Is frailty a stable predictor of mortality across time? Evidence from the Cognitive Function and Ageing Studies

Abstract

Background: age-specific mortality reduction has been accompanied by a decrease in the prevalence of some diseases and an increase in others. Whether populations are becoming 'healthier' depends on which aspect of health is being considered. Frailty has been proposed as an integrative measure to quantify health status.

Objective: to investigate changes in the near-term lethality of frailty before and after a 20-year interval using the frailty index (FI), a summary of age-related health deficit accumulation.

Design: baseline data from the Cognitive Function and Ageing Studies (CFAS) in 1991 (n = 7,635) and 2011 (n = 7,762).

Setting: three geographically distinct UK centres (Newcastle, Cambridgeshire and Nottingham).

Subjects: individuals aged 65 and over (both institutionalised and community-living).

Methods: a 30-item frailty score was used, which includes morbidities, risk factors and subjective measures of disability. Missing items were imputed using multiple imputations by chained equations. Binomial regression was used to investigate the relationship between frailty, age, sex and cohort. Two-year mortality was modelled using logistic regression.

Results: mean frailty was slightly higher in CFAS II (0.19, 95% confidence interval (CI): 0.19-0.20) than CFAS I (0.18, 95% CI: 0.17-0.18). Two-year mortality in CFAS I was higher than in CFAS II (odds ratio (OR) = 1.16, 95% CI: 1.03-1.30). The association between frailty and 2-year mortality was non-linear with an OR of ~1.6 for each 0.10 increment in the FI.

Conclusions: the relationship between frailty and mortality did not significantly differ across the studies. Severe frailty as an indicator of mortality is shown to be a stable construct.

Figure 1.

The relationship between age and the frailty in Cambridgeshire, Newcastle and Nottingham, UK, 1991 (CFAS I) and 2011 (CFAS II). The frailty index is shown as a proportion of deficits at baseline. The solid and dotted lines show the predicted frailty as derived from the binomial model. The symbols denote the observed means of frailty at each age, calculated from the imputed dataset.

Figure 2.

Crude 2-year mortality (%) by frailty index in CFAS I and II. The solid and dotted lines show the predicted frailty as derived by the logistic regression model and the symbols denote the means of mortality for each frailty score as a proportion of deficits.