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Frailty predicts short-term survival even in older adults without multimorbidity

  • Alberto Zucchelli
    Correspondence
    Correspondence to: A. Zucchelli, Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, 25121 Brescia, Italy.
    Affiliations
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden

    Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
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  • Davide L. Vetrano
    Correspondence
    Correspondence to: D. L. Vetrano, Aging Research Center, Karolinska Institutet, Tomtebodavägen, 18A, 10th floor, 17165 Solna, Sweden.
    Affiliations
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden

    Department of Geriatrics, Catholic University of Rome, 00168 Rome, Italy
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  • Alessandra Marengoni
    Affiliations
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden

    Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
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  • Giulia Grande
    Affiliations
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden
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  • Giuseppe Romanelli
    Affiliations
    Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
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  • Amaia Calderón-Larrañaga
    Affiliations
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden
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  • Laura Fratiglioni
    Affiliations
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden

    Stockholm Gerontology Research Center, 11330 Stockholm, Sweden
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  • Debora Rizzuto
    Affiliations
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden
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      Highlights

      • Forty percent of subjects without multimorbidity are frail or prefrail.
      • Frailty and pre-frailty increase mortality risk even in absence of multimorbidity.
      • Screening for frailty in individuals without multimorbidity might be beneficial.
      • Future research should focus on causes of frailty other than chronic diseases.

      Abstract

      Background

      Frailty and multimorbidity are both strongly associated with poor health-related outcomes, including mortality. Being multimorbidity one of the major determinants of frailty, we aimed to explore whether, and to what extent, frailty without multimorbidity plays an independent role in shortening life.

      Methods

      We used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Among the 3363 adults aged 60+ enrolled at baseline, those without multimorbidity (i.e.: less than two chronic diseases) (N = 1115) have been characterized according to Fried's frailty phenotype (i.e. robust, prefrail, and frail). The association between frailty and mortality was estimated using piecewise proportional hazard regression models in three five-year time periods.

      Results

      Among participants without multimorbidity, 424 (38%) were prefrail and 19 (2%) were frail. During the 15-year follow-up, 263 (24%) participants died: 19%, 29%, and 63% of those who were robust, prefrail, and frail at baseline, respectively. Within the first 5 years of follow-up, prefrail and frail participants had more than doubled mortality risk in comparison to robust ones (HR for pre-frailty 2.08, 95% CI 1.15–3.76; HR for frailty 2.69, 95% CI 1.22–5.97). Beyond 5 years, a trend of increased mortality rate was still detectable for prefrail and frail subjects in comparison to robust ones.

      Conclusions

      Physical frailty and pre-frailty are associated with short-term mortality in a cohort of older adults free from multimorbidity. Frailty could be a clinical indicator of increased risk of negative health outcomes even among subjects without multiple chronic conditions.

      Keywords

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