Substantial
differences by income also found
Newswise, September 25, 2015 — A large-scale survey of older Americans living at home or in assisted living settings found that 15 percent are frail, a diminished state that makes people more vulnerable to falls, chronic disease and disability, while another 45 percent are considered pre-frail, or at heightened risk of becoming physically diminished.
Newswise, September 25, 2015 — A large-scale survey of older Americans living at home or in assisted living settings found that 15 percent are frail, a diminished state that makes people more vulnerable to falls, chronic disease and disability, while another 45 percent are considered pre-frail, or at heightened risk of becoming physically diminished.
The
Johns Hopkins Bloomberg School of Public Health study found frailty to be more
prevalent in older people and more common among women and the poor. In
addition, the study found wide regional differences in the U.S., with older
people in central southern states more than three times as likely to be frail
than those in the western states.
The researchers also found significant racial
differences, with blacks and Hispanics nearly twice as likely to be frail as
whites.
The
study is published in the September 2015 issue ofJournals of Gerontology:
Medical Sciences.
Frailty,
once thought of as a generalized fragile state that befalls some people as they
get older, is increasingly considered a medical process in and of itself.
Frailty is thought to be exhibited by a set of symptoms including weakness,
exhaustion and limited mobility. It often progresses separately from any
underlying conditions, and is also common among patients with chronic diseases
such as heart disease and diabetes, especially in their advanced stages.
Understanding
frailty, and finding ways to prevent its onset or slow its progression, could
improve older people’s quality of life by extending their so-called robust years.
It could also increase their chances of surviving surgery, for example;
previous research has suggested that older, frail patients are less likely to
survive major surgical procedures.
Reducing frailty could lower health care
costs, since frail persons are prone to falls and falls often lead to
hospitalization. Hospital care is the largest component of Medicare spending.
Of
their findings, the authors were most surprised by the significant racial and
regional differences, says study leader Karen Bandeen-Roche, PhD, the Frank
Hurley and Catharine Dorrier Professor and Chair of the Department of
Biostatistics at the Johns Hopkins Bloomberg School of Public Health. The study
is believed to be the first that examines regional differences in frailty in
the U.S.
“We
can’t really explain the regional differences,” says Bandeen-Roche, who also
co-directs the Johns Hopkins Older Americans Independence Center and is a Core
Faculty member at the Johns Hopkins Center on Aging and Health.
“We know there
are health differences across the country, differences in diet and to some
extent exercise habits. Observing the relatively low prevalence in the mountain
west, you can imagine an active lifestyle might be a factor.”
As for the racial
differences, Bandeen-Roche says it’s too early to speculate, noting that they
could be due to any number of factors, and merit further study.
For
the study, researchers drew on interviews with 7,439 participants in the 2011
National Health and Aging Trends Study, a longitudinal study of people age 65
and older drawn from Medicare records.
Participants, who resided either at home
or in an assisted living facility, completed a two-hour, in-person interview
that assessed frailty using several criteria: exhaustion, weakness, low
physical activity, shrinking and low walking speed.
Participants were also
asked about their medical history and ability to perform daily tasks such as
meal preparation and other household activities. The researchers assessed
probable dementia with a combination of questions and cognitive tests.
Among
the survey’s other findings: Residents of assisted living facilities were more
than twice as likely to be frail than those living in private homes.
Prevalence
increased with age, with 9 percent of those ages 65 to 69 found to be frail
compared to 38 percent of those aged 90 or older. Among the frail, more than
half had fallen in the previous year, and more than one-third had fallen
several times, with 40 percent of those who had fallen being hospitalized.
As
frailty becomes better understood, the researchers hope clinicians will develop
recommendations that specifically address risks associated with frailty, for
instance, having people engage in strengthening activities before major
surgery.
Such recommendations, if adapted by older people who had not yet
slipped into advanced frailty, could help delay or even prevent its onset.
Aside
from the 15 percent found to be frail, the researchers also found that 45
percent were what the authors deemed “pre-frail,” or older people who have
begun to experience the same symptoms of frailty, but to a lesser extent. “It’s
a question of degree,” Bandeen-Roche says.
The so-called pre-frail are a prime
target of study in order to help researchers understand the progression of
frailty so doctors can develop recommendations – for instance, changes in diet
or exercise – that could extend a person’s robust years.
“We
would love for frailty assessment to become a standard component of assessment
of older Americans,” Bandeen-Roche says. “Understanding frailty could
potentially help us extend people’s quality of life into their later years.”
“Frailty
in Older Adults: A Nationally Representative Profile in the United States” was
written by Karen Bandeen-Roche, Christopher L. Seplaki, Jin Huang, Brian Buta,
Rita R. Kalyani, Ravi Varadhan, Qian-Li Xue, Jeremy D. Walston and Judith D.
Kasper.
