Incidence of frailty and factors associated with functional deterioration in oldest old during the covid-19 pandemic: A cohort study

Saldanha, Marcelle Ferreira; Moraes, Egdar Nunes de; Santos, Rodrigo Ribeiro dos; Jansen, Ann Kristine

doi:10.1590/1981-22562022025.220077.pt

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Original Articles • Rev. bras. geriatr. gerontol. 25 (6) • 2022 • https://doi.org/10.1590/1981-22562022025.220077.en linkcopy

Incidence of frailty and factors associated with functional deterioration in oldest old during the covid-19 pandemic: A cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To assess the incidence of frailty in oldest old during the covid-19 pandemic and to evaluate the associations between the domains of the Clinical-Functional Vulnerability Index (IVCF -20) and frailty.

Methods A cohort study of 64 non-frail oldest old was conducted. Participants were evaluated at two timepoints: at baseline up to one year before the onset of the pandemic; and at follow-up, with an average interval between the two timepoints of 15 months. Frailty was assessed using the VS – Frailty (baseline) and remote application of the IVCF-20 (follow-up).

Results Mean participant age was 88.7±5 years and the incidence of frailty was 20.6%. Frail participants exhibited greater dependence shopping (p<0.001), controlling their own money (p<0.001) and doing housework (p=0.010), as well as bathing alone (p=0.041). Cognitive decline was more prevalent in the frail individuals. The presence of despondency sadness or hopelessness proved high (92.3%) and was associated with frailty (p<0.001). On the multivariate analysis, frailty was associated with worsening forgetfulness (RR=2.39; 95%CI 1.27-4.46), loss of interest and pleasure in performing activities (RR=4.94; 95%CI 1.98-12.35) and fecal/urinary incontinence (RR=2.40; 95%CI 2.91-1.53).

Conclusions

Keywords Frailty; Aged 80 and over; Telemedicine; Covid-19

Frailty status	Baseline	Follow-up	Frailty incidence
Frailty status	N (%)	N (%)	N (%)
Non-frail	63 (98.4)	50 (78.1)	+13 (20.6)
Frail	1 (1.6)	14 (21.8)

IVCF-20 domains	Developing frailty (n=13)	Not developing frailty (n=51)	p-value*
Age
≥ 85 years	13 (100%)	33 (64.7%)	0.013^a
Self-rated health
Fair or poor	8 (61.5%)	7 (13.7%)	< 0.001^a
Dependence for IADLs
No longer does shopping	8 (61.5%)	6 (11.8%)	< 0.001^a
No longer controls money	5 (38.5 %)	3 (5.9%)	< 0.001^a
No longer does domestic chores	4 (30.8%)	3 (5.9%)	0.010^b
Dependence for BADLs
No longer bathes alone	2 (15.4%)	1 (2.0%)	0.041^b
Cognition
Forgetfulness perceived by others	9 (69.2%)	8 (15.7%)	< 0.001^a
Recent worsening of forgetfulness	6 (46.2%)	3 (5.9%)	< 0.001^a
Forgetfulness impacting daily activities	6 (46.2%)	1 (2.0%)	< 0.001^a
Mood
Despondency, sadness or hopelessness	12 (92.3%)	15 (29.4%)	< 0.001^a
Loss of interest/pleasure in activities	9 (69.2%)	4 (7.8%)	< 0.001^a
Mobility
Inability to raise arms above shoulder level	5 (38.5%)	4 (7.8%)	0.052^a
Inability to handle small objects	1 (7.7%)	1 (2.0%)	0.289^b
Aerobic capacity – weight loss	6 (46.2%)	9 (17.6%)	0.030^a
Walking difficulties	6 (46.2%)	4 (7.8%)	0.001^a
Falls	4 (30.8%)	6 (11.8%)	0.092^b
Fecal/urinary incontinence	9 (69.2%)	9 (17.6%)	<0.001^a
Communication
Vision problems	7 (53.8%)	6 (11.8%)	0.001^a
Hearing problems	7 (53.8%)	10 (19.6%)	0.003^a
Multiple comorbidities	8 (61.5%)	15 (29.4%)	0.031^a

Explanatory variables	RR	95%CI	p-value
Worsening of forgetfulness
No	1
Yes	2.39	1.27 – 4.46	0.006
Loss of interest/pleasure in activities
No	1
Yes	4.94	1.98 - 12.35	0.001
Fecal/urinary incontinence
No	1
Yes	2.40	2.91 - 1.53	<0.001

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Universidade do Estado do Rio Janeiro Rua São Francisco Xavier, 524 - Bloco F, 20559-900 Rio de Janeiro - RJ Brasil, Tel.: (55 21) 2334-0168 - Rio de Janeiro - RJ - Brazil
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[tfne2] *Chi-squared test; ^a: test power ≥0.80; ^b: test power <0.80. IVCF: Clinical-functional vulnerability index; IADLs=Instrumental Activities of Daily Living; BADLs=Basic Activities of Daily Living