Overview of epidemiology studies on frailty. Leocadio Rodriguez Mañas Sº de Geriatría

Transcription

1 Overview of epidemiology studies on frailty Leocadio Rodriguez Mañas Sº de Geriatría

2 1. FRAILTY PREVALENCE a) HIGH INCOME COUNTRIES (HIC) b) LOW AND MEDIUM INCOME COUNTRIES (LAMIC) 2. POTENTIAL EXPLANATIONS FOR DIFFERENCES a) TRUE DIFFERENCES b) DIFFERENCES DUE TO THE CONCEPTUAL FRAMEWORK c) DIFFERENCES DUE TO THE INSTRUMENT USED d) DIFFERENCES DUE TO HOW THE INSTRUMENT IS PASSED 3. FRAILTY INCIDENCE 4. FRAILTY TRAJECTORIES

3 PREVALENCE OF FRAILTY IN EUROPE-SHARE STUDY (HIC) Santos-Eggimann y cols, J Gerontol 2009

4 PREVALENCE IN LATINAMERICA (LAMIC) Frail (%) Prefrail (%) Robust (%) Cohort (Year) Mexico Mexico City (2014) Peru Hospital Naval Lima (2014) Brasil FIBRA (2013) Cuba 21.6 NA NA Habana/Matanzas (2014) Colombia (rural) 12.2 NA NA Andian Mountains (2014) Costa Rica 24.2 NA NA San Jose (2010)

5 PREVALENCE IN ASIA (HIC?/LAMIC?) Frail (%) Prefrail (%) Robust (%) Cohort (Year) CHINA??? Beijing Longitudinal Study KOREA 13.2 NA NA 2014 TAIWAN JAPAN 11.3 NA NA North Japan (2013) INDIA 12.2 NA NA PAKISTAN NA NA NA

6 1. FRAILTY PREVALENCE a) HIGH INCOME COUNTRIES (HIC) b) LOW AND MEDIUM INCOME COUNTRIES (LAMIC) 2. POTENTIAL EXPLANATIONS FOR DIFFERENCES a) TRUE DIFFERENCES b) DIFFERENCES DUE TO THE CONCEPTUAL FRAMEWORK c) DIFFERENCES DUE TO THE INSTRUMENT USED d) DIFFERENCES DUE TO HOW THE INSTRUMENT IS PASSED 3. FRAILTY INCIDENCE 4. FRAILTY TRAJECTORIES

7 PREVALENCE OF FRAILTY IN EUROPE 3-C Study: 7% TSHA: 8.4% InChianti: 8.8%

8 PREVALENCE OF FRAILTY IN LATINAMERICA Frail (%) Publication Year Frail (%) Mexico Peru Brasil Colombia SABE Men Women Publication Year

9 1. FRAILTY PREVALENCE a) HIGH INCOME COUNTRIES (HIC) b) LOW AND MEDIUM INCOME COUNTRIES (LAMIC) 2. POTENTIAL EXPLANATIONS FOR DIFFERENCES a) TRUE DIFFERENCES b) DIFFERENCES DUE TO THE CONCEPTUAL FRAMEWORK c) DIFFERENCES DUE TO THE INSTRUMENT USED d) DIFFERENCES DUE TO HOW THE INSTRUMENT IS PASSED 3. FRAILTY INCIDENCE 4. FRAILTY TRAJECTORIES

10 Global prevalence: 22.7% FOD-CC Global prevalence: 8.4% Song et al., 2010 Garcia et al., 2011

11 FOD-CC BA= (.18 x frailty score) García-García FJ, Larrión JL & Rodríguez-Mañas L., Gac Sanit (in press)

12 1. FRAILTY TRAJECTORIES 1. FRAILTY PREVALENCE a) HIGH INCOME COUNTRIES (HIC) b) LOW AND MEDIUM INCOME COUNTRIES (LAMIC) 2. POTENTIAL EXPLANATIONS FOR DIFFERENCES a) TRUE DIFFERENCES b) DIFFERENCES DUE TO THE CONCEPTUAL FRAMEWORK c) DIFFERENCES DUE TO THE INSTRUMENT USED a) Domains b) Outcomes c) Criteria for definition of frailty d) DIFFERENCES DUE TO HOW THE INSTRUMENT IS PASSED 3. FRAILTY INCIDENCE

13 percentage Proportion of definitions including each frailty domain ,3 66,6 81,080,0 Since 1990 Since ,6 43,0 38,1 53,3 28,6 40,0 38,1 53,3 40,0 33,3 33,3 28, de Vries et al. Ageing Research Reviews, 2011

14 4. FRAILTY TRAJECTORIES 1. FRAILTY PREVALENCE a) HIGH INCOME COUNTRIES (HIC) b) LOW AND MEDIUM INCOME COUNTRIES (LAMIC) 2. POTENTIAL EXPLANATIONS FOR DIFFERENCES a) TRUE DIFFERENCES b) DIFFERENCES DUE TO THE CONCEPTUAL FRAMEWORK c) DIFFERENCES DUE TO THE INSTRUMENT USED a) Domains b) Outcomes c) Criteria for definition of frailty d) DIFFERENCES DUE TO HOW THE INSTRUMENT IS PASSED 3. FRAILTY INCIDENCE

15 FOD-CC Sternberg SA et al., JAGS 2011

16 4. FRAILTY TRAJECTORIES 1. FRAILTY PREVALENCE a) HIGH INCOME COUNTRIES (HIC) b) LOW AND MEDIUM INCOME COUNTRIES (LAMIC) 2. POTENTIAL EXPLANATIONS FOR DIFFERENCES a) TRUE DIFFERENCES b) DIFFERENCES DUE TO THE CONCEPTUAL FRAMEWORK c) DIFFERENCES DUE TO THE INSTRUMENT USED a) Domains b) Outcomes c) Criteria for definition of frailty d) DIFFERENCES DUE TO HOW THE INSTRUMENT IS PASSED 3. FRAILTY INCIDENCE

17 Reference Frailty instrument name Study name, setting, country Population character.: N, age (mean (SD); range), % female Components Score Comment Reference Frailty instrument name Study name, setting, country Population character.: N, age (mean (SD); range), % female Components Score Comment Subjective frailty instruments Strawbridge et al, The Alameda 1998 [31]: 1994 County Study, Frailty Measure Prospective cohort, USA Dayhoff et al, 1998 [30] Rockwood et al, 1999 [32]: CSHA rules based definition Subsample of a larger study examining effects of two exercise interventions, Crosssectional analysis, USA The Canadian Study of Health and Aging (CSHA), Prospective cohort, Communitydwelling population N= years; % Communitydwelling participants N=84 Non-frail: 73.2 years (6.0) Frail: 73.5 years (7.9) Age range : 60 to 88 years 85.7% Random sample of community residents N=not reported domains: Physical functioning: Sudden loss of balance Weakness in arms Weakness in legs Dizziness when standing up quickly Nutritive functioning: Loss of appetite Unexplained weight loss Cognitive functioning: Difficulty paying attention Trouble finding the right word Difficulty remembering things Forgetting where put something Sensory problems: Difficulty reading a newspaper Difficulty in recognizing a friend across the street Difficulty reading signs at night Hearing over the phone Hearing a normal conversation Hearing a conversation in a noisy room Performance of ADLs/IADLs using the World Health Organisation Assessment of Functional Capacity (14 items, each scored from 1 to 5 (5=unable to perform)) Self-report of perceived health. 0: Those who walk without help, perform basic ADL, are continent of bowel and bladder, and are not cognitively Score for the 6 sensory items: 1: have no difficulty 2: have a little difficulty 3: have some difficulty 4: have a great deal of difficulty. Scores on the other 10 items: 1: rarely or never had the problem in the last 12 months 2: sometimes had the problem 3: often had the problem 4: very often had the problem Participant was considered to have a problem or difficulty for one domain when he/she had a score 3 at least 1 of the items. Frail if 2 domains were considered to have a problem or difficulty. Score range: 14 (selfsufficiency) to 70 (total dependency) Frailty defined as disability. Non-frail if score 20 & excellent/goo d health. Frail if score 21 & fair/poor health -- Frailty defined as disability or comorbidity. Objective frailty instruments Brown et al, 2000 Crosssectional [41]: Modified Physical analysis, Performance USA Test (PPT) Based on Reuben & Siu, 1990, USA [59]: PPT and Guralnik et al, 1995, USA [61] Gill et al, 2002 [42] Based on Gill et al, 1995, USA [60] Klein et al, 2003 [43]: Frailty index Bandinelli, 2006 [44]: Short Physical Performance Battery (SPPB) Based on Guralnik et al, 1995, USA [61] Primary care practices, Randomized controlled trial, USA Beaver Dam Eye Study, Prospective cohort, USA The FRAilty Screening and Intervention trial, Italy Communitydwelling elderly N= years (4); 77+ %=not available Communitydwelling elderly N=188 Intervention group: n=94, 82.8 years (5.0); 75+, 80% Control group: n=94, 83.5 years (5.2); 75+, 70% Sample from a private census of the population of Beaver Dam 43+ years Communitydwelling elderly visiting their primary care physicians N=251 Treatment group: n=126, 76.4 years (3.6), 66% Control group: n=125, 76.4 years (3.4), 60% 9 items scored 0 to 4: Lift a 7-pound book to a shelf Put on and remove a jacket Pick up penny from floor Performance of a 360 degrees turn 50-foot walk test Climb one flight of stairs Climb up and down 4 flights of stairs Stand up 5 times from a 16-inch chair Progressive Romberg test Rapid gait (walking back and forth over a 10-foot (3-m) course as quickly as possible) Single chair stand Timed 10-ft walk (score=1 if in the highest quartile, stratified by sex) Handgrip strength (score=1 if in the lowest quartile, stratified by sex) Peak expiratory flow rate (score=1 if in the lowest quartile, stratified by sex) Ability to stand from a sitting position without using arms in one try (score=1 if unable) 3 items scored 0 (unable to perform complete the test) to 4 (highest level of performance): Walking speed over 4 metres 5 timed repeated chair rises Standing balance Score range: 0-36 Not frail: Mild frailty: Moderate frailty: Dependent: <17 Moderately frail if rapid gait>10 s or could not stand from the chair. Severely frail if meet both criteria. Score range: 0 (better) to 4 (worse) Score range: 0 to 12 Frail if 9

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19 1. FRAILTY PREVALENCE a) HIGH INCOME COUNTRIES (HIC) b) LOW AND MEDIUM INCOME COUNTRIES (LAMIC) 2. POTENTIAL EXPLANATIONS FOR DIFFERENCES a) TRUE DIFFERENCES b) DIFFERENCES DUE TO THE CONCEPTUAL FRAMEWORK c) DIFFERENCES DUE TO THE INSTRUMENT USED d) DIFFERENCES DUE TO HOW THE INSTRUMENT IS PASSED 3. FRAILTY INCIDENCE 4. FRAILTY TRAJECTORIES

20 FOD-CC RATIONALE There is a necessity to identify old people at high risk for developing some outcomes There are many definitions. With different conceptual frameworks and domains. The criteria are not universally applicable. Depending upon the used definition, the prevalence comes from <5% to >80% The definitions have been validated in epidemiological settings, but not in clinical ones

21 FOD-CC Same criteria? CRITERIA DEFINITION 1. Weight loss Unintentional weight loss of 4.5 Kg during the last year 2. Exhaustion Using the responses (YES/NO) to two statements of the CES-D Depression Scale (Orme J et al., 1986) 3. Physical activity Assessed by the short version of the Minnesota Leisure Time Activity questionnaire (Taylor HL et al., 1978) 4. Slowness Assessed by walk time and stratified by gender and height 5. Weakness Assessed by grip strength and stratified by gender and Body Mass Index Frailty will be identified by the presence of three or more of the criteria. Pre-frailty will be identified by the presence of one or two of the criteria In TSHA, we used the lowest percentil 20 in our population meeting the frailty criteria 4 and 5 Prevalence: 8.7% In TSHA, if we use the Fried s criteria comme il faut, as they were validated. Prevalence: 17.9%

22 FOD-CC Table 4: Rate of Accepted and Excluded Statements According to Each Block of Questions, Final Analysis Table 5: Rate of Accepted and Excluded Statements According to the Alternative Classification. Final Analysis

23 FOD-CC RATIONALE There is a necessity to identify old people at high risk for developing some outcomes There are many definitions. With different conceptual frameworks and domains. The criteria are not universally applicable. Depending upon the used definition, the prevalence comes from <5% to >80% The definitions have been validated in epidemiological settings, but not in clinical ones

24 HOW SHOULD WE PROGRESS? Building instruments with low variability among populations easy to pass consistently integrating clinical and biological items validated in clinical and social settings

25 FACTORIAL ANALYSIS ABI ROMBERG PASE

26 RISK DIAGNOSIS PROGNOSIS Best Fitted Models TOOLKITS

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29 THANK YOU