Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493,737 UK Biobank participants

Hanlon, P. , Nicholl, B. I. , Jani, B. D. , Lee, D. , McQueenie, R. and Mair, F. S. (2018) Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493,737 UK Biobank participants. Lancet Public Health, 3(7), e323-e332. (doi: 10.1016/S2468-2667(18)30091-4) (PMID:29908859) (PMCID:PMC6028743)

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Background: Frailty is associated with older age and multimorbidity (two or more long-term conditions); however, little is known about its prevalence or effects on mortality in younger populations. This paper aims to examine the association between frailty, multimorbidity, specific long-term conditions, and mortality in a middle-aged and older aged population. Methods: Data were sourced from the UK Biobank. Frailty phenotype was based on five criteria (weight loss, exhaustion, grip strength, low physical activity, slow walking pace). Participants were deemed frail if they met at least three criteria, pre-frail if they fulfilled one or two criteria, and not frail if no criteria were met. Sociodemographic characteristics and long-term conditions were examined. The outcome was all-cause mortality, which was measured at a median of 7 years follow-up. Multinomial logistic regression compared sociodemographic characteristics and long-term conditions of frail or pre-frail participants with non-frail participants. Cox proportional hazards models examined associations between frailty or pre-frailty and mortality. Results were stratified by age group (37–45, 45–55, 55–65, 65–73 years) and sex, and were adjusted for multimorbidity count, socioeconomic status, body-mass index, smoking status, and alcohol use. Findings: 493 737 participants aged 37–73 years were included in the study, of whom 16 538 (3%) were considered frail, 185 360 (38%) pre-frail, and 291 839 (59%) not frail. Frailty was significantly associated with multimorbidity (prevalence 18% [4435/25 338] in those with four or more long-term conditions; odds ratio [OR] 27·1, 95% CI 25·3–29·1) socioeconomic deprivation, smoking, obesity, and infrequent alcohol consumption. The top five long-term conditions associated with frailty were multiple sclerosis (OR 15·3; 99·75% CI 12·8–18·2); chronic fatigue syndrome (12·9; 11·1–15·0); chronic obstructive pulmonary disease (5·6; 5·2–6·1); connective tissue disease (5·4; 5·0–5·8); and diabetes (5·0; 4·7–5·2). Pre-frailty and frailty were significantly associated with mortality for all age strata in men and women (except in women aged 37–45 years) after adjustment for confounders. Interpretation: Efforts to identify, manage, and prevent frailty should include middle-aged individuals with multimorbidity, in whom frailty is significantly associated with mortality, even after adjustment for number of long-term conditions, sociodemographics, and lifestyle. Research, clinical guidelines, and health-care services must shift focus from single conditions to the requirements of increasingly complex patient populations.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Jani, Dr Bhautesh and Lee, Professor Duncan and Mair, Professor Frances and Nicholl, Dr Barbara and McQueenie, Dr Ross and Hanlon, Dr Peter
Authors: Hanlon, P., Nicholl, B. I., Jani, B. D., Lee, D., McQueenie, R., and Mair, F. S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
College of Science and Engineering > School of Mathematics and Statistics
Journal Name:Lancet Public Health
ISSN (Online):2468-2667
Published Online:14 June 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Lancet Public Health 3(7): e323-e332
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
756022Multimorbidity in UK BiobankBarbara NichollOffice of the Chief Scientist (CSO)CGA/16/39IHW - GENERAL PRACTICE & PRIMARY CARE