Frailty risk in America depends on where you live

"We can't really explain the regional differences," says Karen Bandeen-Roche. "We know there are health differences across the country, differences in diet and to some extent exercise habits." (Credit: Michael Premo/Flickr)

Older women and the poor in the United States, especially those who live in the central southern states, are much more likely to suffer from frailty than people who are white or who live in other parts of the US.

Frailty is a diminished state that makes people more vulnerable to falls, chronic disease, and disability.

A new analysis of a large-scale survey of older Americans living at home or in assisted living settings—but not in nursing homes—finds that 15 percent are frail and another 45 percent are considered at heightened risk for becoming frail.

Researchers were most surprised by the significant racial and regional differences, says Karen Bandeen-Roche, professor and chair of the biostatistics department at Johns Hopkins University.

Lower income older people in central southern states—roughly from Texas to Kentucky—were two to nearly three times as likely to be frail as those in the Mountain West. Blacks and Hispanics were nearly twice as likely to be frail as whites.

“We can’t really explain the regional differences,” says Bandeen-Roche, who also co-directs the Johns Hopkins Older Americans Independence Center and is a faculty member in the Center on Aging and Health.

“We know there are health differences across the country, differences in diet and to some extent exercise habits. Observing the relatively low prevalence in the Mountain West, you can imagine an active lifestyle might be a factor.”

Racial differences could be due to any number of factors and merit further study, the researchers say.

Standard test for older Americans

Checking for signs of frailty should become a more routine part of health care for older Americans, says Karen Bandeen-Roche, professor and chair of the biostatistics department at Johns Hopkins University.

“We would love for frailty assessment to become a standard component of assessment of older Americans. Understanding frailty could potentially help us extend people’s quality of life into their later years.”

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Frailty, once thought of as a generalized fragile state that befalls some people as they get older, is increasingly considered a medical process in and of itself. Symptoms include weakness, exhaustion and limited mobility. It often progresses separately from underlying conditions, but is common among patients with chronic diseases such as heart disease and diabetes, especially in their advanced stages.

Understanding frailty, and finding ways to prevent its onset or slow its progression, could improve older people’s quality of life by extending their so-called robust years.

It could also increase chances of surviving surgery. Previous research has suggested that older frail patients are less likely to survive major surgical procedures. Reducing frailty could also lower health care costs, since frail persons are prone to falls that often lead to hospitalization. Hospital care is the largest component of Medicare spending.

For the study, published in Journals of Gerontology: Medical Sciences, researchers drew on interviews with 7,439 participants in the 2011 National Health and Aging Trends Study, a longitudinal study of people age 65 and older drawn from Medicare records.

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Participants completed a two-hour in-person interview that assessed frailty using several criteria: exhaustion, weakness, low physical activity, shrinking, and low walking speed. Participants were also asked about their medical history and ability to perform daily tasks such as meal preparation and other household activities. The researchers assessed probable dementia with a combination of questions and cognitive tests.

As frailty becomes better understood, the researchers hope clinicians will develop recommendations that specifically address risks associated with frailty, for instance, having people engage in strengthening activities before major surgery. Such recommendations, if adopted by older people who had not yet slipped into advanced frailty, could help delay or even prevent its onset.

Aside from the 15 percent found to be frail, researchers also found that 45 percent were what they deemed “pre-frail,” or older people who have begun to experience the same symptoms of frailty but to a lesser extent. The pre-frail are a prime target for future study to help understand the progression of frailty and develop recommendations—for instance, changes in diet or exercise—that could extend a person’s robust years.

The National Institute on Aging and the National Institute of Diabetes and Digestive and Kidney Diseases supported the work.

Source: Johns Hopkins University