Frailty in Older Men: Prevalence, Progression, and Relationship with Mortality

Authors

  • Peggy M. Cawthon PhD, MPH,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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  • Lynn M. Marshall ScD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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  • Yvonne Michael ScD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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  • Thuy-Tien Dam MD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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  • Kristine E. Ensrud MD, MPH,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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  • Elizabeth Barrett-Connor MD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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  • Eric S. Orwoll MD,

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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  • for the Osteoporotic Fractures in Men Research Group

    1. From the *Research Institute, California Pacific Medical Center, San Francisco, CaliforniaDepartment of Public Health and Preventive Medicine, and Bone and Mineral Unit, **Department of Medicine, Oregon Health and Science University, Portland, Oregon§Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, La Jolla, CaliforniaCenter for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota#Department of Medicine, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.
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Address correspondence to Peggy M. Cawthon, PhD, MPH, Research Institute, California Pacific Medical Center, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA 94107-1762. E-mail: pcawthon@sfcc-cpmc.net

Abstract

OBJECTIVES: To describe the association between frailty and health status, the progression of frailty, and the relationship between frailty and mortality in older men.

DESIGN: Cross-sectional and prospective cohort study.

SETTING: Six U.S. clinical centers.

PARTICIPANTS: Five thousand nine hundred ninety-three community-dwelling men aged 65 and older.

MEASUREMENTS: Frailty was defined as three or more of the following: sarcopenia (low appendicular skeletal mass adjusted for height and body fat), weakness (grip strength), self-reported exhaustion, low activity level, and slow walking speed. Prefrail men met one or two criteria; robust men had none. Follow-up averaged 4.7 years.

RESULTS: At baseline, 240 subjects (4.0%) were frail, 2,395 (40.0%) were prefrail, and 3,358 were robust (56.0%). Frail men were less healthy in most measures of self-reported health than prefrail or robust men. Frailty was somewhat more common in African Americans (6.6%) and Asians (5.8%) than Caucasians (3.8%). At the second visit, men who were frail at baseline tended to remain frail (24.2%) or die (37.1%) or were unable to complete the follow-up visit (26.2%); robust men tended to remain robust (54.4%). Frail men were approximately twice as likely to die as robust men (multivariate hazard ratio (MHR)=2.05, 95% confidence interval (CI)=1.55–2.72). Mortality risk for frail men was greater in all weight categories than for nonfrail men but was highest for normal-weight frail men (MHR=2.39, 95% CI=1.51–3.79, P for interaction=.01). The relationship between frailty and mortality was somewhat stronger in younger men than older men (P for interaction=.01).

CONCLUSION: Frailty in older men is associated with poorer health and a greater risk of mortality.

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