Factors associated with transitions between frailty states among older persons in Brazil, 2006-2010

Alves, Luciana Correia; Santos, Jair Licio Ferreira; Duarte, Yeda Aparecida de Oliveira

doi:10.1590/1414-462X202199010328

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Sumário

ORIGINAL ARTICLE • Cad. saúde colet. 29 (spe) • 2021 • https://doi.org/10.1590/1414-462X202199010328 copy

Factors associated with transitions between frailty states among older persons in Brazil, 2006-2010

Fatores associados às transições nos estados de fragilidade entre idosos no Brasil, 2006-2010

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Frailty is considered one of the major conditions faced by ageing societies. Little has been reported about the transitions between the different frailty states in developing countries.

Objective

This study aimed to identify the factors associated with transitions between frailty states between 2006 and 2010 among older adults in Brazil.

Method

The present investigation is part of the SABE study (Health, Well-being and Ageing). Frailty state was classified according to the Fried’s criteria (nonfrail, prefrail, and frail). The final study sample was composed of 1,399 individuals representing 1,019,243 older adults in the city of Sao Paulo, Brazil. Multiple logistic regression was used to identify factors associated with changes in frailty states.

Results

Women were more likely to present a decline in frailty states. In the prefrail-to-nonfrail model, level of education was the most strongly associated factor. Advanced age and difficulty in performing at least one basic activity of daily living reduced in 9 and 64% the risk of becoming nonfrail, respectively.

Conclusion

Addressing the factors associated with transition between frailty states among older adults is essential. Adequate interventions are important to reduce vulnerability and improve the health and well-being of older persons.

Keywords:
ageing; frailty; transitions; risk factors; Brazil

Variables	n (1,019,243)	Relative distribution (%)
Age (years)
60-64	291575	28.6
65-69	276147	27.1
70-74	202625	19.9
75-79	128466	12.6
≥80	120430	11.8
Sex
Male	413971	40.6
Female	605272	59.4
Marital status
Single	43679	4.3
Married/Stable union	583447	57.2
Separated/Divorced	78348	7.7
Widowed	312778	30.7
Living arrangement
Lives alone	134620	13.2
Lives with others	882933	86.6
Schooling (years)
None	199396	19.6
1 to 4	548739	53.8
≥5	270385	26.5
Employment status
Employed	287474	28.2
Unemployed	646585	63.4
Income
None	33329	3.3
Less than BMMW	186715	18.3
1 to 2.99 times BMMW	393936	38.6
3 to 4.99 times BMMW	146152	14.3
5 or more times BMMW	141781	13.9

Variable	n (1,019,243)	Relative distribution (%)
Self-rated health
Good	454503	44.6
Fair	468385	46
Poor	89461	8.8
Hypertension*
Yes	636783	62.5
Diabetes*
Yes	213333	20.9
Lung disease *
Yes	121576	11.9
Heart disease*
Yes	224073	22
Embolism/stroke*
Yes	84070	8.2
Arthritis/arthrosis/rheumatism*
Yes	329656	32.3
Cancer*
Yes	48344	4.7
Osteoporosis*
Yes	221487	21.7
Psychiatric disorders ^* * Self-reported;
Yes	139199	13.7
Depression ^ Measured by the Geriatric Depression Scale;
Yes	133275	13.1
Cognitive decline ^* ***** Mini Mental Health Examination.
Yes	286081	28.1
Number of chronic diseases
0	141195	13.9
1	252087	24.7
2-3	434419	42.6
≥4	191542	18.8
Fall in the previous 12 months
Yes	290220	28.5
Hospitalization in the previous 12 months
Yes	98259	9.6
Use of medications
Yes	923046	90.6
Body mass index
Underweight	211774	20.8
Ideal range	426549	41.8
Overweight	116384	11.4
Obesity	223191	21.9
Difficulty with at least one IADL
Yes	419951	41.2
Difficulty with at least one mobility
Yes	904303	88.7
Difficulty with at least one BADL
Yes	231215	22.7
Regular physical activity
Yes	177309	17.4
Alcohol consumption
Yes	315338	30.9
Smoking
Non-smoker	528118	51.8
Smoker	143420	14.1
Ex-smoker	347705	34.1
Consumption of fruits and vegetables
Yes	819876	80.4

Variable	Prefrail to Frail	Prefrail to Nonfrail	Nonfrail to Prefrail or Frail	Frail to Prefrail or Nonfrail
Variable	Risk Ratio 95% CI	Risk Ratio 95% CI	Risk Ratio 95% CI	Risk Ratio 95% CI
Age (years)	1.13(1.06-1.20)	0.91(0.88-0.95)	1.06(1.02-1.11)	_
Sex
Male	1	_	_	1
Female	0.29(0.11-0.80)			2.25(2.05-44.10)
Schooling (years)
None	_	1	_	_
1 to 4		2.48(1.12-5.50)
≥ 5		2.43(0.96-6.14)
Diabetes
No	1	_	_	_
Yes	5.47(1.77-19.10)
Cancer
No	1	_	_	_
Yes	8.50(1.77-39.25)
Osteoporosis
No	1	_	_	_
Yes	5.26(1.49-19.88)
Number of chronic diseases
0	1	_	_	_
1	0.09(0.01-0.58)
2-3	0.06(0.01-0.51)
≥ 4	0.02(0.00-0.36)
Body mass index
Underweight	1	_	_	_
Ideal range	0.84(0.28-2.58)
Overweight	0.04(0.00-0.56)
Obesity	3.67(1.05-14.15)
Difficulty with at least one BADL
No	_	1	_	_
Yes		0.36(0.16-0.80)
Cognitive decline
No	_	_	_	1
Yes				0.03(0.00-0.36)
Regular physical activity
No	_	_	1	_
Yes			0.40(0.23-0.69)
Goes to the movies or restaurants
No	_	_	1	_
Yes			1.86(1.17-2.94)
Intercept	p<0.01	p<0.01	p<0.01	p>0.05

Instituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de Janeiro Avenida Horácio Macedo, S/N, CEP: 21941-598, Tel.: (55 21) 3938 9494 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@iesc.ufrj.br

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[1] Correspondence: Luciana Correia Alves. E-mail: lcalves@unicamp.br