Transitions between frailty states in the very old: the influence of socioeconomic status and multi-morbidity in the Newcastle 85+ cohort study

Abstract

Background: Using Newcastle 85+ Study data, we investigated transitions between frailty states from age 85 to 90 years and whether multi-morbidities and socioeconomic status (SES) modify transitions.

Methods: The Newcastle 85+ Study is a prospective, longitudinal cohort study of all people born in 1921 in Newcastle and North Tyneside. Data included: a multidimensional health assessment; general practice record review (GPRR) and date of death. Using the Fried phenotype (participants defined as robust, pre-frail or frail), frailty was measured at baseline, 18, 36 and 60 months.

Results: Frailty scores were available for 82% (696/845) of participants at baseline. The prevalence of frailty was higher in women (29.7%, 123/414) than men (17.7%, 50/282) at baseline and all subsequent time points. Of those robust at baseline, 44.6% (50/112) remained robust at 18 months and 28% (14/50) at age 90. Most (52%) remained in the same state across consecutive interviews; only 6% of the transitions were recovery (from pre-frail to robust or frail to pre-frail), and none were from frail to robust. Four or more diseases inferred a greater likelihood of progression from robust to pre-frail even after adjustment for SES. SES did not influence the likelihood of moving from one frailty state to another.

Conclusions: Almost half the time between age 85 and 90, on average, was spent in a pre-frail state; multi-morbidity increased the chance of progression from robust and to frail; greater clinical intervention at the onset of a first chronic illness, to prevent transition to multi-morbidity, should be encouraged.

Keywords: aged 80 and over; deprivation; frailty; multi-morbidity; older people, education.

Figure 1

Fried frailty states and death (%), by follow-up and sex.

Figure 2

Hazard ratios and 95% confidence intervals for socioeconomic inequalities, disease count (multi-morbidity) and transitions between frailty states and death. Educ, years of full-time education; IMD, index of multiple deprivation. All three separate models (education, IMD and disease count) were adjusted for age and sex. Quartiles of IMD were as follows: Q1 (25th percentile), 3–12; Q2 + Q3 (25–75th percentile), 12–43; Q4 (75th percentile), 43–78.