Gesundheitswesen 2017; 79(08/09): 656-804
DOI: 10.1055/s-0037-1605794
Vorträge
Georg Thieme Verlag KG Stuttgart · New York

Frailty and risk of mortality in community dwelling older adults: results of the ActiFE study

D Dallmeier
1   Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
2   Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
,
U Braisch
1   Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
2   Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
3   Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
,
J Klenk
3   Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
,
D Rothenbacher
3   Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
,
M Denkinger
1   Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
2   Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
› Author Affiliations
Further Information

Publication History

Publication Date:
01 September 2017 (online)

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Background:

Deficit accumulation is a well acknowledged approach to determine frailty in older people. The Activity and Function in the Elderly (ActiFE Ulm) Study is a cohort study among individuals ≥65 years, which started in 2009. We intended to study whether deficit accumulation was associated with six-year mortality in community dwelling older adults.

Methods:

A frailty index (FI) was built according to the model proposed by Rockwood. We identified 38 items at baseline representing following domains: basic and instrumental activities of daily living, comorbidities, number of medications, fall risk, psychosocial anamnesis, cognitive function, physical activity, fitness and self-awareness. Each variable had a score from 0 (no deficit) to 1 (presence of deficit). FI represents the sum of all scores divided by 38. Cox-proportional hazards models evaluated the association of the estimated FI and six-year mortality stratified by sex, adjusted for age, smoking and education.

Results:

A total of 948 subjects were considered for this analysis (mean age 75.3 ± 6.3, 57.5% men). Median FI was 0.11 (interquartile range (IQR) [0.07, 0.17]) in men, and 0.12 (IQR [0.07, 0.19]) in women, 16.2% men and 21.6% women had a FI ≥0.2. We observed a total of 128 deaths (median FU 2434 days). A 10% increment of FI was associated with an adjusted hazard ratio (HR) of 2.28 [95% CI 1.79, 2.89] in men and a HR of 1.81 [95% CI 1.40, 2.35] in women for death during six-year follow-up. As categorical, those with FI ≥0.2 had a HR of 3.40 [95% CI 2.26, 5.11] in men, and a HR of 3.18 [95% CI 1.59, 6.33] in women.

Conclusions:

Using a deficit accumulation approach for frailty requires a thorough assessment of older people, which may not be easily accomplished in the clinical settings. In this relatively healthy population-based cohort, ca. 20% were categorized as frail (FI ≥0.2). FI, both as continuous and categorical measure, was clearly associated with six-year mortality in men and women.