Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE).

OBJECTIVES: The aim of this study was to investigate socioeconomic inequalities in frailty among older adults in six low- and middle-income countries (LMICs), and to examine to what extent chronic diseases account for these inequalities. STUDY DESIGN: Data were used from the Study on global AGEing and adult health (SAGE) wave 1 (2007-2010). Nationally representative samples of adults aged 50+ years from China, Ghana, India, Mexico, the Russian Federation and South Africa were analyzed (n = 31,174). MAIN OUTCOME MEASURES: Educational level and wealth were used as socioeconomic indicators. Frailty was assessed with modified criteria for the frailty phenotype. Self-reported disease diagnoses were used. A relative index of inequality (RII) was calculated to compare socioeconomic inequalities in frailty between countries. RESULTS: People in lower socioeconomic positions had higher prevalence rates of frailty. The largest inequalities in frailty were found in Mexico (RII 3.7, 95% CI 2.1-6.4), and the smallest inequalities in Ghana (RII 1.1, 95% CI 0.7-1.8). Mediation analyses revealed that the chronic diseases considered in this study do not explain the higher prevalence of frailty seen in lower socioeconomic groups. CONCLUSIONS: Substantial socioeconomic inequalities in frailty were observed in LMICs, but additional research is needed to find explanations for these. Given that the population of older adults in many LMICs is expanding at a greater rate than in many high-income countries, our results indicate an urgent public health need to address frailty in these countries.

Sarcopenia and post-hospital outcomes in older adults: A longitudinal study.

INTRODUCTION: Sarcopenia poses a significant problem for older adults, yet very little is known about this medical condition in the hospital setting. The aims of this hospital-based study were to determine: (i) the prevalence of sarcopenia; (ii) factors associated with sarcopenia; and (iii) the association of sarcopenia with adverse clinical outcomes post-hospitalisation. METHODS: This is a longitudinal analysis of consecutive patients aged ≥70 years admitted to a Geriatric Management and Evaluation Unit (GEMU) ward. Sarcopenia was classified using the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm, which included: handgrip strength, gait speed, and muscle mass using Bioelectrical Impedance Analysis (BIA). Outcomes were assessed at 12-months post-hospital discharge, and included both mortality and admission to a hospital Emergency Department (ED). Kaplan-Meier methods were used to estimate survival, with Cox proportion hazard models then applied. All regression analyses controlled for age, sex, and co-morbidity. RESULTS: 172 patients (72% female) with a mean (SD) age of 85.2 (6.4) years were included. Sarcopenia was present in 69 (40.1%) of patients. Patients with sarcopenia were twice as likely to die in the 12-months post-hospitalisation (HR, 95% CI=2.23, 1.15-4.34), but did not have an increased likelihood of ED admission. CONCLUSIONS: Sarcopenia showed an independent association with 12-month post-hospital mortality in older adults. With the new recognition of sarcopenia as a medical condition with its own unique ICD-10-CM code, awareness and diagnosis of sarcopenia in clinical settings is paramount.

Frailty prevalence and associated factors in the Mexican health and aging study: A comparison of the frailty index and the phenotype.

BACKGROUND: Frailty is a relatively new phenomenon described mainly in the older population. There are a number of different tools that aim at categorizing an older adult as frail. Two of the main tools for this purpose are the Fried's frailty phenotype (FFP) and the frailty index (FI). The aim of this report is to determine the prevalence of frailty and associated factors using both FFP and the FI. METHODS: Secondary analysis of 1108 individuals aged 60 or older is participating in the third (2012) wave from the Mexican Health and Aging Study (MHAS). The FFP and the FI were constructed and a set of variables from different domains were used to explore associations. Domains included were: socio-demographic, health-related, and psychological factors. Regarding prevalence, concordance was tested with a kappa statistic. To test significant associations when classifying with each of the tools, multiple logistic regression models were fitted. RESULTS: Mean (SD) age was 69.8 (7.6) years, and 54.6% (n=606) were women. The prevalence of frailty with FFP was 24.9% (n=276) while with FI 27.5% (n=305). Kappa statistics for concordance between tools was 0.34 (p<0.001). Age, years in school, number of past days in bed due to health problems, number of times that consulted a physician last year for health problems, having smoked in the past, and life satisfaction were associated with frailty when using any of the tools. CONCLUSIONS: There is a persistent heterogeneity on how frailty is measured that should be addressed in future research.

Comparison of five indices for prediction of adverse outcomes in hospitalised Mexican older adults: a cohort study.

The aim of this prospective study was to investigate the ability of five indices of risk stratification to predict functional decline and prolonged length of stay (LOS) in older Mexicans hospitalized in the acute care setting. A total of 254 patients aged ≥60 years were followed up. Risk indices were constructed from baseline data collected during the first 48h of ward admission, and included: Frailty Index (FI), Hospital Admission Risk Profile (HARP), Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie (SHERPA), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Charlson's Co-morbidity Index (CCI). Area Under Receiver Operating Characteristic (auROC) curves was used to compare the ability of risk indices to predict adverse outcome, with outcomes of interest being prolonged LOS, and functional decline, the latter defined as ≥10% drop in Barthel Index score across hospitalization. Mean (SD) FI score was 0.31 (0.14). Effective in predicting long LOS were FI, SHERPA and APACHE II; effective in predicting functional decline were SHERPA and HARP. Indices generally showed high specificity values (most were >80%), although all indices lacked adequate sensitivity values for outcome prediction (<80%). Geriatricians could use information from FI, SHERPA, APACHE II, HARP to guide patient management decisions. However, given that all indices lacked accuracy of prediction, results should be interpreted with caution.