Bouillon, K; (2013) Frailty in older age in the Whitehall II study: Measurement, validation, and predictive algorithms. Doctoral thesis , UCL (University College London).

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Abstract

BACKGROUND: With population ageing, prevention of frailty is increasingly important. However, significant gaps in the evidence base exist. Accordingly, the purpose of this thesis was to: (1) identify the current measures of frailty undertaking an overview; (2) validate the ‘phenotype of frailty’ using data from the Whitehall II study; and (3) examine the relation of cardiovascular disease (CVD) and diabetes risk factors with future frailty risk. METHODS AND RESULTS: For objective 1, a literature review identified 27 original articles describing 27 different frailty measurements. Of them, the most tested and frequently used measure was the ‘phenotype of frailty’ which comprises five components: weight loss, exhaustion, physical activity, walking speed, and grip strength. For objectives 2 and 3, I used data from the Whitehall II study, an occupationally-based cohort of 10,308 British men and women aged 35-55 years followed-up since 1985. Of the participants aged 55 to 79 years in 2007-2009 (n=5,169), 2.8% were frail and 38.6% pre-frail. Using survival analyses, in sex- and age-adjusted model, compared with the non-frail group, the frail group was 2.40 (95% confidence interval (CI): 1.83, 3.14) times more likely to be hospitalised for any cause during the mean follow-up of 15.2 months, while for the pre-frail group the risk was 1.20 (95%CI: 1.06, 1.35) greater. Logistic regression models were used to examine the performance of risk algorithms for CVD and diabetes assessed in 1997-1999 in predicting frailty in 2007-2009. CVD and diabetes risk scores were significantly associated with frailty: odds ratios per 1-standard deviation increment (disadvantage) in CVD scores ranged from 1.17 (95%CI: 1.10, 1.25) to 1.20 (95%CI: 1.13, 1.28) and in diabetes scores ranged from 1.05 (95%CI: 0.98, 1.14) to 1.27 (95%CI: 1.17, 1.37) depending on the risk score used. CONCLUSIONS: Both frailty and pre-frailty are associated with increased risk of hospitalisation. Better prevention of cardiovascular and diabetes risk factors in midlife is likely to reduce frailty at older ages.

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