scholarly journals Beyond the Health Deficit Count: Examining Deficit Patterns in a Deficit‐Accumulation Frailty Index

2020 ◽  
Author(s):  
Brianne L. Olivieri‐Mui ◽  
Sandra M. Shi ◽  
Ellen P. McCarthy ◽  
Daniel Habtemariam ◽  
Dae H. Kim
Keyword(s):  
Frailty Index ◽  
Deficit Accumulation ◽  
Health Deficit

scholarly journals Cumulative health deficits, APOE genotype, and risk for later-life mild cognitive impairment and dementia

2020 ◽  
pp. jnnp-2020-324081
Author(s):  
David D Ward ◽  
Lindsay M K Wallace ◽  
Kenneth Rockwood
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Frailty Index ◽  
Apoe Genotype ◽  
Cognitive Status ◽  
Lower Probability ◽  
Deficit Accumulation ◽  
Cognitive Improvement ◽  
Health Deficit

ObjectiveTo determine whether health-deficit accumulation is associated with the risks of mild cognitive impairment (MCI) and dementia independently of APOE genotype.MethodsA frailty index was calculated using the deficit-accumulation approach in participants aged 50 years and older from the National Alzheimer’s Coordinating Center. Cognitive status was determined by clinical evaluation. Using multistate transition models, we assessed the extent to which an increasing degree of frailty affected the probabilities of transitioning between not cognitively impaired (NCI), MCI, and dementia.ResultsParticipants (n=14 490) had a mean age of 72.2 years (SD=8.9 years; range=50–103 years). Among those NCI at baseline (n=9773), each 0.1 increment increase in the frailty index was associated with a higher risk of developing MCI and a higher risk of progressing to dementia. Among those with MCI at baseline (n=4717), higher frailty was associated with a higher risk of progressing to dementia, a lower probability of being reclassified as NCI, and a higher likelihood of returning to MCI in those that were reclassified as NCI. These risk effects were present and similar in both carriers and non-carriers of the APOE ε4 allele.ConclusionAmong older Americans, health-deficit accumulation affects the likelihood of progressive cognitive impairment and the likelihood of cognitive improvement independently of a strong genetic risk factor for dementia. Frailty represents an important risk factor for cognitive dysfunction and a marker of potential prognostic value.

scholarly journals Acceleration of health deficit accumulation in late-life: evidence of terminal decline in frailty index three years before death in the US Health and Retirement Study

2021 ◽  
Vol 58 ◽  
pp. 156-161
Author(s):  
Erwin Stolz ◽  
Hannes Mayerl ◽  
Emiel O. Hoogendijk ◽  
Joshua J. Armstrong ◽  
Regina Roller-Wirnsberger ◽  
...  
Keyword(s):  
Frailty Index ◽  
Late Life ◽  
Health And Retirement Study ◽  
Deficit Accumulation ◽  
The Us ◽  
Health Deficit ◽  
Retirement Study

scholarly journals Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement study

2020 ◽  
Author(s):  
Erwin Stolz ◽  
Hannes Mayerl ◽  
Emiel O. Hoogendijk ◽  
Joshua J. Armstrong ◽  
Regina Roller-Wirnsberger ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Accumulation Rate ◽  
Frailty Index ◽  
Late Life ◽  
Health And Retirement Study ◽  
Deficit Accumulation ◽  
Health Decline ◽  
Health Deficit ◽  
Retirement Study

AbstractBackgroundLittle is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life.Material and methods23,393 observations from up to the last 21 years of life of 5,713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points.ResultsThe average normal (pre-terminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI value of 0.29 in the total sample, 0.27 for men, and 0.30 for women.ConclusionWe found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30.

Associations between life-course frailty and later-life heart size and function in the 1946 NSHD British birth cohort-an epidemiological study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.C Topriceanu ◽  
J.C Moon ◽  
R Hardy ◽  
A.D Hughes ◽  
N Chaturvedi ◽  
...  
Keyword(s):  
Life Course ◽  
Birth Cohort ◽  
Frailty Index ◽  
Later Life ◽  
Left Ventricular ◽  
Step Change ◽  
Deficit Accumulation ◽  
Heart Size ◽  
And Function ◽  
The Life Course

Abstract Background Cardiovascular diseases are an important component of the multi-morbidity syndrome which is associated with negative health outcomes resulting in a major societal economic burden. An objective way to assess multi-morbidity is to calculate a frailty index based on medical deficit accumulation. Late-life frailty has been validated to predict mortality, but little is known about the association between life-course frailty and cardiovascular health in later-life. Purpose To study the association between life-course frailty and later-life heart size and function using data from the world's longest running birth cohort with continuous follow-up. Methods A 45-deficit frailty index (FI) was calculated at 4 age-intervals across the life-course (0 to 16 years old, 19 to 44 years old, 45 to 54 years old and 60 to 64 years old) in participants from the UK 1946 Medical Research Council (MRC) National Survey of Heath and Development (NSHD) birth cohort. The life-course frailty indices (FI0_16, FI19_44, FI45_54 and FI60_64) reflect the cumulative medical deficits at the corresponding age-intervals. They were used to derive FImean and FIsum reflecting overall-life frailty. The step change in deficit accumulation between age-intervals was also calculated (FI2-1, FI3-1, FI4-1, FI3-2, FI4-2, FI4-3). Echocardiographic data at 60–64 years provided: E/e' ratio, ejection fraction (EF), myocardial contraction fraction index (MCFi) and left ventricular mass index (LVmassi). Generalized linear mixed models with gamma distribution and log link assessed the association between FIs and echo parameters after adjustment for sex, socio-economic position and body mass index. Results 1.805 NSHD participants were included (834 male). Accumulation of a single deficit had a significant impact (p<0.0001 to p<0.049) on LVmassi and MCFi in all the life-course FIs and overall FIs. LVmassi increased by 0.89% to 1.42% for the life-course FIs and by 0.36%/1.82% for FIsum and FImean respectively. MCFi decreased by 0.62% to 1.02% for the life-course FIs and by 0.33%/ 1.04%. for FIsum and FImean respectively. One accumulated deficit translated into higher multiplicative odds (13.2 for FI60-64, 2.1 for FI4-1, 75.4 for FI4-2 and 78.5 for FI4-3) of elevated filling pressure (defined as E/e' ratio >13, p<0.0.005 to p<0.02).A unit increase in frailty decreased LV EF (%) by 11%/12% for FI45-54 and FI60-64 respectively, by 10% to 12% for FI2-1, FI3-1, FI4-1 and FI4-2, and 4%/15% for FIsum and FImean respectively (p<0.0014 to p<0.044). Conclusion Frailty during the life-course, overall life-frailty and the step change in deficit accumulation is associated with later-life cardiac dysfunction. Frailty strain appears to have its greatest impact on pathological myocardial hypertrophy (high LVmassi and low MCFi) potentially paving the way to later-life systolic or diastolic dysfunction in susceptible individuals. Funding Acknowledgement Type of funding source: None

scholarly journals Longitudinal birth cohort study finds that life-course frailty associates with later-life heart size and function

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Constantin-Cristian Topriceanu ◽  
James C. Moon ◽  
Rebecca Hardy ◽  
Nishi Chaturvedi ◽  
Alun D. Hughes ◽  
...  
Keyword(s):  
Life Course ◽  
Birth Cohort ◽  
Left Ventricular ◽  
Step Change ◽  
Deficit Accumulation ◽  
Cardiac Phenotype ◽  
Time Period ◽  
Time Periods ◽  
The Life Course ◽  
Health Deficit

AbstractA frailty index (FI) counts health deficit accumulation. Besides traditional risk factors, it is unknown whether the health deficit burden is related to the appearance of cardiovascular disease. In order to answer this question, the same multidimensional FI looking at 45-health deficits was serially calculated per participant at 4 time periods (0–16, 19–44, 45–54 and 60–64 years) using data from the 1946 Medical Research Council (MRC) British National Survey of Health and Development (NSHD)—the world’s longest running longitudinal birth cohort with continuous follow-up. From these the mean and total FI for the life-course, and the step change in deficit accumulation from one time period to another was derived. Echocardiographic data at 60–64 years provided: ejection fraction (EF), left ventricular mass indexed to body surface area (LVmassi, BSA), myocardial contraction fraction indexed to BSA (MCFi) and E/e′. Generalized linear models assessed the association between FIs and echocardiographic parameters after adjustment for relevant covariates. 1375 participants were included. For each single new deficit accumulated at any one of the 4 time periods, LVmassi increased by 0.91–1.44% (p < 0.013), while MCFi decreased by 0.6–1.02% (p < 0.05). A unit increase in FI at age 45–54 and 60–64, decreased EF by 11–12% (p < 0.013). A single health deficit step change occurring between 60 and 64 years and one of the earlier time periods, translated into higher odds (2.1–78.5, p < 0.020) of elevated LV filling pressure. Thus, the accumulation of health deficits at any time period of the life-course associates with a maladaptive cardiac phenotype in older age, dominated by myocardial hypertrophy and poorer function.

scholarly journals Wealth and occupation determine health deficit accumulation onset in Europe – Results from the SHARE study

2018 ◽  
Vol 113 ◽  
pp. 74-79
Author(s):  
Anna-Janina Stephan ◽  
Ralf Strobl ◽  
Rolf Holle ◽  
Eva Grill
Keyword(s):  
Deficit Accumulation ◽  
Share Study ◽  
Health Deficit

scholarly journals 444Frailty status and all-cause mortality in the community-dwelling individuals: An umbrella review

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
A R M Saifuddin Ekram ◽  
Joanne Ryan ◽  
Carlene Britt ◽  
Sara Espinoza ◽  
Robyn Woods
Keyword(s):  
Systematic Reviews ◽  
Critical Appraisal ◽  
Frailty Index ◽  
Community Dwelling ◽  
Umbrella Review ◽  
Deficit Accumulation ◽  
Frailty Phenotype ◽  
Essential Information ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Frailty is increasingly recognised for its association with adverse health outcomes, including mortality. However, various measures are used to assess frailty, and the strength of association could vary depending on the specific definition used. This umbrella review aims to map which frailty scale can best predict the relationship between frailty and all-cause mortality among community-dwelling older people. Methods A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Results Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. Conclusion This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale. Key messages Frailty is associated with an increased risk of all-cause mortality in community-dwelling individuals signifying the importance of assessment in the primary healthcare setting.

Frailty in Caregivers and Its Relationship with Psychological Stress and Resilience: A Cross-Sectional Study Based on the Deficit Accumulation Model

2021 ◽  
pp. 1-8
Author(s):  
M. F.S. Bersani ◽  
F.S. Bersani ◽  
F. Sciancalepore ◽  
M. Salzillo ◽  
M. Cesari ◽  
...  
Keyword(s):  
Psychological Stress ◽  
Frailty Index ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Deficit Accumulation ◽  
Cross Sectional ◽  
Accumulation Model ◽  
Emotional Strain ◽  
Relationship Of ◽  
The Relationship

Background: Studies increasingly suggest that chronic exposure to psychological stress can lead to health deterioration and accelerated ageing, thus possibly contributing to the development of frailty. Recent approaches based on the deficit accumulation model measure frailty on a continuous grading through the “Frailty Index” (FI), i.e. a macroscopic indicator of biological senescence and functional status. OBJECTIVES: The study aimed at testing the relationship of FI with caregiving, psychological stress, and psychological resilience. DESIGN: Cross-sectional study, with case-control and correlational analyses. PARTICIPANTS: Caregivers of patients with dementia (n=64), i.e. individuals a priori considered to be exposed to prolonged psychosocial stressors, and matched controls (n=64) were enrolled. MEASUREMENTS: The two groups were compared using a 38-item FI condensing biological, clinical, and functional assessments. Within caregivers, the association of FI with Perceived Stress Scale (PSS) and Brief Resilience Scale (BRS) was tested. RESULTS: Caregivers had higher FI than controls (F=8.308, p=0.005). FI was associated directly with PSS (r=0.660, p<0.001) and inversely with BRS (r=-0.637, p<0.001). Findings remained significant after adjusting for certain confounding variables, after excluding from the FI the conditions directly related to psychological stress, and when the analyses were performed separately among participants older and younger than 65 years. CONCLUSIONS: The results provide insight on the relationship of frailty with caregiving, psychological stress, and resilience, with potential implications for the clinical management of individuals exposed to chronic emotional strain.

83 A Deficit Accumulation Frailty Index Predicts Mortality in Older South Africans: Findings from the HAALSI Study

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i27-i27
Author(s):  
F J Barker ◽  
J I Davies ◽  
F X Gomez-Olive ◽  
K Kahn ◽  
F E Matthews ◽  
...  
Keyword(s):  
South Africa ◽  
Older People ◽  
Frailty Index ◽  
Cox Proportional Hazards ◽  
Sub Saharan Africa ◽  
Deficit Accumulation ◽  
South Africans ◽  
Risk Of Death ◽  
The Mean ◽  
Cumulative Deficit

Abstract Introduction Few studies have investigated frailty in older people in sub-Saharan Africa, yet such information is vital to prepare responses to rapid population ageing. We aimed to derive and test a cumulative deficit frailty index in a population of older people from rural South Africa. Methods We analysed data from the Health and Ageing in Africa: Longitudinal Studies of an INDEPTH Community (HAALSI) study, which enrolled participants aged 40 years and older nested within the Agincourt Health and Demographic Survey Site, South Africa. We created a 32-variable cumulative deficit frailty index using questionnaire (illnesses, symptoms and activities of daily living), physical performance and physiological indices, and blood test results. Each variable was dichotomised to 1 (deficit) or 0 (no deficit). The frailty index for each individual was calculated as the mean of all frailty variables. Frailty categories were defined using cut-offs from the UK electronic frailty index: 0-0.12 (non-frail), &gt;0.12-0.24 (mild frailty), &gt;0.24-0.36 (moderate frailty) and &gt;0.36 (severe frailty). Cox proportional hazards models, both unadjusted and adjusted for age and sex, were fitted to test the association between frailty status and all-cause mortality. Results We analysed data from 3989 participants, mean age 61 years (SD 13); 2175 (54.5%) were female. The mean follow-up period was 17 months; 1464 (36.7%) were non-frail, 2059 (51.6%) had mild frailty, 402 (10.1%) had moderate frailty and 64 (1.6%) had severe frailty. A total of 135 (3.4%) died. Adjusted Cox models showed worse frailty category was associated with higher risk of death compared with non-frail individuals: hazard ratios 1.94 (95% CI 1.23, 3.07) for mild frailty, 3.25 (95% CI 1.86, 5.68) for moderate frailty, and 5.50 (95% CI 2.44, 12.40) for severe frailty. Conclusions Frailty measured by a cumulative deficits index is common and predicts mortality in a rural population of older South Africans.

scholarly journals THE EFFECTS OF FRAILTY, POLYPHARMACY, AND COGNITION ON HEALTH OUTCOMES: A STUDY ON INTERRAI RESIDENTIAL CARE DATA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S86-S86
Author(s):  
Macy Zou ◽  
Ronald Kelly ◽  
Betty Chinda ◽  
Mckenzie Braley ◽  
Tony Zhang ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Residential Care ◽  
Frailty Index ◽  
Interactive Effects ◽  
Deficit Accumulation ◽  
Emergency Visits ◽  
Ongoing Research ◽  
Risk Of Death ◽  
Increased Risk

Abstract Frailty Index (FI), polypharmacy and cognition status are significant health concerns in older adults. We conducted this study to investigate the interplay of frailty, polypharmacy, and cognition, in determining health outcomes. InterRAI Residential Care (RAI-RC MDS2.0) data were retrieved from residential care homes in Surrey, BC, Canada. Older residents (65+ years) who had RAI-RC records between 2016 and 2018 were used in the analysis (n=976). A deficit accumulation-based FI was generated using 36 variables. Information on polypharmacy and cognition were obtained by accounting the total number of medications and the cognitive performance scale. Information on falls, emergency visits, and mortality were followed. Multivariate Cox proportional hazard models were used to examine the effects of these variables on different outcomes. The FI showed a near Gaussian distribution (median= 0.370 mean= 0.372 SD= 0.143), and increased linearly with age on a logarithm scale (R=0.75, p&lt;0.001). Residents with cognitive impairment showed a higher level of the FI (KW= 863.3, p&lt;0.001). A higher FI was associated with an increased risk of death (HR=15.2 p=0.006) and emergency visits (HR=2.72 p=0.048), adjusting for age, sex, medications, and education levels. Frailty, polypharmacy, and cognition levels are associated and have interactive effects on health outcomes. Ongoing research is to validate the findings with large samples in different health settings, and to understand the underlying processes of the effect. The close relationships between frailty, polypharmacy, and cognition with health outcomes call for effective integrated strategies for healthcare of older adults with multiple complex health problems.

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