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Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004.
J Am Geriatr Soc. 2018 03; 66(3):496-502.JA

Abstract

OBJECTIVES

To determine the relationship between frailty and overall and cardiovascular mortality.

DESIGN

Longitudinal mortality analysis.

SETTING

National Health and Nutrition Examination Survey (NHANES) 1999-2004.

PARTICIPANTS

Community-dwelling older adults aged 60 and older (N = 4,984; mean age 71.1 ± 0.19, 56% female).

MEASUREMENTS

We used data from 1999-2004 cross-sectional NHANES and mortality data from the National Death Index, updated through December 2011. An adapted version of Fried's frailty criteria was used (low body mass index, slow walking speed, weakness, exhaustion, low physical activity). Frailty was defined as persons meeting 3 or more criteria, prefrailty as meeting 1 or 2 criteria, and robust (reference) as not meeting any criteria. The primary outcome was to evaluate the association between frailty and overall and cardiovascular mortality. Cox proportional hazard models were used to evaluate the association between risk of death and frailty category adjusted for age, sex, race, smoking, education, coronary artery disease, heart failure, nonskin cancer, diabetes, and arthritis.

RESULTS

Half (50.4%) of participants were classified as robust, 40.3% as prefrail, and 9.2% as frail. Fully adjusted models demonstrated that prefrail (hazard ratio (HR) = 1.64, 95% confidence interval (CI) = 1.45-1.85) and frail (HR = 2.79, 95% CI = 2.35-3.30) participants had a greater risk of death and of cardiovascular death (prefrail: HR = 1.84, 95% CI = 1.45-2.34; frail: HR = 3.39, 95% CI = 2.45-4.70).

CONCLUSION

Frailty and prefrailty are associated with increased risk of death. Demonstrating the association between prefrail status and mortality is the first step to identifying potential targets of intervention in future studies.

Authors+Show Affiliations

Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire. Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire.Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire. Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire.Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire.Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire. Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire. Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire.Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire. Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire. Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire. Dartmouth Weight & Wellness Center, Lebanon, New Hampshire.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

29368330

Citation

Crow, Rebecca S., et al. "Mortality Risk Along the Frailty Spectrum: Data From the National Health and Nutrition Examination Survey 1999 to 2004." Journal of the American Geriatrics Society, vol. 66, no. 3, 2018, pp. 496-502.
Crow RS, Lohman MC, Titus AJ, et al. Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004. J Am Geriatr Soc. 2018;66(3):496-502.
Crow, R. S., Lohman, M. C., Titus, A. J., Bruce, M. L., Mackenzie, T. A., Bartels, S. J., & Batsis, J. A. (2018). Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004. Journal of the American Geriatrics Society, 66(3), 496-502. https://doi.org/10.1111/jgs.15220
Crow RS, et al. Mortality Risk Along the Frailty Spectrum: Data From the National Health and Nutrition Examination Survey 1999 to 2004. J Am Geriatr Soc. 2018;66(3):496-502. PubMed PMID: 29368330.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004. AU - Crow,Rebecca S, AU - Lohman,Matthew C, AU - Titus,Alexander J, AU - Bruce,Martha L, AU - Mackenzie,Todd A, AU - Bartels,Stephen J, AU - Batsis,John A, Y1 - 2018/01/25/ PY - 2018/1/26/pubmed PY - 2019/8/31/medline PY - 2018/1/26/entrez KW - cardiovascular KW - frailty KW - mortality KW - prefrailty SP - 496 EP - 502 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 66 IS - 3 N2 - OBJECTIVES: To determine the relationship between frailty and overall and cardiovascular mortality. DESIGN: Longitudinal mortality analysis. SETTING: National Health and Nutrition Examination Survey (NHANES) 1999-2004. PARTICIPANTS: Community-dwelling older adults aged 60 and older (N = 4,984; mean age 71.1 ± 0.19, 56% female). MEASUREMENTS: We used data from 1999-2004 cross-sectional NHANES and mortality data from the National Death Index, updated through December 2011. An adapted version of Fried's frailty criteria was used (low body mass index, slow walking speed, weakness, exhaustion, low physical activity). Frailty was defined as persons meeting 3 or more criteria, prefrailty as meeting 1 or 2 criteria, and robust (reference) as not meeting any criteria. The primary outcome was to evaluate the association between frailty and overall and cardiovascular mortality. Cox proportional hazard models were used to evaluate the association between risk of death and frailty category adjusted for age, sex, race, smoking, education, coronary artery disease, heart failure, nonskin cancer, diabetes, and arthritis. RESULTS: Half (50.4%) of participants were classified as robust, 40.3% as prefrail, and 9.2% as frail. Fully adjusted models demonstrated that prefrail (hazard ratio (HR) = 1.64, 95% confidence interval (CI) = 1.45-1.85) and frail (HR = 2.79, 95% CI = 2.35-3.30) participants had a greater risk of death and of cardiovascular death (prefrail: HR = 1.84, 95% CI = 1.45-2.34; frail: HR = 3.39, 95% CI = 2.45-4.70). CONCLUSION: Frailty and prefrailty are associated with increased risk of death. Demonstrating the association between prefrail status and mortality is the first step to identifying potential targets of intervention in future studies. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/29368330/Mortality_Risk_Along_the_Frailty_Spectrum:_Data_from_the_National_Health_and_Nutrition_Examination_Survey_1999_to_2004_ L2 - https://doi.org/10.1111/jgs.15220 DB - PRIME DP - Unbound Medicine ER -