Frailty in the very old – longitudinal analysis of the Newcastle 85+ study

Conference:

SAPC ASM 2018 - London

Talk Code:

4E.4

Presenter:

Mohammad Yadegarfar

Co-authors:

Rachel Duncan, Helen Hanson, Barbara Hanratty, Andrew Kingston, Carol Jagger, Stuart Parker, Louise Robinson

Author institutions:

Institute of Health and Society, Newcastle University Institute for Ageing

Problem

Frailty is a loss of biological reserve across multiple organ systems leading to an increased risk of adverse outcomes e.g. hospital admission. Frailty increases with age, however ageing and frailty are not synonymous. Frailty, and its clinical detection and management, has become a key issue for primary care, especially the transition from pre-frail to frail. Using data from the Newcastle 85+ study, we investigate the course of frailty in the very old especially transitions between different frailty states.

Approach

The Newcastle 85+ study is a prospective observational longitudinal population cohort study of all people registered with general practitioners in Newcastle and North Tyneside and who were born in 1921 and were 85 years old in 2006. Three types of data were collected (i) a multidimensional health assessment - (questionnaires, measurement and function tests, blood tests), (ii) GP record review and (iii) death data. Frailty, defined using the Fried phenotype, was measured at baseline, 18 months, 36 and 60 months, with participants defined as robust, pre-frail or frail.

Findings

Frailty scores were available for 82% (696/845) of participants at baseline, 81% (511/629) of participants at 18 months, 76% (377/485) at 36 months and 75% (258/344) at 60 months. At baseline those without a frailty score were more likely to: be living in care homes (43.0%), be cognitively impaired (38.9%), have depressive symptoms (25.7%), and have higher levels of disability and morbidity.

At baseline the prevalence of frailty was higher in women (29.7%, 123/414) than men (17.7%, 50/282). These differences remained at all subsequent time points, the prevalence of frailty increasing to a maximum at 5 years (women: 45.1%, 74/164; men: 26.6%, 25/90).

Of the participants who were robust at baseline, 44.6% (50/112) remained robust at 18 months, and 28% (14/50) were still robust at age 90. Around half of those robust at baseline (49.1%, 55/112) became pre-frail by 18 months whilst 6.3% (7/112) became frail. However, decline was not inevitable and 7.3% (22/300) of those pre-frail at baseline were robust at 18 months.

Every participant with a frailty status at baseline survived at least 36 months. Between 36 and 60 months, 5.6% of the robust, 21.6% of pre-frail and 38.5% of the frail participants died.

Consequences

Although frailty increases with age, we observed the possibility of improvement from frail to pre-frail and pre-frail to robust even at very old ages. Future work to be presented will investigate transitions between different frailty states.

Submitted by:

Mohammad Yadegarfar

Funding acknowledgement:

The Newcastle 85+ study has been funded by the Medical Research Council, Biotechnology and Biological Sciences Research Council, the Dunhill Medical Trust and the National Institute of Health Research School for Primary Care. Parts of the work have also been funded by the British Heart Foundation, Unilever Corporate Research, Newcastle University, Newcastle Healthcare Charity and the North of England Commissioning Support Unit.