Frailty Transitions in the San Antonio Longitudinal Study of Aging

Authors

  • Sara E. Espinoza MD,

    Corresponding author
    1. Division of Geriatrics, Gerontology, and Palliative Medicine
    2. Department of Medicine, Division of Clinical Epidemiology
    3. Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas
    • Geriatrics Research, Education, and Clinical Center
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  • Inkyung Jung PhD,

    1. Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
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  • Helen Hazuda PhD

    1. Veterans Research Dissemination and Implementation Center, South Texas Veterans Healthcare System
    2. Department of Medicine, Division of Clinical Epidemiology
    3. Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Address correspondence to Sara E. Espinoza, Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7875, San Antonio, TX 78229. E-mail: espinozas2@uthscsa.edu

Abstract

Objectives

To examine frailty transitions in Mexican American (MA) and European American (EA) older adults.

Design

Longitudinal, observational cohort study.

Setting

Socioeconomically diverse neighborhoods in San Antonio, Texas.

Participants

Three hundred twelve MA and 285 EA community-dwelling older adults (≥65) with frailty information at baseline (1992–1996) and transition information at follow-up (2000/01) in the San Antonio Longitudinal Study of Aging.

Measurements

Five frailty characteristics (weight loss, exhaustion, weakness, slowness, and low physical activity), frailty score (0–5), and overall frailty state (nonfrail = 0 characteristics, prefrail = 1 or 2, frail = ≥3) were assessed at baseline. Transitions (progressed, regressed, or no change) were assessed for frailty score and state. Odds ratios (ORs) of progression and regression in individual characteristics were estimated using generalized estimating equations adjusted for age, sex, ethnic group, socioeconomic status, comorbidity, diabetes, and follow-up interval.

Results

Diabetes mellitus with macrovascular complications (OR = 1.84, 95% confidence interval (CI) = 1.02–3.33), fewer years of education (OR = 0.96, 95% CI = 0.93–1.0) and follow-up interval (OR = 1.3, 95% CI = 1.17–1.46) were significant predictors of progression in any frailty characteristic. Mortality increased with greater frailty state, and prefrail individuals were more likely than frail individuals to regress.

Conclusion

Diabetes mellitus with macrovascular complications and fewer years of education are important predictors of progression in any frailty characteristic. Because of greater risk of death than for the nonfrail state and greater likelihood of regression than for the frail state, the prefrail state may be an optimal target for intervention.

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