Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults

doi:10.1016/j.jamda.2017.04.020

Journal of the American Medical Directors Association

Volume 18, Issue 8, 1 August 2017, Pages 734.e9-734.e14

https://doi.org/10.1016/j.jamda.2017.04.020 Get rights and content

Abstract

Background

In the context of a rapidly ageing population, Singapore is anticipating a rise in multimorbidity, disability, and dependency, which are driven by physical frailty. Healthy Older People Everyday (HOPE) is an epidemiologic population-based study on community-dwelling older adults aged 65 years and older in Singapore.

Objective

To investigate the prevalence of frail and prefrail states and their association with polypharmacy, multimorbidity, cognitive and functional status, and perceived health status among community-dwelling older adults in Singapore.

Methods

Participants for HOPE were older adults aged 65 years and older recruited from a cohort study on the northwest region of Singapore. Analysis was performed on data collected from a combination of interviewer-administered questionnaires (including FRAIL scale, EQ-5D, Mini Mental State Examination, Barthel index, and Lawton IADL scale), clinical assessments, and physical measurements (including hand grip strength and Timed-Up-and-Go [TUG] test).

Results

A total of 1051 older adults (mean age 71.2 years) completed the study. More than half (57.2%) were female. The prevalence of frailty and prefrailty was 6.2% and 37%, respectively. Frailty was associated with older age, female gender, Indian (instead of Chinese) ethnicity, multimorbidity, polypharmacy, cognitive and functional impairment, weaker hand grip strength, longer TUG times, and poor perceived health status. Those with underlying cognitive impairment and frailty were at greater risk of adverse health outcome.

Conclusion

Frailty is a complex health state with multiple domains and dimensions. In our study in a multiethnic Asian population, we identified nonmodifiable factors and modifiable risk factors (multimorbidity, polypharmacy, cognitive and functional impairment) that were associated with frailty. Interventions will have to be multipronged and will require a collaborated effort in order to effect change and improve the health span in rapidly ageing populations.

Section snippets

Methodology

Healthy Older People Everyday (HOPE) study is an epidemiologic population-based study involving a sample of 1051 community-dwelling older adults aged 65 years and older from a defined geographical area in the Northwest region of Singapore. Baseline data were collected between April 2015 and August 2016. The research was approved by the National Healthcare Group Institutional Review Board.

The HOPE study was embedded in the larger Singapore Population Health Studies (SPHS) cohort in the

Statistical Analysis

All statistical analyses were carried out using SPSS, version 23.0. Mean and standard deviations were calculated for continuous variables, whereas frequencies and percentages were calculated for categorical variables. To test for independent associations between frailty state and sociodemographic, medical, and cognitive variables, χ² tests of independence were conducted between the 3 frailty states (robust, prefrail, and frail) and each individual variable. Statistical significance was

Results

We included 1051 older adults who completed the screening in our analysis. The demographics associated with frailty are shown in Table 1. The participants’ mean age was 71.2 years, and 57.2% were female. The prevalence of frailty and prefrailty was 6.2% and 37%, respectively. The prevalence of frailty increased from 5.4% in the 65- to 79-year-olds to 14.0% in the 80 years and older group. There was higher prevalence of frailty among females. There was a significant difference in the prevalence

Discussion

Our study is one of a few being conducted in a country with multiple ethnic groups on the prevalence of frailty and its associated factors.27, 28 The findings from our study on the prevalence of frailty using the FRAIL scale is consistent with previous studies using phenotypic and multidimensional models where the prevalence of frailty is between 5.7% and 11.3%.8, 27, 29, 30 This suggests that the simple FRAIL scale can be used for rapid and easy identification and risk stratification of frail

Conclusion

Frailty is a complex health state contributed by multiple domains and dimensions. Through our study in a multiethnic population, we identified modifiable and nonmodifiable factors that were associated with frailty, with modifiable factors being the majority (multimorbidity, polypharmacy, and cognitive and functional impairment). Interventions will have to be multipronged and will require a collaborated effort in order to effect change and prolong the health span in our rapidly ageing population.

Acknowledgments

The Singapore Population Health Studies is funded by the Ministry of Health, National University Health System and the National University of Singapore.

Singapore Healthy Older People Everyday (HOPE) Study is funded by Dr Oon Chiew Seng and the National University of Singapore.

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: The authors declare no conflicts of interest.

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JAMDA OnlineOriginal StudySingapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults

Abstract

Background

Objective

Methods

Results

Conclusion

Section snippets

Methodology

Statistical Analysis

Results

Discussion

Conclusion

Acknowledgments

J Am Med Dir Assoc

J Am Med Dir Assoc

J Nutr Health Aging

Health Policy

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

Ageing Res Rev

J Nutr Health Aging

Ageing Res Rev

J Nutr Health Aging

Am J Geriatr Psychiatry

J Am Med Dir Assoc

J Am Med Dir Assoc

World Population Ageing Report

Population and Vital Statistics

World Report on Ageing and Health

Effect of structured physical activity on prevention of major mobility disability in older adults: The LIFE study randomized clinical trial

JAMA

Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: A randomized controlled trial

Am J Med

Frailty in older adults: Evidence for a phenotype

J Gerontol A Biol Sci Med Sci

A comparison of two approaches to measuring frailty in elderly people

J Gerontol A Biol Sci Med Sci

Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: A systematic review

Age Ageing

Screening for frailty with the FRAIL Scale: A comparison with the phenotype criteria

J Am Med Dir Assoc

JAMDA Online
Original Study
Singapore Healthy Older People Everyday (HOPE) Study: Prevalence of Frailty and Associated Factors in Older Adults