	105	54.7	91	42.7	9	40.9	205	48
	Non-married	87	45.3	122	57.3	13	59.1	222	52
Income in minimum wages	0-2	100	52.1	124	58.2	14	63.6	238	55.7
	2.1-5	63	32.8	61	28.6	7	31.8	131	30.7
	> 5	29	15.1	28	13.1	1	4.5	58	13.6
Comorbidities	No	87	45.3	69	32.4	5	22.7	161	37.7
	Yes	105	54.7	144	67.6	17	77.3	266	62.3
Activities of daily living	Independent	175	91.1	177	83.1	15	68.2	367	85.9
	Dependent	17	8.9	36	16.9	7	31.8	60	14.1
Self-perceived health	Poor-Very poor/Fair	64	33.3	100	46.9	17	77.3	181	42.4
	Good-Very Good	128	66.7	113	53.1	5	22.7	246	57.6
Falls	Yes	57	29.7	70	32.9	11	50	138	32.3
	No	135	70.3	143	67.1	11	50	289	67.7
Muscle mass^* * Muscle mass as per Lee (percentile 20).	Normal	170	89	159	75	15	68	344	80.9
	Altered	21	11	53	25	7	31.8	81	19.1

		Univariada				Multivariate
		p	OR	CI (95%)		p	OR	CI (95%)
Gender	Male
	Female	0.886	1.071	0.416	2.759	0.216	0.398	0.092	1.713
Age	65-74
	> 74	0	8.469	2.978	24.082	0.005	6.496	1.768	23.869
Ethnicity	Non-white
	White	0.717	1.193	0.461	3.086	0.839	1.137	0.33	3.911
Marital status	Married
	Non-married	0.224	1.743	0.712	4.271	0.265	2.32	0.529	10.178
Schooling	> 9
	0-4	0.668	1.263	0.435	3.671	0.391	0.386	0.044	3.406
	5-8	0.607	0.64	0.117	3.511	0.201	3.101	0.547	17.587
Income	0-2
	2.1-5	0.185	4.06	0.512	32.189	0.848	0.878	0.231	3.339
	> 5	0.284	3.222	0.379	27.413	0.079	0.087	0.006	1.327
Activities of daily living	Independent
	Dependent	0.003	4.804	1.722	13.403	0.029	5.225	1.181	23.108
Self-perceived health	Good-Very Good
	Fair/Poor-Very Poor	0	0.147	0.052	0.417	0.002	0.131	0.036	0.471
MMSE	MMSE_TOTAL	0	0.766	0.663	0.886	0.36	0.914	0.753	1.109
Comorbidities	Without comorbidities
	> 1	0.05	2.817	0.999	7.945	0.189	2.324	0.661	8.166
Falls	No
	Yes	0.058	0.422	0.173	1.029	0.504	0.675	0.214	2.135

	Pre-frail		Frail		Total
	n (%)		n (%)		n (%)
Weight loss	45	57.7	12	66.7	57	43.2
Fatigue	45	21.1	14	63.6	59	13.8
Low caloric expenditure	58	42.3	9	75.0	67	24.9
Slowing of gait speed	67	31.5	21	95.5	88	20.8
Muscle weakness	64	30.0	15	68.2	79	18.5

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[1] Collaborations

RA Lourenço, VG Moreira, EFC Banhato, DV Guedes, KCA Silva, FEF Delgado and CHC Marmona contributed to the design and interpretation of the data, in addition to the writing of the paper.