Frailty and mortality or incident disability in institutionalized older adults: the FINAL study

Abstract

Background: Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.

Objectives: To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults.

Design: Concurrent cohort study.

Setting: Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.

Participants: Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data.

Measurements: Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3).

Results: 287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables.

Conclusion: In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.

Keywords: Disability; Frail elderly; Institutionalization; Mortality; Nursing home.