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Purpose: To compare the perception of the quality of life (QOL) of community-dwelling older adults with the phenotype of frailty., Methods: Cross-sectional analysis of baseline data of the "Cohort of Obesity, Sarcopenia and Frailty of Mexican Older Adults" (COSFOMA). Operationalization of frailty was carried out using the phenotype as follows: weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness. QOL was measured using two scales: World Health Organization Quality of Life of Older Adults (WHOQOL-OLD), which is a specific instrument for the elderly population, and Short Form-36 Health Survey (SF-36), a generic instrument to evaluate the QOL related to health. One-way analyses of variance were conducted to assess the differences among the three phenotypes of frailty and QOL perception., Results: There were 1252 older adult participants who were analyzed; 11.2% (n = 140) had frailty, 50.3% (n = 630) pre-frailty and 38.5% (n = 482) were not frail. The mean (±SD) total score of the WHOQOL-OLD according to the phenotype of frailty was 60.3 (13.9) for those with frailty, 67.4 (12.7) pre-frailty and 72.4 (11.2) not frail (ANOVA, p < 0.001). The mean (±SD) of the SF-36 of the physical and mental component measures the sum, 38.9 (9.9) and 41.9 (11.3) with frailty, 45.7 (9.1) and 46.6 (9.8) pre-frailty, and 49.6 (7.3) and 49.4 (7.9) not frail, respectively (ANOVA, p < 0.001)., Conclusions: Frailty is observed in 1/10 community-dwelling older adults. Those with frailty and pre-frailty had a lower perception of QOL compared with those who were not frail.

Background: The study of frailty is important to identify the additional needs of medical long-term care and prevent adverse outcomes in community dwelling older adults. This study aimed to determine the prevalence of frailty and its association with adverse outcomes in community dwelling older adults., Methods: A cross-sectional study was carried out from April to September 2014. The population sample was 1,252 older adults (≥60 years) who were beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico City. Data were derived from the database of the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA). Operationalization of the phenotype of frailty was performed using the criteria of Fried et al (weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness). Adverse outcomes studied were limitation in basic activities of daily living (ADLs), falls and admission to emergency services in the previous year, and low quality of life (WHOQOL-OLD)., Results: Frailty was identified in 20.6% (n=258), pre-frailty in 57.6% (n=721), and not frail in 21.8% (n=273). The association between frailty and limitations in ADL was odds ratio (OR) =2.3 (95% confidence interval [CI] 1.7-3.2) and adjusted OR =1.7 (95% CI 1.2-2.4); falls OR =1.6 (95% CI 1.2-2.1) and adjusted OR =1.4 (95% CI 1.0-1.9); admission to emergency services OR =1.9 (95% CI 1.1-3.1) and adjusted OR =1.9 (95% CI 1.1-3.4); low quality of life OR =3.4 (95% CI 2.6-4.6) and adjusted OR =2.1 (95% CI 1.5-2.9)., Conclusion: Approximately 2 out of 10 older adults demonstrate frailty. This is associated with limitations in ADL, falls, and admission to emergency rooms during the previous year as well as low quality of life., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objectives. To construct a frailty index from next-of-kin information of the last year of life of community-dwelling 50 years old or older adults and test its association with health services utilization. Methods. Cross-sectional analysis from next-of-kin data available from the last wave of the Mexican Health and Aging Study (MHAS). Measurements. Along with descriptive statistics, the frailty index (FI) was tested in regression models to assess its association with adverse outcomes previous to death: number of hospitalized days in the previous year and number of visits to a physician in the previous year, in unadjusted and adjusted models. Results. From a total of 2,649 individuals the mean of age was 74.8 (±11.4) and 56.3% ( n = 1,183) were women. The mean of the FI was of 0.279 (±SD 0.131, R = 0.0-0.738) and distribution was biased to the right. There was a significant association ( p < 0.001) between the FI and number of hospitalized days ( β = 45.7, 95% CI 36.1-55.4, p < 0.001) and for the number of visits to a physician ( β = 25.93, 95% CI 19.27-32.6, p < 0.001) both models adjusted for age and sex. Conclusion. The FI constructed with next-of-kin data showed similar characteristics to similar indexes of older adults. It was independently associated with health care use.

Background: Frailty is a relatively new phenomenon described mainly in the older population. There are a number of different tools that aim at categorizing an older adult as frail. Two of the main tools for this purpose are the Fried's frailty phenotype (FFP) and the frailty index (FI). The aim of this report is to determine the prevalence of frailty and associated factors using both FFP and the FI., Methods: Secondary analysis of 1108 individuals aged 60 or older is participating in the third (2012) wave from the Mexican Health and Aging Study (MHAS). The FFP and the FI were constructed and a set of variables from different domains were used to explore associations. Domains included were: socio-demographic, health-related, and psychological factors. Regarding prevalence, concordance was tested with a kappa statistic. To test significant associations when classifying with each of the tools, multiple logistic regression models were fitted., Results: Mean (SD) age was 69.8 (7.6) years, and 54.6% (n=606) were women. The prevalence of frailty with FFP was 24.9% (n=276) while with FI 27.5% (n=305). Kappa statistics for concordance between tools was 0.34 (p<0.001). Age, years in school, number of past days in bed due to health problems, number of times that consulted a physician last year for health problems, having smoked in the past, and life satisfaction were associated with frailty when using any of the tools., Conclusions: There is a persistent heterogeneity on how frailty is measured that should be addressed in future research., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: There are two widely used tools to classify frailty in older adults: the frailty phenotype and the frailty index. Both have been validated for prediction of adverse outcomes., Objective: To assess the ability of different frailty indices to predict a number of adverse outcomes (falls, disability, and mortality) by adding deficits in a fixed sequence (with the first five deficits as in the frailty phenotype: weakness, weight loss, slowness, exhaustion and low physical activity) or randomly., Methods: This is an analysis of the Costa-Rican Longevity and Healthy Aging Study in which ≥ 60-year-old adults were included and followed up for four years. Frailty indices were constructed, including the frailty phenotype components in the first five indices followed by the random addition of other deficits and estimating for each one the odds ratios for falls and disability and hazard ratios for mortality, adjusted for age and sex., Results: We included 2,708 adults; mean age was 76.31 years, 54.28% were women. Indices with the highest number of deficits had the highest estimates for each adverse outcome, independent of the deficit., Conclusion: The higher the number of deficits in an index, the higher the estimates for adverse outcomes, independent of the type of deficit added.

Background: Frailty in elderly results from impaired physiological reserve in multiple systems. Establishing if frail elderly inpatients develop more functional impairment at discharge, will allow the development of strategies for preventing or limiting the deterioration in this vulnerable group., Methods: Prospective cohort in 133 elderly inpatients. At admission, frailty, functional status, comorbidity and comprehensive geriatric evaluation were determined. The main outcome was functional state at hospital discharge., Results: 64 patients presented frailty (48.1%) and 69 did not present that state (51.9%), with a mean age of 73 and 68 years, respectively. Mean decrement in functional state at discharge was -8.06 % (IC 95 % -10.38 to -5.74), from 97.97 % to 89.91 % (p < 0.001) in patients who did not present frailty, and -21.18 % (IC 95 % -24.97 to -17.38), from 87.52 % to 66.34 % (p < 0.001) in frail patients. The difference between groups at discharge was -14.37 % (IC 95 % -16.80 to -11.94, p < 0.001) to the detriment of the frail. Frailty was associated with functional impairment in the univariated and multivariated analysis, beta -13.11 % (IC 95 % -17.45 to -8.78, p < 0.001) and beta -17.27 (IC 95 % -23.27 to -11.28, p < 0.001), respectively. In the final model, frailty (beta -14.73, IC 95 % -19.39 to -10.07, p < 0.001) and cognitive impairment (beta -8.19, IC 95 % -15.28 to -1.10, p = 0.024) predict functional decrement., Conclusion: Frailty independently predicts functional impairment at hospital discharge.

Aim: To estimate the prevalence of frailty phenotypes and their association with the sociodemographic characteristics, health state and the use of health services in the last 6 months among community-dwelling elderly in Mexico City., Methods: The present study included 1933 elderly individuals from Mexico City. We estimated the prevalence of the frailty phenotype based on Fried and Walston. Household interviews were carried out to collect information on sociodemographics (sex, age, education, marital status, live alone, paid job), health state (activities of daily living, cognitive function, depression, comorbidity, nutritional status) and the use of health services in the last 6 months., Results: The estimated prevalence of frailty was 15.7%, pre-frailty at 33.3% and non-frailty at 51.0%. The statistically relevant associations in the pre-frail elderly were female (OR 0.83), older age (OR 2.48), single (OR 1.03), living alone (OR 1.23), no paid work (OR 0.82), limitations in the basic activities of daily living (OR 2.11) and instrumental activities of daily living (OR 2.10), cognitive impairment (OR 1.49), depression symptoms (OR 3.82), underweight/malnourished (OR 1.89), overweight/obesity (OR 0.80), moderate comorbidity (OR 2.05), and use of health services (OR 1.04) using the non-frail phenotype as the comparison category. Frailly is associated with female (OR 1.05), older age (OR 10.32), less educated (OR 2.51), single OR 1.39), living alone (OR 0.86), no paid work (OR 1.16), limitations in the basic activities of daily living (OR 7.66) and instrumental activities of daily living (OR 8.42), cognitive impairment (OR 3.02), depression symptoms (OR 11.23), underweight/malnourished (OR 1.49), overweight/obesity (OR 0.49), moderate comorbidity (OR 3.55), and use of health services (OR 1.99) using the non-frail phenotype as the comparison category., Conclusions: The results suggest that older age, disability, comorbidity, cognitive impairment and depression could have an influence role in frailty., (© 2013 Japan Geriatrics Society.)

Background: Frailty in the elderly can be regarded as nonspecific vulnerability to adverse health outcomes, caused by multiple factors. The aim was to analyze the relationships between the frailty index, age and mortality in a two year follow up study of Mexican elderly., Methods: A frailty index was developed using 34 variables. To obtain the index, the mean of the total score for each individual was obtained. Survival analyses techniques were used to examine the risk ratios for the different levels of the frailty index. Kaplan-Meier estimates were obtained, adjusted for age and gender. Cox proportional hazards models were also built to obtain hazard ratio estimates., Results: A total of 4082 participants was analyzed. Participants had an average age of 73 years and 52.5% were women. On average, participants were followed-up for 710 days (standard deviation = 111 days) and 279 of them died. Mortality increased with the frailty index level, especially in those with levels between .21 to .65, reaching approximately 17% and 21%, respectively. Cox proportional hazards models showed that participants with frailty index levels associated to increased mortality (.21 and higher) represent 24.0% of those aged 65-69 years and 47.6% of those 85 and older., Conclusion: The frailty index shows the properties found in the other studies, it allows stratifying older Mexican into several groups different by the degree of the risk of mortality, and therefore the frailty index can be used in assessing health of elderly.

Identifying relationships between components of an index helps to gain a better understanding of the condition they define. The Frailty Index (FI) measures the global health of individuals and can be used to predict outcomes as mortality. Previously, we modelled the relationship between the FI components (deficits) and death through an undirected graphical model and a social network analysis framework. Here, we model the FI components and death through an averaged Bayesian network obtained through a structural learning process and resampling, in order to understand how the FI components and death are causally related. We identified that components are not similarly related between them and that deficits are related according to their type. Two deficits were the most relevant in terms of their connections, and two others were directly associated with death. We obtained the strength of the relationships in order to identify the most plausible, identifying clusters of deficits. Finally, we propagated evidence and studied how FI components predict mortality, obtaining a correct assignation of almost 74% and a true positive rate (TPR) of 56%. Values were obtained after changing the model threshold (via Youden's Index maximization) whose possible values are represented in a Receiving Operating Characteristic (ROC) curve (TPR vs. 1-True Negative Rate). The greater number of deficits included for the evidence, the best performances; nevertheless, the FI does not seem to be quite efficient to correctly differentiate between dead and living people. [ABSTRACT FROM AUTHOR]

Background: To determine the association between oral health condition and development of frailty over a 12-month period in community-dwelling older adults. Methods: Population-based, case-cohort study derived from the Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults (COSFOMA) study, including data from years 2015 and 2016. Using latent class analysis, we determined the oral health condition of older adults with teeth (t0), i.e., functional teeth, presence of coronal caries, root caries, periodontal disease, dental calculus, dental biofilm, root remains, xerostomia, and need for dental prosthesis. Edentulous was considered as a separate class. Criteria of the Frailty Phenotype (t1) by Fried et al. were used: weight loss, self-report of exhaustion, walking speed, decreased muscle strength, and low physical activity. The presence of three or more criteria indicated a frail condition. The strength of the association (odds ratio, OR) between oral health condition and development of frailty was estimated through bivariate analysis. Multiple logistic regression was used to adjust for the other variables of study: sociodemographic data (sex, age, marital status, level of education, paid work activity, and living alone), comorbidities, cognitive impairment, depressive symptoms, nutritional status, and use of oral health services. Results: 663 non-frail older adults were evaluated, with a mean age of 68.1 years (SD ± 6.1), of whom 55.7% were women. In t0, a three-class model with an acceptable value was obtained (entropy = 0.796). The study participants were classified as: edentulous persons (6.9%); Class 1 = Acceptable oral health (57.9%); Class 2 = Somewhat acceptable oral health (13.9%); and Class 3 = Poor oral health (21.3%). In t1, 18.0% (n = 97) of participants developed frailty. Using Acceptable oral health (Class 1) as a reference, we observed that older adults with edentulism (OR 4.1, OR adjusted 2.3) and Poor oral health (OR 2.4, OR adjusted 2.2) were at an increased risk of developing frailty compared to those with Acceptable oral health. Conclusion: Older adults with edentulism and poor oral health had an increased risk of developing frailty over a 12-month period. [ABSTRACT FROM AUTHOR]

Frailty has been recognized as a common condition in older adults, however, there is scarce information on the association between frailty and commonly used biomarkers. The aim of this study was to assess the individual and cumulative association of biomarkers with frailty status. This is a cross-sectional analysis of the 2012 wave of the Mexican Health and Aging Study. A sub-sample of 60-year or older adults with anthropometric measurements was analyzed. Frailty was defined with a 31-item frailty index and those considered frail had a score ≥ 0.21. Biomarkers were further categorized as normal/abnormal and tested both one by one and grouped (according to their usual cutoff values). Adjusted logistic models were performed. A total of 1128 older adults were analyzed and their mean age was 69.45 years and 51.24% of them were women. 26.7% (n = 301) were categorized as frail. Individual biomarkers associated with frailty after adjusting for confounding were: hemoglobin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.13–2.46, p = 0.009], glycated hemoglobin (OR 2.04, 95% CI 1.54–2.7, p < 0.001) and vitamin D (OR 1.53, 95% CI 1.13–2.07, p = 0.005). Those with ≥ 4 abnormal biomarkers had an independent association with frailty when compared to those without any abnormal biomarker (OR 2.64, 95% CI 1.3–5.25, p = 0.005). Aside from the individual associations of specific biomarkers, our findings show that an incremental association of abnormal biomarkers increases the probability of frailty, accounting for the multidimensional nature of frailty and the possible interplay between components of the system that potentiate to give rise to a negative condition such as frailty. [ABSTRACT FROM AUTHOR]

Background: Frailty in elderly results from impaired physiological reserve in multiple systems. Establishing if frail elderly inpatients develop more functional impairment at discharge, will allow the development of strategies for preventing or limiting the deterioration in this vulnerable group. Methods: Prospective cohort in 133 elderly inpatients. At admission, frailty, functional status, comorbidity and comprehensive geriatric evaluation were determined. The main outcome was functional state at hospital discharge. Results: 64 patients presented frailty (48.1%) and 69 did not present that state (51.9%), with a mean age of 73 and 68 years, respectively. Mean decrement in functional state at discharge was -8.06 % (IC 95 % -10.38 to -5.74), from 97.97 % to 89.91 % (p < 0.001) in patients who did not present frailty, and -21.18 % (IC 95 % -24.97 to -17.38), from 87.52 % to 66.34 % (p < 0.001) in frail patients. The difference between groups at discharge was -14.37 % (IC 95 % -16.80 to -11.94, p < 0.001) to the detriment of the frail. Frailty was associated with functional impairment in the univariated and multivariated analysis, beta -13.11 % (IC 95 % -17.45 to -8.78, p < 0.001) and beta -17.27 (IC 95 % -23.27 to -11.28, p < 0.001), respectively. In the final model, frailty (beta -14.73, IC 95 % -19.39 to -10.07, p < 0.001) and cognitive impairment (beta -8.19, IC 95 % -15.28 to -1.10, p = 0.024) predict functional decrement. Conclusion: Frailty independently predicts functional impairment at hospital discharge. [ABSTRACT FROM AUTHOR]

ObjectiveThe objective of the current work was to determine the association between food insecurity and frailty in older adults, within the context of a country with accelerated ageing and nutritional problems.DesignCross-sectional analysis of a representative nationwide survey on health and nutrition.SettingMexican nationwide survey.SubjectsA sample of 7108 adults aged 60 years or older living in communities, representative of Mexican older adults.ResultsMultivariate regression and descriptive analyses of food insecurity and frailty were performed. From a total of 7108 adults aged 60 years or older, with a mean age of 70·7 years, most (54·7 %) were women. Food security categories were: 26·3 % had food security, 40·3 % had mild food insecurity, 20·5 % had moderate food insecurity and 12·9 % had severe food insecurity. Food insecurity categories were associated with frailty, with the severe category having the highest odds ratio of 2·41 (95 % CI 2·03, 2·86; P<0·001) after adjustment for confounding factors.ConclusionsAccording to our results, food insecurity is associated to frailty, which in turn is a condition that renders the older adult at a higher risk of developing adverse outcomes. Targeted food programmes for older adults with a high risk of having food insecurity or of being frail may improve health in this population group. [ABSTRACT FROM AUTHOR]