SUMMARY
OBJECTIVE:
While the literature contains several studies on the frailty assessed during hospitalization and/or outpatient settings and nursing homes, few studies have assessed frailty in community-dwelling older adults. We investigated the prevalence of frailty and associated factors among older adults in a sample of community-dwelling older adults.
METHODS:
We included community-dwelling older adults >60 years living in the Fatih District of the Istanbul Province. We conducted the study between November 2014 and May 2015. We collected the data such as age, sex, number of diseases and drugs, functional status, frailty, the presence of geriatric syndromes, common diseases, and quality-of-life assessment. Frailty was evaluated by the FRAIL scale.
RESULTS:
A total of 204 adults (mean age: 75.4±7.3 years) were included, of whom 30.4% were robust, 42.6% were pre-frail, and 27% were frail. In multivariate analyses, associated factors of frailty were the number of drugs [odds ratio (OR)=1.240, p=0.036], the presence of cognitive impairment (OR=0.300, p=0.016), and falls (OR=1.984, p=0.048).
CONCLUSION:
The present study established the prevalence of frailty in a large district in the largest metropolis in the country through a valid screening method. Our results suggest that clinicians should consider frailty evaluation in patients with multiple drug usage, cognitive impairment, and falls.
KEYWORDS:
Community dwelling; Older adults; Frail elderly; Geriatric assessments
INTRODUCTION
Our country is experiencing the same significant demographic changes worldwide, along with a
continuous increase, especially in the older population. It is estimated that one in every six (16%)
people will be above 65 years of age by 205011 United Nations Department of Economic and Social Affairs, Population Division. The
United Nations home page. Working paper no. ESA/P/WP.228. 2019. [cited on 2019 July 9]. Available
from: https://population.un.org/wpp/Publications/
https://population.un.org/wpp/Publicatio...
.
Frailty is a multidimensional geriatric syndrome that can be defined as a state of increased
vulnerability resulting from decreased physiological reserves, multiple system irregularities, and
limited capacity to maintain homeostasis22 Angulo J, Assar M, Rodríguez-Mañas L. Frailty and sarcopenia as the basis
for the phenotypic manifestation of chronic diseases in older adults. Mol Aspects Med. 2016;50:1-32.
https://doi.org/10.1016/j.mam.2016.06.001
https://doi.org/10.1016/j.mam.2016.06.00...
. Although
frailty is often associated with comorbidities and restrictions on movement, these terms have
different meanings22 Angulo J, Assar M, Rodríguez-Mañas L. Frailty and sarcopenia as the basis
for the phenotypic manifestation of chronic diseases in older adults. Mol Aspects Med. 2016;50:1-32.
https://doi.org/10.1016/j.mam.2016.06.001
https://doi.org/10.1016/j.mam.2016.06.00...
–66 Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of
frailty in Japan: a systematic review and meta-analysis. J Epidemiol. 2017;27(8):347-53.
https://doi.org/10.1016/j.je.2016.09.008
https://doi.org/10.1016/j.je.2016.09.008...
. The comorbidities that accompany frailty can be caused by frailty but may also be
considered a risk factor for frailty and disability33 Chhetri JK, Chan P, Ma L, Peng D, Rodríguez-Mañas L, Cesari M, et al.
Prevention of disability in the frail Chinese older population. J Frailty Aging. 2019;8(1):2-6.
https://doi.org/10.14283/jfa.2018.27
https://doi.org/10.14283/jfa.2018.27...
–99 Carneiro JA, Ramos GC, Barbosa AT, Mendonça JM, Costa FM, Caldeira AP.
Prevalence and factors associated with frailty in non-institutionalized older adults. Rev Bras
Enferm. 2016;69(3):435-42. https://doi.org/10.1590/0034-7167.2016690304i
https://doi.org/10.1590/0034-7167.201669...
.
While the literature contains several studies on the frailty assessed during hospitalization
and/or outpatient clinic visits and nursing homes, few studies assess the community-dwelling older
adults in our country22 Angulo J, Assar M, Rodríguez-Mañas L. Frailty and sarcopenia as the basis
for the phenotypic manifestation of chronic diseases in older adults. Mol Aspects Med. 2016;50:1-32.
https://doi.org/10.1016/j.mam.2016.06.001
https://doi.org/10.1016/j.mam.2016.06.00...
–55 Akın S, Mazıcıoglu MM, Mucuk S, Gocer S, Deniz Şafak E,
Arguvanlı S, et al. The prevalence of frailty and related factors in community-dwelling
Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res.
2015;27(5):703-9. https://doi.org/10.1007/s40520-015-0337-0
https://doi.org/10.1007/s40520-015-0337-...
. However, there is not yet a frailty prevalence study in the most populated
metropolitan area of our country, where elderly patients are evaluated with home visits. Istanbul is
the 22nd largest metropolitan city in the world and is also located in a region that receives the
most significant number of migrations due to our country's industrialization and cultural and
historical heritage.
In light of this information, the present study investigated the prevalence of frailty and associated factors among the older adults assessed within the scope of a comprehensive geriatric study in the Fatih District of Istanbul Province.
METHODS
This was a population-based, prospective, cross-sectional study. The sample size was calculated considering the prevalence of frailty in the community with a 10% error margin at a power of 80% and a 95% confidence interval.
The study included community-dwelling older adults aged 61–101 years living in the Fatih District of Istanbul Province between November 2014 and May 2015. We selected the participants by a simple random sampling method among the older adults living at the addresses determined in the Fatih District of Istanbul. Participants aged over 60 years who agreed to participate in the study were included, while participants who had an implant, had edema/major fluid-electrolyte disorders, had cognitive impairment without anyone to accompany them, and were illiterate were excluded.
Functional capacity was measured using a six-item KATZ Activities of Daily Living (ADL) Scale and
an eight-item LAWTON-BRODY Instrumental Activities of Daily Living Scale (IADL)1010 Katz S, Ford AB, Moskowıtz RW, Jackson BA, Jaffe MW. Studıes of
ıllness ın the aged. The index of ADL: a standardızed measure of
bıologıcal and psychosocıal functıon. JAMA. 1963;185:185:914-9.
https://doi.org/10.1001/jama.1963.03060120024016
https://doi.org/10.1001/jama.1963.030601...
.
Frailty was assessed through the application of the FRAIL scale. Based on the results of the
five-item FRAIL scale, fatigue, resistance, ambulation, illnesses, and weight loss were
measured1111 Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts
outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-8.
https://doi.org/10.1007/s12603-012-0084-2
https://doi.org/10.1007/s12603-012-0084-...
.
The malnutrition screening was carried out using the Mini Nutritional Assessment-Short Form
(MNA-SF)1212 Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of
the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of
nutritional status. J Nutr Health Aging. 2009;13(9):782-8.
https://doi.org/10.1007/s12603-009-0214-7
https://doi.org/10.1007/s12603-009-0214-...
.
The cognitive screening was carried out using a Mini-Cog test1313 Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive
‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr
Psychiatry. 2000;15(11):1021-7.
https://doi.org/10.1002/1099-1166(200011)15:11<1021::aid-gps234>3.0.co;2-6
https://doi.org/10.1002/1099-1166(200011...
.
The depressive mood was evaluated using the Geriatric Depression Scale-Short Form
(GDS-SF)1414 Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of
their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J
Geriatr Psychiatry. 1999;14(10):858-65.
https://doi.org/10.1002/(sici)1099-1166(199910)14:10<858::aid-gps35>3.0.co;2-8
https://doi.org/10.1002/(sici)1099-1166(...
.
For the chronic pain assessment, we asked participants if they had pain for more than 6 months
and, in the presence of pain, we asked them to give a score between 0 and 10 using the visual analog
scale (VAS)1515 Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al.
Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog
scale in adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088.
https://doi.org/10.5435/JAAOSGlobal-D-17-00088
https://doi.org/10.5435/JAAOSGlobal-D-17...
.
Handgrip strength (HGS) was measured using a Jamar hydraulic hand dynamometer. For HGS, the
previously reported cutoffs of 27 and 16 kg for males and females, respectively, were used according
to the European Working Group on Sarcopenia in Older People2 (EWSGOP2)1616 Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of
the measurement of grip strength in clinical and epidemiological studies: towards a standardised
approach. Age Ageing. 2011;40(4):423-9. https://doi.org/10.1093/ageing/afr051
https://doi.org/10.1093/ageing/afr051...
,1717 Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al.
Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.
https://doi.org/10.1093/ageing/afy169
https://doi.org/10.1093/ageing/afy169...
.
Statistical analysis
The normality of continuous data was analyzed with a Kolmogorov-Smirnov test. For the descriptive statistics, continuous variables were expressed as mean±standard deviation, median, and minimum-maximum values, while categorical variables were expressed as number (of subjects) and percentages. The differences between groups were determined by independent samples t-test or Mann-Whitney U test. The chi-square test and Fisher's exact test for 2×2 probability tables are suitable for categorical variables. Multivariate logistic regression analysis with the Enter method was used to determine the independent factors associated with frailty among the factors found to be significant in univariate analyses. Multicollinearity was checked among the selected parameters.
RESULTS
The study involved 204 older adults (94 men and 110 women) with a mean age of 75.4±7.3 years. Of the cases, 30.4% were robust, 42.6% were pre-frail, and 27% were frail. Significant differences between the genders were recorded in the number of diseases and drugs, IADL score, FRAIL score, malnutrition, GDS-SF score, fear of falling, urinary incontinence, chronic pain, and handgrip strength (Table 1).
In univariate analysis, the frailty groups (robust vs. frail) differed significantly in terms of age, sex, number of diseases and drugs, ADL-IADL score, the presence of malnutrition, the risk of malnutrition, cognitive impairment, dementia, depression, fear of falling, falls, urinary incontinence, chronic pain, and probable sarcopenia (Table 2).
A multivariate logistic regression analysis evaluating frailty-associated independent factors [dependent variable: frailty (robust vs. pre-frail+frail)] revealed an association between the frailty and the number of drugs (OR=1.240, p=0.036, CI=1.010–1.500), cognitive impairment (OR=0.300, p=0.016, CI=0.113–0.799), and falls (OR=1.984, p=0.048) (Table 3).
DISCUSSION
There have been several studies examining frailty and potentially associated factors among
patients during hospitalization and outpatient clinic visits, while there have been only few studies
making extensive assessments of older people living in the community66 Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of
frailty in Japan: a systematic review and meta-analysis. J Epidemiol. 2017;27(8):347-53.
https://doi.org/10.1016/j.je.2016.09.008
https://doi.org/10.1016/j.je.2016.09.008...
,88 Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an
older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics (Sao Paulo).
2013;68(7):979-85. https://doi.org/10.6061/clinics/2013(07)15
https://doi.org/10.6061/clinics/2013(07)...
,1818 Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, et al. Frailty
ıntervention trial (FIT). BMC Geriatr. 2008;8:27.
https://doi.org/10.1186/1471-2318-8-27
https://doi.org/10.1186/1471-2318-8-27...
–2222 Woo J, Zheng Z, Leung J, Chan P. Prevalence of frailty and contributory factors in
three Chinese populations with different socioeconomic and healthcare characteristics. BMC Geriatr.
2015;15:163. https://doi.org/10.1186/s12877-015-0160-7
https://doi.org/10.1186/s12877-015-0160-...
. There have also been studies
conducted in our country evaluating the older inpatients and outpatients admitted to family health
centers. To the best of our knowledge, to date, no study involving a community screening for
frailty, as in the present study, has been conducted1212 Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of
the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of
nutritional status. J Nutr Health Aging. 2009;13(9):782-8.
https://doi.org/10.1007/s12603-009-0214-7
https://doi.org/10.1007/s12603-009-0214-...
.
We established that 42.6% of the respondents were pre-frail, while 27% were frail. Çakmur et
al., in their population-based study in Kars, a rural area of Turkiye, screened frailty in
community-dwelling older adults with the FFI scale1919 Çakmur H. Frailty among elderly adults in a rural area of Turkey. Med Sci
Monit. 2015;21:1232-42. https://doi.org/10.12659/MSM.893400
https://doi.org/10.12659/MSM.893400...
. They found the prevalence of frailty to be 7.1% and the prevalence of pre-frailty
to be 47.3%. In addition, they found advanced age, lower education level, lower economic level,
comorbidities, polypharmacy, diabetes, chronic obstructive pulmonary disease, stomach disease,
arthritis, widespread pain, benign prostatic hyperplasia, urinary incontinence, auditory disorder,
impaired oral care, caregiver, burden, cognitive dysfunction, depression, and social isolation as
factors associated between frailty in univariate analyses in this study1919 Çakmur H. Frailty among elderly adults in a rural area of Turkey. Med Sci
Monit. 2015;21:1232-42. https://doi.org/10.12659/MSM.893400
https://doi.org/10.12659/MSM.893400...
. In the study conducted by Jurschik et al., among people aged 75 years and
older living in a community in Spain, the frailty prevalence was identified as 9.6% by the Fried
Frailty Index (FFI) criteria2121 Jürschik P, Nunin C, Botigué T, Escobar MA, Lavedán A, Viladrosa M.
Prevalence of frailty and factors associated with frailty in the elderly population of Lleida,
Spain: the FRALLE survey. Arch Gerontol Geriatr. 2012;55(3):625-31.
https://doi.org/10.1016/j.archger.2012.07.002
https://doi.org/10.1016/j.archger.2012.0...
. In the study by
Moreira et al., of the participants aged over 65 years living in a community in Brazil, 9.1% were
frail and 47.3% were pre-frail, based on the results of the FRAIL scale88 Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an
older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics (Sao Paulo).
2013;68(7):979-85. https://doi.org/10.6061/clinics/2013(07)15
https://doi.org/10.6061/clinics/2013(07)...
. A meta-analysis by Kojima et al., examining five studies in which frailty
was assessed using the FFI, involving 11,940 community residents aged 65 years or older in Japan,
identified frailty in 7.4% and pre-frailty in 48.1% of the respondents66 Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of
frailty in Japan: a systematic review and meta-analysis. J Epidemiol. 2017;27(8):347-53.
https://doi.org/10.1016/j.je.2016.09.008
https://doi.org/10.1016/j.je.2016.09.008...
. The study by Collard et al., assessed 21 studies with 61,500 participants
using the FFI and reported frailty in 10.7% and pre-frailty in 41.6% of the older community
residents2323 Zheng Z, Guan S, Ding H, Wang Z, Zhang J, Zhao J, et al. Prevalence and
ıncidence of frailty in community-dwelling older people: Beijing longitudinal study of aging
II. J Am Geriatr Soc. 2016;64(6):1281-6. https://doi.org/10.1111/jgs.14135
https://doi.org/10.1111/jgs.14135...
. Roche et al., used the FFI in
community-dwelling people aged 65 years and older in the United States and identified frailty in 15%
and pre-frailty in 45% of the population77 Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty
in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med
Sci. 2015;70(11):1427-34. https://doi.org/10.1093/gerona/glv133
https://doi.org/10.1093/gerona/glv133...
. The
differences in the prevalence of frailty may result from differences in the mean ages of the study
groups, the genetic differences between communities, and the differences in sociodemographic
characteristics between regions, along with differences in the scales used for the frailty
assessment44 Yilmaz O, Aykent B, Kucukdagli P, Tascioglu C, Bahat G. Frailty is associated with
multimorbidities due to decreased physical reserve independent of age. Eur J Intern Med.
2019;61:61:e12-e13. https://doi.org/10.1016/j.ejim.2019.01.017
https://doi.org/10.1016/j.ejim.2019.01.0...
,88 Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an
older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics (Sao Paulo).
2013;68(7):979-85. https://doi.org/10.6061/clinics/2013(07)15
https://doi.org/10.6061/clinics/2013(07)...
,99 Carneiro JA, Ramos GC, Barbosa AT, Mendonça JM, Costa FM, Caldeira AP.
Prevalence and factors associated with frailty in non-institutionalized older adults. Rev Bras
Enferm. 2016;69(3):435-42. https://doi.org/10.1590/0034-7167.2016690304i
https://doi.org/10.1590/0034-7167.201669...
,2121 Jürschik P, Nunin C, Botigué T, Escobar MA, Lavedán A, Viladrosa M.
Prevalence of frailty and factors associated with frailty in the elderly population of Lleida,
Spain: the FRALLE survey. Arch Gerontol Geriatr. 2012;55(3):625-31.
https://doi.org/10.1016/j.archger.2012.07.002
https://doi.org/10.1016/j.archger.2012.0...
. In Akın et
al.'s study, the FRAIL scale was used in those aged 65 years and over who applied to family
health centers in Turkiye, and frailty was identified in 10% and pre-frailty in 45.6% of the
participants. They also used the FFI scale to screen for frailty. They found frailty at 27.8% and
pre-frailty at 34.8% on the FFI scale55 Akın S, Mazıcıoglu MM, Mucuk S, Gocer S, Deniz Şafak E,
Arguvanlı S, et al. The prevalence of frailty and related factors in community-dwelling
Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res.
2015;27(5):703-9. https://doi.org/10.1007/s40520-015-0337-0
https://doi.org/10.1007/s40520-015-0337-...
. Unlike the
present study, which involved the community screening of a sample selected by stratification, the
study by Akın et al., included patients applying to a family health center (primary care
health center). The difference in the prevalence of frailty between the two studies may be due to
older people's poorer general health status during home visits, thus not being able to apply to
health centers and the higher prevalence of frailty.
Our findings indicated that multiple drug use was associated with frailty. The study by Woo et
al., examined frailty and associated factors among community-dwelling residents above 65 years
residing in rural and urban areas in China and found polypharmacy to be associated with frailty in
both such areas, which was consistent with the findings of our study2222 Woo J, Zheng Z, Leung J, Chan P. Prevalence of frailty and contributory factors in
three Chinese populations with different socioeconomic and healthcare characteristics. BMC Geriatr.
2015;15:163. https://doi.org/10.1186/s12877-015-0160-7
https://doi.org/10.1186/s12877-015-0160-...
. The retrospective study by Zheng et al., followed older residents of a
community for 1 year and found that older people with polypharmacy became frail within 1 year more
frequently2323 Zheng Z, Guan S, Ding H, Wang Z, Zhang J, Zhao J, et al. Prevalence and
ıncidence of frailty in community-dwelling older people: Beijing longitudinal study of aging
II. J Am Geriatr Soc. 2016;64(6):1281-6. https://doi.org/10.1111/jgs.14135
https://doi.org/10.1111/jgs.14135...
. These findings were in line with
those of the present study and suggested that a prescribing cascade occurred with older patients due
to their focus on different complaints at each admission with no extensive geriatric assessment,
leading to polypharmacy. This revealed that a complete examination was required for a comprehensive
evaluation of the older population.
In the present study, cognitive impairment was also associated with frailty, which was consistent
with the studies of Jurschik et al.2121 Jürschik P, Nunin C, Botigué T, Escobar MA, Lavedán A, Viladrosa M.
Prevalence of frailty and factors associated with frailty in the elderly population of Lleida,
Spain: the FRALLE survey. Arch Gerontol Geriatr. 2012;55(3):625-31.
https://doi.org/10.1016/j.archger.2012.07.002
https://doi.org/10.1016/j.archger.2012.0...
, Akın
et al.55 Akın S, Mazıcıoglu MM, Mucuk S, Gocer S, Deniz Şafak E,
Arguvanlı S, et al. The prevalence of frailty and related factors in community-dwelling
Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res.
2015;27(5):703-9. https://doi.org/10.1007/s40520-015-0337-0
https://doi.org/10.1007/s40520-015-0337-...
, Moreira et al.88 Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an
older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics (Sao Paulo).
2013;68(7):979-85. https://doi.org/10.6061/clinics/2013(07)15
https://doi.org/10.6061/clinics/2013(07)...
, and García et al.2424 Sánchez-García S, Sánchez-Arenas R, García-Peña C,
Rosas-Carrasco O, Avila-Funes JA, Ruiz-Arregui L, et al. Frailty among community-dwelling elderly
Mexican people: prevalence and association with sociodemographic characteristics, health state and
the use of health services. Geriatr Gerontol Int. 2014;14(2):395-402.
https://doi.org/10.1111/ggi.12114
https://doi.org/10.1111/ggi.12114...
,
all of which demonstrated an association between frailty and cognitive disorder. Furthermore,
frailty may lead to cognitive impairment through social isolation, just as cognitive impairment may
also lead to frailty. The association between these two factors is two-sided and embedded55 Akın S, Mazıcıoglu MM, Mucuk S, Gocer S, Deniz Şafak E,
Arguvanlı S, et al. The prevalence of frailty and related factors in community-dwelling
Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res.
2015;27(5):703-9. https://doi.org/10.1007/s40520-015-0337-0
https://doi.org/10.1007/s40520-015-0337-...
,88 Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an
older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics (Sao Paulo).
2013;68(7):979-85. https://doi.org/10.6061/clinics/2013(07)15
https://doi.org/10.6061/clinics/2013(07)...
,2121 Jürschik P, Nunin C, Botigué T, Escobar MA, Lavedán A, Viladrosa M.
Prevalence of frailty and factors associated with frailty in the elderly population of Lleida,
Spain: the FRALLE survey. Arch Gerontol Geriatr. 2012;55(3):625-31.
https://doi.org/10.1016/j.archger.2012.07.002
https://doi.org/10.1016/j.archger.2012.0...
,2424 Sánchez-García S, Sánchez-Arenas R, García-Peña C,
Rosas-Carrasco O, Avila-Funes JA, Ruiz-Arregui L, et al. Frailty among community-dwelling elderly
Mexican people: prevalence and association with sociodemographic characteristics, health state and
the use of health services. Geriatr Gerontol Int. 2014;14(2):395-402.
https://doi.org/10.1111/ggi.12114
https://doi.org/10.1111/ggi.12114...
.
Similar to other national studies, the results of our study showed an association between falls
and frailty in community-dwelling older adults1818 Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, et al. Frailty
ıntervention trial (FIT). BMC Geriatr. 2008;8:27.
https://doi.org/10.1186/1471-2318-8-27
https://doi.org/10.1186/1471-2318-8-27...
,2020 Heuberger RA. The frailty syndrome: a comprehensive review. J Nutr Gerontol Geriatr.
2011;30(4):315-68. https://doi.org/10.1080/21551197.2011.623931
https://doi.org/10.1080/21551197.2011.62...
–2424 Sánchez-García S, Sánchez-Arenas R, García-Peña C,
Rosas-Carrasco O, Avila-Funes JA, Ruiz-Arregui L, et al. Frailty among community-dwelling elderly
Mexican people: prevalence and association with sociodemographic characteristics, health state and
the use of health services. Geriatr Gerontol Int. 2014;14(2):395-402.
https://doi.org/10.1111/ggi.12114
https://doi.org/10.1111/ggi.12114...
. Again,
it was conducted in our society. Akın et al., detected a relationship between falls and
frailty, like our study and most studies in the literature55 Akın S, Mazıcıoglu MM, Mucuk S, Gocer S, Deniz Şafak E,
Arguvanlı S, et al. The prevalence of frailty and related factors in community-dwelling
Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res.
2015;27(5):703-9. https://doi.org/10.1007/s40520-015-0337-0
https://doi.org/10.1007/s40520-015-0337-...
.
The findings of the present study could serve as a guide for the assessment of frail older adults living in the community, as well as for the development and implementation of intervention strategies and measures for the treatment of frailty in older patients. The strength of the present study lies in its presentation of the results of an extensive geriatric assessment of the older population residing in the community in the Fatih District of Istanbul Province. Furthermore, the fact that the study was conducted in a large district of a metropolitan city like Istanbul is also of importance as it provides insight into frailty in the general population. The patient screening in the present study was based on a stratification method, which enhanced the importance of study findings even further, and the strength of the study is further increased in its analysis of the multiple and variable factors associated with frailty.
There were also some limitations. The exact causes of frailty could not be ascertained due to the cross-sectional design of the study, although major contributing factors were established.
CONCLUSION
The present study established the prevalence of frailty in a large district like Fatih, the largest metropolis in the country, through a valid screening method. The prominent associated factors were multiple drug usage, cognitive impairment, falls, and low quality of life. Nationwide population studies involving multiple centers are required.
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Funding: This study was funded by the support of the Istanbul University Scientific Research Projects Unit. Except this, this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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ETHICS APPROVALWe obtained ethical approval from the Istanbul University Istanbul Medical School ethical board (number: 1213 and file number: 2014/1199).
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Publication Dates
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Publication in this collection
13 Nov 2023 -
Date of issue
2023
History
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Received
07 June 2023 -
Accepted
26 Aug 2023