Frailty Phenotype: Evidence of Both Physical and Mental Health Components in Community-Dwelling Early-Old Adults

Figures & data

Figure 1 Recruitment of study participants.

Table 1 Cohort Clinical and Functional Characteristics Including Sex Distribution and Distribution According to the Presence of One or More Positive Frailty Criteria (PF) Against No Positive Frailty Criteria (NF) – Mean Values and Standard Deviations ( ± SD) for Quantitative Variables and Percentages for Categorical Variables

Variable	Whole Group n=160	Women n = 71	Men n = 89	Women vs Men P-value	PF n = 43	NF n = 117	PF vs NF P-value
Age, years	66.8±4.2	66.7±4.0	66.9±4.3	0.852	68.0±3.4	66.4±4.2	0.034
Sex, percentage of females	44.4	–	–	–	58.1	39.3	0.034
Current smokers	13.8	9.9	16.9	0.203	14.0	13.7	0.964
Ever-smokers	38.8	28.2	47.2	0.014	37.2	39.3	0.808
Pack-years	10.5±17.6	7.3±14.1	13.1±19.7	0.027	10.7±21.0	10.4±16.3	0.850
Regular alcohol consumption	47.5	29.6	61.8	0.001	32.6	53.0	0.022
Total number of diseases or comorbidities	3.81±2.23	3.93±2.11	3.71±2.33	0.413	4.30±2.30	3.62±2.18	0.111
Charlson Comorbidity Index	3.38±1.5	3.15±1.5	3.55±1.48	0.037	3.74±1.73	3.24±1.38	0.083
Total number of oral medications	3.79±3.16	3.65±3.11	3.91±3.21	0.639	4.28±3.13	3.62±3.17	0.160
Total number of oral, herbal and topical medications and supplements	4.29±3.60	4.21±3.63	4.36±3.59	0.720	4.88±3.74	4.08±3.54	0.208
Osteoarthritis, %	75.0	87.3	65.2	0.001	88.4	70.1	0.018
Hypertension, %	60.6	56.3	64.0	0.321	55.8	62.4	0.450
Coronary heart disease, %	29.4	25.4	32.6	0.318	23.3	31.6	0.303
Diabetes, %	18.8	9.9	25.8	0.010	23.3	17.1	0.376
Depression, %	15.6	21.1	11.2	0.087	30.2	10.3	0.002
Heart failure, %	14.4	12.7	15.7	0.586	14.0	14.5	0.927
Osteoporosis, %	11.9	22.5	3.4	<0.001	23.3	7.7	0.007
Peripheral artery disease, %	10.6	5.6	14.6	0.116	14.0	9.4	0.409
Cancer, %	10.6	11.3	10.1	0.814	14.0	9.4	0.409
Chronic obstructive pulmonary disease, %	7.5	8.5	6.7	0.684	11.6	6.0	0.231
Asthma, %	7.5	9.9	5.6	0.313	11.6	6.0	0.231
Weight, kg	79.3±14.5	72.4±13.5	84.9±12.8	<0.001	76.2±16.3	80.5±13.6	0.070
Height, m	1,67±0,09	1,60±0.06	1.73±0.06	<0.001	1.64±0.09	1.68±0.09	0.037
Body mass index, kg/m^2	28.4±4.6	28.4±5.3	28.4±3.9	0.592	28.3±6.2	28.5±3.8	0.438
Total body fat percentage^a	30.3±8.3	36.4±6.7	25.2±5.6	<0.001	31.5±9.2	29.9±7.9	0.463
Total fat mass^a, kg	24.4±8.8	27.1±9.8	22.1±7.3	0.002	24.5±11.5	24.3±7.7	0.566
Fat-free mass^a, kg	54.1±12.1	44.3±6.8	62.2±9.1	<0.001	49.7±11.9	55.6±11.8	0.018
Total water content^a, kg	40.2±8.6	32.9±3.9	46.4±6.4	<0.001	37.3±7.2	41.3±8.9	0.026
Total abdominal fat^a, %	37.8±9.9	43.0±7.9	33.3±9.4	<0.001	36.9±11.7	38.1±9.3	0.316
Visceral fat rating^a, score	15.4±6.6	12.0±3.8	18.2±7.1	<0.001	14.7±8.8	15.6±5.6	0.107
Systolic blood pressure, mm Hg	142.3±19.7	136.7±16.7	146.9±20.7	0.002	138.7±17.6	143.7±20.3	0.205
Diastolic blood pressure, mm Hg	85.7±11.2	82.6±10.3	88.1±11.3	0.002	83.3±11.1	86.5±11.1	0.134
Heart rate per minute	76.1±11.8	74.0±11.2	77.8±12.0	0.038	77.3±12.0	75.6±11.7	0.502
Mini-Mental State Examination, score	29.0±1.5	29.0±1.5	28.9±1.6	0.868	28.4±1.7	29.1±1.3	0.030
Geriatric Depression Scale, score	3.13±2.84	3.55±2.80	2.80±2.83	0.044	4.23±3.15	2.73±2.61	0.002
Barthel Index	98.1±8.2	97.5±6.0	98.5±9.6	0.010	95.4±15.1	99.1±2.5	0.498
Instrumental Activities of Daily Living Scale, score	26.3±2.1	26.3±1.8	26.4±2.3	0.305	25.6±3.4	26.6±1.2	0.284
Tinetti POMA, score	26.9±3.1	26.7±2.9	27.1±3.2	0.112	25.4±5.3	27.5±5.3	0.008
Timed Get-up and Go, s	8.4±2.9	9.1±3.2	7.8±2.5	0.014	9.35±4.17	8.05±2.21	0.181
6-min Walk Test, m	445.8±90.9	433.7±83.2	454.9±95.8	0.089	409.1±118.9	458.3±76.0	0.011
Hemoglobin, g/dL	14.8±1.2	14.2±0.9	15.2±1.2	<0.001	14.47±1.07	14.87±1.24	0.112
Red blood cells, T/L	4.80±0.45	4.68±0.37	4.90±0.48	0.002	4.72±0.38	4.83±0.47	0.300
White blood cells, G/L	6.88±2.49	6.78±2.27	6.96±2.67	0.833	7.03±2.79	6.83±2.38	0.922
Total protein, g/dL	7.41±0.40	7.39±0.41	7.43±0.39	0.674	7.34±0.46	7.44±0.37	0.187
Albumin, mg/mL	43.2±3.2	42.7±3.1	43.7±3.2	0.017	42.6±3.9	43.5±2.9	0.246
Creatinine, mg/dL	0.89±0.19	0.81±0.19	0.95±0.16	<0.001	0.83±0.22	0.91±0.18	0.005
eGFR, mL/min/1,73 m^2	72.9±13.1	71.2±14.6	74.2±11.8	0.089	74.6±14.9	72.2±12.4	0.375
Glucose, mg/dL	108.3±41.6	104.1±48.0	111.7±35.7	<0.001	112.7±61.4	106.7±31.6	0.211
Alanine aminotransferase, IU/L	26.4±27.1	20.4±9.4	31.3±34.6	<0.001	26.1±22.8	26.6±28.6	0.566
Calcium, mg/dL	9.56±0.39	9.59±0.39	9.53±0.39	0.310	9.52±0.43	9.57±0.38	0.368
Vitamin D, ng/mL	28.4±14.1	30.7±15.9	26.5±12.3	0.155	30.3±15.3	27.6±13.7	0.242
Cortisol, ng/mL	12.6±3.7	12.6±3.9	12.7±3.7	0.975	12.9±3.3	12.5±3.9	0.469

Note: ^aAnalysis included 149 subjects, among them 68 women and 81 men, 110 subjects with no positive frailty criterion and 39 subjects with one or more positive frailty criteria.

Table 2 Mean and Median Values of Grip Strength, Usual Pace Walk Speed and Physical Activity ( ±SD; Median) and Prevalence of Positive Frailty Components in the Studied Cohort (Percentage of Subjects (95% Confidence Interval)) as Assessed by Fried et al Criteria⁹

Frailty Components	Community-Dwelling Elderly
	Total n=160	Women n=71	Men n=89	Women versus Men P value
Unintentional weight loss over the last year
Prevalence of positive frailty criterion	7.5; (3.4–11.6)	7.0; (1.1–13.0)	7.9; (2.3–13.5)	0.845
Weakness
Grip strength, kg	55±29; 46.9	38±17; 35.0	70±29; 73.3	<0.001
Prevalence of positive frailty criterion	5.6; (2,1–9,2)	9.9; (2.9–16.8)	2.2; (0.8–5.3)	0.084
Poor endurance; exhaustion
Prevalence of positive criterion	7.5; (3.4–11.6)	11.3; (3.9–18.6)	4.5; (0.2–8.8)	0.189
Slowness
Usual pace walk speed, m/s	1.14±0.32; 1.14	1.11±0.37; 1.13	1.16±0.27; 1.14	0.149
Prevalence of positive frailty criterion	8.1; (3.9–12.4)	15.5; (7.1–23.9)	2.2; (0.8–5.3)	0.006
Low physical activity
Physical activity, Kcal/week	4423±6291; 2811	3450±4583; 2207	5200±6169; 7309	0.043
Prevalence of positive frailty criterion	8.1; (3.9–12.4)	8.5; (2.0–14.9)	7.9; (2.3–13.5)	0.865

Table 3 Factors Associated with Quantitative Frailty Measures (Grip Strength, Usual Pace Walk Speed, and Physical Activity) in Multivariate Linear Regression Analysis

Frailty Measure	Associated Factors	β Coefficient	95% Confidence Interval for β	P value
Grip strength	Female sex	−0.471	−0.604 – −0.337	<0.001
	Osteoporosis	−0.171	−0.302 – −0.039	0.011
	Albumin level	0.198	0.068–0.327	0.003
	Mini-Mental State Examination score	0.211	0.084–0.339	0.001
Usual pace walk speed	Total number of medications	−0.255	−0.392 – −0.118	<0.001
	Hemoglobin level	0.151	0.011–0.291	0.034
	Total protein level	0.192	0.054–0.330	0.007
	Barthel Index	0.305	0.166–0.444	<0.001
Physical activity	Fat-free mass	0.183	0.026–0.340	0.023
	Mini-Mental State Examination score	0.188	0.032–0.344	0.018
	Calcium level	0.200	0.043–0.357	0.013

Table 4 Factors Associated with Positive Frailty Criteria (Unintentional Weight Loss and Exhaustion in Multivariate Logistic Regression Analysis)

Frailty Criterion	Associated Factors	Odds Ratio (OR)	95% Confidence Interval for OR	P value
Unintentional weight loss	Depression	6.000	1.629–22.103	0.007
Poor endurance; exhaustion	Instrumental Activities of Daily Living Scale score	0.705	0.538–0.924	0.011
	Geriatric Depression Scale score	1.287	1.063–1.559	0.010

Fried LP, Tangen CM, Walston J, et al.; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol Med Sci. 2001;56A:M146–M156. doi:10.1093/gerona/56.3.M146

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