Frailty and its association with long-term mortality among community-dwelling older adults aged 75 years and over

Maor Lewis, Galia Zacay, Anthony Heymann, Dan Justo

Keywords: Community-dwelling, Cumulative deficit, Frailty, Mortality, Older adults.

Background:

The prevalence of frailty in a population of community-dwelling older adults and its association with long-term mortality has not been previously studied in Israel in a large scale.

Research questions:

We sought to demonstrate the potential utility of a frailty index in a large database of community-dwelling older adults aged 75 years and over in Israel by studying the prevalence of frailty and its association with long-term mortality in this population.

Method:

A retrospective cohort study using a large Israeli Health Maintenance Organization database. The prevalence of frailty and its association with all-cause mortality were studied among older adults aged 75 years and over who were followed for 2-8 years. The Frailty index was calculated using the cumulative deficit method including 28 chronic diseases and age-related health deficits.

Results:

The cohort included 43,737 community-dwelling older adults: median age was 77 years (IQR 75-82 years); 19,300 (44.1%) patients were males; most patients were non-orthodox Jews (n=35,515, 81.2%). Overall, 19,396 (44.3%) older adults were frail: 12,260 (28.0%) mildly frail, 5,533 (12.7%) moderately frail, and 1,603 (3.7%) severely frail. Overall, 15,064 (34.4%) older adults died during the follow-up period: 4,782 (39.0%) mildly frail, 3,016 (54.5%) moderately frail, and 1,080 (67.4%) severely frail. Cox regression analysis showed that mortality was associated with severe frailty (HR 2.63, 95%CI 2.45-2.80), moderate frailty (HR 2.05, 95%CI 1.96-2.14), and mild frailty (HR 1.45, 95%CI 1.39-1.51), controlled for age, gender, and population sector. In patients aged 90 years and over there were no longer differences in cumulative survival between patients with moderate and severe frailty (p=0.408).

Conclusions:

Frailty is common among the population of community-dwelling Israeli older adults aged 75 years and over and associated with long-term mortality across frailty levels. Among older patients aged 90 years and over there are no longer differences in cumulative survival between patients with moderate and severe frailty.

Points for discussion:

The utility of frailty scores in primary care

Different methods for the evaluation of frailty

Is there an age limit for the utility of frailty scores?

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