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. 2019 Jul 12;74(8):1257-1264.
doi: 10.1093/gerona/gly232.

The Burden of Frailty Among U.S. Veterans and Its Association With Mortality, 2002-2012

Ariela R Orkaby  1   2   3 , Lisa Nussbaum  2 , Yuk-Lam Ho  2 , David Gagnon  2   4 , Lien Quach  2   5 , Rachel Ward  2 , Rachel Quaden  2 , Enzo Yaksic  2 , Kelly Harrington  2   6 , Julie M Paik  1   7 , Dae H Kim  8   9 , Peter W Wilson  2   10   11   12 , J Michael Gaziano  2   3 , Luc Djousse  2   3 , Kelly Cho  2   3 , Jane A Driver  1   2   3
Affiliations

The Burden of Frailty Among U.S. Veterans and Its Association With Mortality, 2002-2012

Ariela R Orkaby et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Frailty is a key determinant of clinical outcomes. We sought to describe frailty among U.S. Veterans and its association with mortality.

Methods: Nationwide retrospective cohort study of regular Veterans Affairs (VA) users, aged at least 65 years in 2002-2012, followed through 2014, using national VA administrative and Medicare and Medicaid data. A frailty index (FI) for VA (VA-FI) was calculated using the cumulative deficit method. Thirty-one age-related deficits in health from diagnostic and procedure codes were included and were updated biennially. Survival analysis assessed associations between VA-FI and mortality.

Results: A VA-FI was calculated for 2,837,152 Veterans over 10 years. In 2002, 35.5% were non-frail (FI = 0-0.10), 32.6% were pre-frail (FI = 0.11-0.20), 18.9% were mildly frail (FI = 0.21-0.30), 8.7% were moderately frail (FI = 0.31-0.40), and 4.3% were severely frail (FI > 0.40). From 2002 to 2012, the prevalence of moderate frailty increased to 12.7%and severe frailty to 14.1%. Frailty was strongly associated with survival and was independent of age, sex, race, and smoking; the VA-FI better predicted mortality than age alone. Although prevalence of frailty rose over time, compared to non-frail Veterans, 2 years' hazard ratios (95% confidence intervals) for mortality declined from a peak in 2004 of 2.01 (1.97-2.04), 3.49 (3.44-3.55), 5.88 (5.79-5.97), and 10.39 (10.23-10.56) for pre-frail, mildly, moderately, and severely frail, respectively, to 1.51 (1.49-1.53), 2.36 (2.33-2.39), 3.68 (3.63-3.73), 6.62 (6.53-6.71) in 2012. At every frailty level, risk of mortality was lower for women versus men and higher for blacks versus whites.

Conclusions: Frailty affects at least 3 of every 10 U.S. Veterans aged 65 years and older, and is strongly associated with mortality. The VA-FI could be used to more accurately estimate life expectancy and individualize care for Veterans.

Keywords: Epidemiology; Frailty; Mortality.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier curves for mortality in men and women (2002–2014).
Figure 2.
Figure 2.
Association between level of frailty and 2 years’ all-cause mortality in U.S. Veterans of age at least 65 years (2012–2014).
See this image and copyright information in PMC

References

    1. Eibner C, Krull H, Brown KM, et al. Current and projected characteristics and unique health care needs of the patient population served by the department of veterans affairs. Rand Health Q. 2016;5:13. doi: 10.1097/MLR.0b013e31827da95a - DOI - PMC - PubMed
    1. Wang L, Porter B, Maynard C, et al. Predicting risk of hospitalization or death among patients receiving primary care in the Veterans health administration. Med Care. 2013;51:368–373. doi: 10.1097/MLR.0b013e31827da95a - DOI - PubMed
    1. Rockwood K, Stolee P, McDowell I. Factors associated with institutionalization of older people in Canada: testing a multifactorial definition of frailty. J Am Geriatr Soc. 1996;44:578–582. - PubMed
    1. Fried LP, Tangen CM, Walston J, et al. ; Cardiovascular Health Study Collaborative Research Group Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M156. - PubMed
    1. Lee SJ, Kim CM. Individualizing prevention for older adults. J Am Geriatr Soc. 2018;66:229–234. doi: 10.1111/jgs.15216 - DOI - PMC - PubMed

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