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      Multidimensional frailty and quality of life: data from the English Longitudinal Study of Ageing

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          Abstract

          Purpose

          Frailty has been found to be associated with poor quality of life (QoL) in older people, but data available are limited to cross-sectional studies. We therefore aimed to assess the association between multidimensional frailty, determined by Multidimensional Prognostic Index (MPI), with mortality and good QoL expectancy (GQoLE) in a large representative sample of older adults, over 10 years of follow-up.

          Methods

          In the English Longitudinal Study of Ageing, using the data from 2004–2005 and 2014–2015, MPI was calculated using a weighted score of domains of comprehensive geriatric assessment, i.e., number of difficulties in activities of daily living (ADL) and instrumental ADL, depressive symptoms, number of medical conditions, body mass index, physical activity level, and social aspects. Mortality was assessed using administrative data, GQoLE indicators were used for longitudinal changes in QoL.

          Results

          6244 Participants (mean age 71.8 years, 44.5% males) were followed up for 10 years. After adjusting for potential confounders, compared to people in the MPI low-risk group, people in the moderate (hazard ratio, HR = 4.27; 95% confidence interval, CI 3.55–5.14) and severe-risk group (HR = 10.3; 95% CI 7.88–13.5) experienced a significantly higher mortality rate. During the follow-up period, people in the moderate and severe-risk groups reported lower GQoLE values than their counterparts, independently from age and gender.

          Conclusions

          Multidimensional frailty was associated with a higher risk of mortality and significantly lower GQoLE, suggesting that the multifactorial nature of frailty is associated not only with mortality, but also poor QoL.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s11136-022-03152-9.

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          Most cited references36

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          Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living

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            Frailty in elderly people

            Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Frailty: implications for clinical practice and public health

              Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.
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                Author and article information

                Contributors
                nicola.veronese@unipa.it
                Journal
                Qual Life Res
                Qual Life Res
                Quality of Life Research
                Springer International Publishing (Cham )
                0962-9343
                1573-2649
                17 May 2022
                17 May 2022
                2022
                : 31
                : 10
                : 2985-2993
                Affiliations
                [1 ]GRID grid.10776.37, ISNI 0000 0004 1762 5517, Geriatric Unit, Department of Internal Medicine and Geriatrics, , University of Palermo, ; Via del Vespro, 141, 90127 Palermo, Italy
                [2 ]GRID grid.5326.2, ISNI 0000 0001 1940 4177, Neuroscience Institute, , National Research Council, ; Padua, Italy
                [3 ]GRID grid.450697.9, ISNI 0000 0004 1757 8650, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, , E.O. Ospedali Galliera, ; Genoa, Italy
                [4 ]GRID grid.7644.1, ISNI 0000 0001 0120 3326, Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni”, , University of Bari “Aldo Moro”, ; Bari, Italy
                [5 ]GRID grid.5115.0, ISNI 0000 0001 2299 5510, Centre for Health, Performance, and Wellbeing, , Anglia Ruskin University, ; Cambridge, UK
                [6 ]GRID grid.94365.3d, ISNI 0000 0001 2297 5165, National Institute on Aging, , National Institute of Health, ; Bethesda, MD USA
                Author information
                http://orcid.org/0000-0002-9328-289X
                Article
                3152
                10.1007/s11136-022-03152-9
                9470717
                35579730
                31347f3d-9c72-4974-8766-d01155f38895
                © The Author(s) 2022, corrected publication 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 25 April 2022
                Funding
                Funded by: Università degli Studi di Palermo
                Categories
                Article
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                © Springer Nature Switzerland AG 2022

                Public health
                multidimensional prognostic index,frailty,mortality,quality of life,elsa
                Public health
                multidimensional prognostic index, frailty, mortality, quality of life, elsa

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