Frailty & pre-frailty in middle-aged & older adults & its assoc. w/multimorbidity & mortality: prospective analysis of 493,737 UK Biobank participants

[Indigophoton]

Hanlon et al, 2018

Not specifically on ME, but CFS comes out as the condition second most strongly associated with frailty,

Background
Frailty is associated with older age and multimorbidity (two or more long-term conditions); however, little is known about its prevalence or effects on mortality in younger populations. This paper aims to examine the association between frailty, multimorbidity, specific long-term conditions, and mortality in a middle-aged and older aged population.

Methods
Data were sourced from the UK Biobank. Frailty phenotype was based on five criteria (weight loss, exhaustion, grip strength, low physical activity, slow walking pace). Participants were deemed frail if they met at least three criteria, pre-frail if they fulfilled one or two criteria, and not frail if no criteria were met. Sociodemographic characteristics and long-term conditions were examined. The outcome was all-cause mortality, which was measured at a median of 7 years follow-up. Multinomial logistic regression compared sociodemographic characteristics and long-term conditions of frail or pre-frail participants with non-frail participants. Cox proportional hazards models examined associations between frailty or pre-frailty and mortality. Results were stratified by age group (37–45, 45–55, 55–65, 65–73 years) and sex, and were adjusted for multimorbidity count, socioeconomic status, body-mass index, smoking status, and alcohol use.

Findings
493 737 participants aged 37–73 years were included in the study, of whom 16 538 (3%) were considered frail, 185 360 (38%) pre-frail, and 291 839 (59%) not frail. Frailty was significantly associated with multimorbidity (prevalence 18% [4435/25 338] in those with four or more long-term conditions; odds ratio [OR] 27·1, 95% CI 25·3–29·1) socioeconomic deprivation, smoking, obesity, and infrequent alcohol consumption. The top five long-term conditions associated with frailty were multiple sclerosis (OR 15·3; 99·75% CI 12·8–18·2); chronic fatigue syndrome (12·9; 11·1–15·0); chronic obstructive pulmonary disease (5·6; 5·2–6·1); connective tissue disease (5·4; 5·0–5·8); and diabetes (5·0; 4·7–5·2). Pre-frailty and frailty were significantly associated with mortality for all age strata in men and women (except in women aged 37–45 years) after adjustment for confounders.

Interpretation
Efforts to identify, manage, and prevent frailty should include middle-aged individuals with multimorbidity, in whom frailty is significantly associated with mortality, even after adjustment for number of long-term conditions, sociodemographics, and lifestyle. Research, clinical guidelines, and health-care services must shift focus from single conditions to the requirements of increasingly complex patient populations.

Table 1 Frailty criteria

Figure 2

Frailty or pre-frailty for individual long-term conditions adjusted for age, sex, socioeconomic status, smoking status, and body-mass index

A forest plot indicating the odds ratio for frailty (A) and pre-frailty (B) for long-term conditions with >1% prevalence (in the whole cohort) compared those without. *Excludes non-melanoma skin cancer.


https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30091-4/abstract

 

[OverTheHills]

Thanks for posting this @Indigophoton, those graphs look pretty powerful to me. I hope they will prove useful in future advocacy.

So, imagine a long term condition where patients have the worst quality of life*, are likely to become frail early in life and are six times more likely to commit suicide than the general population. What shall we do about it?

A) Disbelieve patients so they avoid doctors as much as possible
B) Insult and put barriers in patients way so they dont attend doctors/have access to benefits or services
C) Try to convince patients there's nothing wrong with them
D) Avoid doing any research so there are no treatments
E) All of the above.

It's a crazy world isn't it where the 'right' answer is E, "nothing to see here, move along". But I suppose it saves the oligarchs money.

*referring to that study on QOL 3/4 years ago with another powerful graph.

 

[Jonathan Edwards]

I would be worried that this 'frailty' label is pretty vague and like 'fatigue' may just confuse everything. Just as you do not treat all fatigue the same way it is unlikely that you would treat frailty, defined by these criteria, the same way.

I am also a bit doubtful about what these figures mean. If 'cancer' includes a rodent ulcer on the ear then it may not be surprising that on average it is low on frailty.

I sense a new branch of the NHS coming into being: 'IAAFT' Increase access to anti-frailty therapies.

 

[OverTheHills]

Yes, having pondered about this a bit more, I suspect the 'treatment' for frailty will be exercise and encouragement to get out and about more. Just what we need. Optimism over.

Someone who understands the science better may like to comment on whether or not this paper provides useful evidence that despite the active encouragement to go away and think ourselves healthy, we in fact get plenty of comorbid conditions and die early. Just like other sick people.

 

[Esther12]

It looks like there's a lot of overlap between CFS and how they define 'frailty':

"Frailty phenotype was based on five criteria (weight loss, exhaustion, grip strength, low physical activity, slow walking pace)."

 

[Skycloud]

There's a weightloss thread on this forum; it's not evidence of any kind, but it does question their assumptions

 

[Cinders66]

Unfit in middle age: Are you doomed?
http://www.bbc.co.uk/news/health-44468755

Mentions "frailty" in middle age as higher risk of early death & says frail people were often found to have MS or CFS. Unfortunately the current recommendations for frailty are identify and treat with exercise :-(


I agree it's firm stats to quote in advocacy terms. Obviously not exactly the most heartening of news to those of us who hardly move but it's not like we didn't already suspect it. What we need to make sure is people realise increasing activity isn't going to be solution for a lot of us without treatment.
If you don't want yet more health burdens from our population, invest in CFS research as you do in MS.

What about frailty?
Frailty is known to be a health risk to people in later life because, among other things, it increases the likelihood of falls.

But a new paper, which examined data from 493,737 people involved in the UK Biobank study, found that being frail earlier in life also appeared to be a predictor of ill health and early death.

The study, published in the Lancet Public Health journal, defined frailty as anyone who had at least three of the following health problems:

• Weight loss
• Exhaustion
• Weak grip strength
• Low physical activity
• Slow walking pace

Image copyrightGETTY IMAGES
Image captionThe key for those who are unfit in middle age is making healthy changes "as soon as possible"
After accounting for other factors (including socio-economic status, a number of long-term conditions, smoking, alcohol and BMI), researchers found men between the ages of 37 and 45 were over two-and-a-half times more likely to die than non-frail people of the same age.

The figures were similar in all the other age groups (45-55, 55-65, and 65-73).

Similar associations were found in women who were judged to be frail and were 45 or older.

Frail people were also far more likely to have conditions such as multiple sclerosis and chronic fatigue syndrome.

Lead author of the study, Prof Frances Mair, from the University of Glasgow, said the findings suggested there was a need to both identify and treat frailty much earlier in life.

So what can we do?
Dr Peter Hanlon, a co-author on the frailty study, said the good news is that frailty might be reversible in people, particularly if it is identified early.

The key for those who are unfit in middle age is making healthy changes "as soon as possible", says Ilaria Bellantuono, professor of musculoskeletal ageing at the University of Sheffield.

"The key is a healthy diet and exercise. It's the only thing we know that works," she says.