Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.

BACKGROUND: Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. OBJECTIVES: To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults. DESIGN: Concurrent cohort study. SETTING: Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. PARTICIPANTS: Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data. MEASUREMENTS: Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3). RESULTS: 287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables. CONCLUSION: In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.

Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: rationale, design, methodology, prevalence and attributes.

BACKGROUND: Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. OBJECTIVES: To determine the prevalence and attributes of frailty in institutionalized Spanish older adults. DESIGN: Cross-sectional analysis of basal data of a concurrent cohort study. SETTING: Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. PARTICIPANTS: 331 institutionalized adults older than 65 years. MEASUREMENTS: Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ(2) tests, t-Student and logistic regression. RESULTS: Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p<0.001), and frail participants were older (85.1 vs. 82.3; p<0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2-6.2), Barthel index (OR 2.2 95%CI 1.2-4.4), depression risk (OR 2.2 95%CI 1.0-4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6-0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8-4.5) and emergency visits (OR 1.5 95%CI 0.7-3.2) in the previous 6 months. CONCLUSION: In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.