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Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

ABSTRACT: To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age, and sex.Cohort study.The Yale Precipitating Events Project, New Haven, Connecticut.Seven hundred fifty-four community-dwelling people aged 70 and older at baseline followed up at 18, 36, and 54 months.Frailty status, assessed at 18-month intervals, was defined using a frailty index (FI) as the number of deficits in 36 health variables. Mobility was defined as time in seconds on the rapid gait test, in which participants walked back and forth over a 20-foot course as quickly as possible. Multistate transition probabilities were calculated with baseline frailty, mobility, age, and sex estimated using Poisson and logistic regressions in survivors and those who died, respectively.In multivariable analyses, baseline frailty status and age were significantly associated with changes in frailty status and risk of death, whereas mobility was significantly associated with the frailty but not with mortality. At all values of the FI, participants with better mobility were more likely than those with poor mobility to remain stable or to improve. For example, at 54 months, 20.6% (95% confidence interval (CI)=16-25.2) of participants with poor mobility had the same or fewer deficits, compared with 32.4% (95% CI=27.9-36.9) of those with better mobility.A multistate transition model effectively measured the probability of change in frailty status and risk of death. Mobility, age, and baseline frailty were significant factors in frailty state transitions.

SUBMITTER: Fallah N

PROVIDER: S-EPMC3125634 | biostudies-literature | 2011 Mar

REPOSITORIES: biostudies-literature

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Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

Fallah Nader N Mitnitski Arnold A Searle Samuel D SD Gahbauer Evelyne A EA Gill Thomas M TM Rockwood Kenneth K

Journal of the American Geriatrics Society 20110301 3

<h4>Objectives</h4>To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age, and sex.<h4>Design</h4>Cohort study.<h4>Setting</h4>The Yale Precipitating Events Project, New Haven, Connecticut.<h4>Participants</h4>Seven hundred fifty-four community-dwelling people aged 70 and older at baseline followed up at 18, 36, and 54 months.<h4>Measurements</h4>Frailty status, assessed at 18-month intervals, was defined using a frailty index ...[more]

PMID: 21391943

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Project description:Impairment of physical function is a major indicator of frailty. Functional performance tests have been shown to be useful for identification of frailty in older adults. However, these tests are often not translatable into unsupervised and remote monitoring of frailty status at home and/or community settings.In this study, we explored daily postural transition quantified using a chest-worn wearable technology to identify frailty in community-dwelling older adults.Spontaneous daily physical activity was monitored over 24 h in 120 community-dwelling elderly (age: 78 ± 8 years) using an unobtrusive wearable sensor (PAMSys™, BioSensics LLC, Watertown, MA, USA). Participants were classified as non-frail and pre-frail/frail using Fried's criteria. A validated software package was used to identify body postures and postural transition between each independent postural activity such as sit-to-stand, stand-to-sit, stand-to-walk, and walk-to-stand. The transition from walking to sitting was further classified as quick sitting and cautious sitting based on presence/absence of a standing posture pause between sitting and walking. A general linear model univariate test was used for between-group comparison. Pearson's correlation was used to determine the association between sensor-derived parameters and age. Logistic regression model was used to identify independent predictors of frailty.According to Fried's criteria, 63% of participants were pre-frail/frail. The total number of postural transitions, stand-to-walk, and walk-to-stand were, respectively, 25.2, 30.2, and 30.6% lower in the pre-frail/frail group when compared to the non-frail group (p < 0.05, Cohen's d = 0.73-0.79). Furthermore, the ratio of cautious sitting was significantly higher by 6.2% in pre-frail/frail compared to non-frail (p = 0.025, Cohen's d = 0.22). Total number of postural transitions and the ratio of cautious sitting also showed significant negative and positive correlations with age, respectively (r = -0.51 and 0.29, p < 0.05). After applying a logistic regression model, among tested parameters, walk-to-stand (odds ratio [OR] = 0.997 p = 0.013), quick sitting (OR = 1.036, p = 0.05), and age (OR = 1.073, p = 0.016) were recognized as independent variables to identify frailty status.This study demonstrated that daily number of specific postural transitions such as walk-to-stand and quick sitting could be used for monitoring frailty status by unsupervised monitoring of daily physical activity. Further study is warranted to explore whether tracking the daily number of specific postural transitions is also sensitive to track change in the status of frailty over time.

Dataset Information

Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

Publications

Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

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