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Frailty and Mortality Outcomes in Cognitively Normal Older People: Sex Differences in a Population-Based Study.

ABSTRACT: To characterize frailty in cognitively normal older adults at baseline and to investigate the relationship between frailty and mortality.Population-based prospective cohort study: Mayo Clinic Study of Aging.Olmsted County, Minnesota.Cognitively normal older persons aged 70 and older (mean age 78.8±5.2, 50.2% male; N=2,356).Frailty was assessed at baseline using a 36-item Frailty Index. Four frailty subgroups were identified based on the Frailty Index (?0.10 (fit), 0.11-0.20 (at risk), 0.21-0.30 (frail), >0.30 (frailest)). All participants underwent comprehensive clinical and cognitive assessments. The association between frailty and mortality was assessed using Cox proportional hazards models.The median Frailty Index was 0.17 (interquartile range 0.11-0.22). Frailty increased with age and was more common in older men than in older women. Over a median follow-up of 6.5 years (range 7 days to 8.9 years), 500 of the 2,356 participants died, including 292 men. The frailest participants had the greatest risk of death (hazard ratio (HR)=3.91, 95% confidence interval (CI)=2.69-5.68). The association was stronger in women (HR=5.26, 95% CI=2.88-9.61) than men (HR=3.15, 95% CI=1.98-5.02).Baseline frailty was common, especially in older men, and increased with age. Frailty was associated with significantly greater risk of death, particularly in women. These sex differences should be considered when designing a geriatric care plan.

SUBMITTER: Bartley MM

PROVIDER: S-EPMC4721254 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Frailty and Mortality Outcomes in Cognitively Normal Older People: Sex Differences in a Population-Based Study.

Bartley Mairead M MM Geda Yonas E YE Christianson Teresa J H TJ Pankratz V Shane VS Roberts Rosebud O RO Petersen Ronald C RC

Journal of the American Geriatrics Society 20160101 1

<h4>Objectives</h4>To characterize frailty in cognitively normal older adults at baseline and to investigate the relationship between frailty and mortality.<h4>Design</h4>Population-based prospective cohort study: Mayo Clinic Study of Aging.<h4>Setting</h4>Olmsted County, Minnesota.<h4>Participants</h4>Cognitively normal older persons aged 70 and older (mean age 78.8±5.2, 50.2% male; N=2,356).<h4>Measurements</h4>Frailty was assessed at baseline using a 36-item Frailty Index. Four frailty subgro ...[more]

PMID: 26782862

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Project description:IntroductionLate onset Alzheimer's disease (AD) is the most common form of dementia, in which almost 70% of patients are women.HypothesisWe hypothesized that women show worse global FC metrics compared to men, and further hypothesized a sex-specific positive correlation between FC metrics and cognitive scores in women.MethodsWe studied cognitively healthy individuals from the Alzheimer's Disease Neuroimaging Initiative cohort, with resting-state functional Magnetic Resonance Imaging. Metrics derived from graph theoretical analysis and functional connectomics were used to assess the global/regional sex differences in terms of functional integration and segregation, considering the amyloid status and the contributions of APOE E4. Linear mixed effect models with covariates (education, handedness, presence of apolipoprotein [APOE] E4 and intra-subject effect) were utilized to evaluate sex differences. The associations of verbal learning and memory abilities with topological network properties were assessed.ResultWomen had a significantly lower magnitude of the global and regional functional network metrics compared to men. Exploratory association analysis showed that higher global clustering coefficient was associated with lower percent forgetting in women and worse cognitive scores in men.ConclusionWomen overall show lower magnitude on measures of resting state functional network topology and connectivity. This factor can play a role in their different vulnerability to AD.Significance statementTwo thirds of AD patients are women but the reasons for these sex difference are not well understood. When this late onset form dementia arises is too late to understand the potential causes of this sex disparities. Studies on cognitively healthy elderly population are a fundamental approach to explore in depth this different vulnerability to the most common form of dementia, currently affecting 6.2 million Americans aged 65 and older are, which means that >1 in 9 people (11.3%) 65 and older are affected by AD. Approaches such as resting-state functional network topology and connectivity may play a key role in understanding and elucidate sex-dependent differences relevant to late-onset dementia syndromes.

Project description:BackgroundFemale sex is an important factor predisposing individuals to frailty. Appropriate nutrition is one of the most effective ways to prevent older adults from developing frailty; Sex-related differences have also been detected in the association between nutritional intervention and health-related outcomes. However, few studies have discussed these sex-related differences. The aim of the present study was to investigate the sex-related differences in the association between frailty and dietary consumption.MethodsWe conducted a cross-sectional study which investigated community-dwelling older adults aged ≥65 years. We surveyed age, sex, body mass index, family arrangement (living alone, living with a partner or living with parent(s) and/or child (ren)), dietary consumption and frailty status. Dietary consumption was surveyed using a food frequency questionnaire that included 13 major food categories (fish, meat, eggs, dairy products, soybean products, vegetables, seaweeds, potatoes, fruits, fats or oils, snacks, salty foods and alcohol). Frailty was defined by the Kihon Checklist score. The Kihon Checklist is composed of 25 simple yes/no questions, and it has been validated as a metric for frailty. A higher score indicates a greater degree of frailty. Multinomial regression analysis was performed to clarify the association between frailty and dietary consumption for each sex.ResultsWe analyzed 905 older adults (420 (46.4%) were male). After adjusting for cofounders, a low frequency of meat consumption (less than twice/week) was associated with a high prevalence of frailty in men (odds ratio: 2.76 (95%CI: 1.12-6.77), p = 0.027). In contrast, in women, low frequencies of consumption of fish, meat, vegetables, potatoes and snacks were associated with a higher prevalence of frailty compared with those who consumed foods from those categories daily (odds ratios: fish 2.45 (1.02-5.89), p = 0.045; meat 4.05 (1.67-9.86), p = 0.002; vegetables 5.03 (2.13-11.92), p < 0.001; potatoes 3.84 (1.63-9.05), p = 0.002; snacks 2.16 (1.02-4.56), p = 0.043).ConclusionsMore food categories were associated with frailty in women than in men. Nutritional intervention to prevent frailty is presumably more effective for women than for men.

Dataset Information

Frailty and Mortality Outcomes in Cognitively Normal Older People: Sex Differences in a Population-Based Study.

Publications

Frailty and Mortality Outcomes in Cognitively Normal Older People: Sex Differences in a Population-Based Study.

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