Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care

BackgroundFrailty in the elderly increases their vulnerability and leads to a greater risk of adverse events. According to various studies, the prevalence of the frailty syndrome in persons age 65 and over ranges between 3% and 37%, depending on age and sex. Walking speed in itself is considered a simple indicator of health status and of survival in older persons. Detecting frailty in primary care consultations can help improve care of the elderly, and walking speed may be an indicator that could facilitate the early diagnosis of frailty in primary care. The objective of this work was to estimate frailty-syndrome prevalence and walking speed in an urban population aged 65 years and over, and to analyze the relationship between the two indicators from the perspective of early diagnosis of frailty in the primary care setting.MethodsPopulation cohort of persons age 65 and over from two urban neighborhoods in northern Madrid (Spain). Cross-sectional analysis. Bivariate and multivariate analysis with binary logistic regression to study the variables associated with frailty. Different cut-off points between 0.4 and 1.4 m/s were used to study walking speed in this population. The relationship between frailty and walking speed was analyzed using likelihood ratios.ResultsThe study sample comprised 1,327 individuals age 65 and older with mean age 75.41 ± 7.41 years; 53.4% were women. Estimated frailty in the study population was 10.5% [95% CI: 8.9-12.3]. Frailty increased with age (OR = 1.14; 95% CI: 1.10-1.19) and was associated with poor self-rated health (OR = 2.52; 95% CI: 1.43-4.44), number of drugs prescribed (OR = 1.17; 95% CI: 1.08-1.26) and disability (OR = 6.58; 95% CI: 3.92-11.05). Walking speed less than 0.8 m/s was found in 42.6% of cases and in 56.4% of persons age 75 and over. Walking speed greater than 0.9 m/s ruled out frailty in the study sample. Persons age 75 and older with walking speed <0.8 m/s are at particularly high risk of frailty (32.1%).ConclusionsFrailty-syndrome prevalence is high in persons aged 75 and over. Detection of walking speed <0.8 m/s is a simple approach to the diagnosis of frailty in the primary care setting.

[1]  P. Weiler.  Preventing dependency in the elderly. , 1988, The Western journal of medicine.

[2]  Antonio Lobo,et al.  Revalidación y normalización del Mini-Examen Cognoscitivo (primera versión en castellano del Mini-Mental Status Examination) en la población general geriátrica , 1999 .

[3]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[4]  L. Ferrucci,et al.  Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[5]  M. Visser,et al.  Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. , 2004, Journal of clinical epidemiology.

[6]  S. Rubin,et al.  Prognostic Value of Usual Gait Speed in Well‐Functioning Older People—Results from the Health, Aging and Body Composition Study , 2005, Journal of the American Geriatrics Society.

[7]  F. Rodríguez‐Artalejo,et al.  Gender differences in the utilization of health-care services among the older adult population of Spain , 2006, BMC public health.

[8]  S. Bandinelli,et al.  Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. , 2006, The American journal of clinical nutrition.

[9]  I. M. Lesende,et al.  Prevención de la dependencia en las personas mayores , 2007 .

[10]  M. Zunzunegui,et al.  Life course social and health conditions linked to frailty in Latin American older men and women. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[11]  J. Purser,et al.  Frailty Predicts Some but Not All Adverse Outcomes in Older Adults Discharged from the Emergency Department , 2008, Journal of the American Geriatrics Society.

[12]  James E. Graham,et al.  Relationship between test methodology and mean velocity in timed walk tests: a review. , 2008, Archives of physical medicine and rehabilitation.

[13]  H. Amièva,et al.  Frailty among community-dwelling elderly people in France: the three-city study. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[14]  M. Inzitari,et al.  Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force , 2009, The journal of nutrition, health & aging.

[15]  Brent C Taylor,et al.  A Comparison of Frailty Indexes for the Prediction of Falls, Disability, Fractures, and Mortality in Older Men , 2009, Journal of the American Geriatrics Society.

[16]  J. Spagnoli,et al.  Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[17]  Sathya Karunananthan,et al.  Role of frailty in patients with cardiovascular disease. , 2009, The American journal of cardiology.

[18]  S. Iliffe,et al.  Frailty: an emerging concept for general practice. , 2009, The British journal of general practice : the journal of the Royal College of General Practitioners.

[19]  Á. O. Puime,et al.  Prevalencia de fragilidad en una población urbana de mayores de 65 años y su relación con comorbilidad y discapacidad , 2010 .

[20]  J. Baeyens,et al.  European working group on sarcopenia in older people. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people , 2010 .

[21]  M. Zunzunegui,et al.  [Prevalence of frailty in an elderly Spanish urban population. Relationship with comorbidity and disability]. , 2010, Atencion primaria.

[22]  W. Uter,et al.  The frailty syndrome in general practitioner care , 2011, Zeitschrift für Gerontologie und Geriatrie.

[23]  Sabina Zambon,et al.  European Project on Osteoarthritis (EPOSA): methodological challenges in harmonization of existing data from five European population-based cohorts on aging , 2011, BMC musculoskeletal disorders.

[24]  T. Botigué Satorra,et al.  [Frailty criteria in the elderly: a pilot study]. , 2011, Atencion primaria.

[25]  S. Studenski,et al.  Gait speed and survival in older adults. , 2011, JAMA.

[26]  [Frailty and dependence in Albacete (FRADEA study): reasoning, design and methodology]. , 2011, Revista espanola de geriatria y gerontologia.

[27]  L. Rodriguez-Manas,et al.  The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging , 2011, The journal of nutrition, health & aging.

[28]  L. Rodríguez Mañas,et al.  [Frailty: a phenotype under review]. , 2011, Gaceta sanitaria.

[29]  Francisco García-García,et al.  [Frailty: a phenotype under review]. , 2011, Gaceta sanitaria.

[30]  J. Wick,et al.  Understanding frailty in the geriatric population. , 2011, The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists.

[31]  J. Afilalo.  Frailty in Patients with Cardiovascular Disease: Why, When, and How to Measure , 2011, Current cardiovascular risk reports.

[32]  C. N. Órrio,et al.  [Frailty criteria in the elderly: a pilot study]. , 2011, Atencion primaria.

[33]  J. L. Hidalgo,et al.  Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseo y metodologa , 2011 .

[34]  [Frailty: a phenotype under review]. , 2011 .

[35]  K. Rockwood,et al.  Frailty in primary care: a review of its conceptualization and implications for practice , 2012, BMC Medicine.

[36]  K. Covinsky,et al.  Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. , 2012, Archives of internal medicine.

[37]  D. Mant,et al.  How well do clinical prediction rules perform in identifying serious infections in acutely ill children across an international network of ambulatory care datasets? , 2013, BMC Medicine.

[38]  R. Kane,et al.  Association of frailty with survival: A systematic literature review , 2013, Ageing Research Reviews.