Frailty and mortality, disability and mobility loss in a Spanish cohort of older adults: the FRADEA study

Abstract

Background: Original Fried's frailty criteria have not demonstrated their prognostic validity of mortality, disability and mobility loss in European cohorts.

Objectives: To analyze whether frailty implies increased risk of death, incident disability in basic (BADL) or instrumental (IADL) activities of daily living, or mobility impairment.

Design: Concurrent cohort study.

Setting: Albacete City, Spain.

Participants: 993 participants over age 70 from the FRADEA Study.

Measurements: Mortality, BADL and mobility using the Barthel Index, and IADL using the Lawton IADL Index, were recorded. BADL disability was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding, while deterioration of mobility was defined as loss of ability to perform transfers, walk, or use stairs, and IADL disability as losing any of the activities included in the Lawton Index. The risk of presenting adverse events was determined by Cox and Kaplan-Meier proportional hazard analysis and logistic regression adjusted for age, sex, function, and comorbidity.

Results: Mean follow-up was 534 days (SD 153), during which 105 participants (10.6%) died. Mean time to death was 363 days (SD 218), while 192 (25.4%) lost at least one BADL, 492 (60%) at least one IADL, and 222 (28.9%) lost mobility. Frail subjects had a greater adjusted risk of death (HR 5.5, CI 95% 1.5-20.2), of losing BADL (HR 2.5, CI 95% 1.3-4.8), of losing mobility (HR 2.7, CI 95% 1.5-5.0), and of losing IADL (HR 1.9, CI 95% 1.1-3.3) than non-frail patients.

Conclusion: Fried's frailty criteria are associated with death, incident disability, and mobility impairment in a Spanish cohort of older adults.