Frailty Phenotype: Evidence of Both Physical and Mental ...

Notably, frailty risk in our sample was associated with depression and lower cognitive function. Fried frailty phenotype is commonly identified ... Journals WhyPublishWithUs? 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Weofferrealbenefitstoourauthors,includingfast-trackprocessingofpapers.Learnmore PromotionalArticleMonitoring RegisteryourspecificdetailsandspecificdrugsofinterestandwewillmatchtheinformationyouprovidetoarticlesfromourextensivedatabaseandemailPDFcopiestoyoupromptly.Learnmore SocialMedia       BacktoJournals»ClinicalInterventionsinAging»Volume15 OriginalResearch FrailtyPhenotype:EvidenceofBothPhysicalandMentalHealthComponentsinCommunity-DwellingEarly-OldAdults            FulltextMetricsGetPermissionCitethisarticle AuthorsBatko-SzwaczkaA ,Dudzińska-GriszekJ,HornikB ,Janusz-JenczeńM ,WłodarczykI,WnukB ,SzołtysekJ ,DurmałaJ ,WilczyńskiK ,CogielA,DulawaJ ,SzewieczekJ  Received13November2019 Acceptedforpublication27December2019 Published5February2020 Volume2020:15Pages141—150 DOIhttps://doi.org/10.2147/CIA.S238521 CheckedforplagiarismYes ReviewbySingleanonymouspeerreview Peerreviewercomments2 Editorwhoapprovedpublication: DrRichardWalker DownloadArticle[PDF]  AgnieszkaBatko-Szwaczka,1JoannaDudzińska-Griszek,1BeataHornik,2MagdalenaJanusz-Jenczeń,2IwonaWłodarczyk,2BartoszWnuk,3JoannaSzołtysek,3JacekDurmała,3KrzysztofWilczyński,1AnnaCogiel,1JanDulawa,4JanSzewieczek11DepartmentofGeriatrics,SchoolofHealthSciencesinKatowice,MedicalUniversityofSilesia,Katowice,Poland;2DepartmentofInternalNursing,SchoolofHealthSciencesinKatowice,MedicalUniversityofSilesia,Katowice,Poland;3DepartmentofRehabilitation,SchoolofHealthSciencesinKatowice,MedicalUniversityofSilesia,Katowice,Poland;4DepartmentofInternalMedicineandMetabolicDiseases,SchoolofHealthSciencesinKatowice,MedicalUniversityofSilesia,Katowice,PolandCorrespondence:JanSzewieczekDepartmentofGeriatrics,GCM,Ul.Ziolowa45/47,Katowice40-635,PolandTel+48323598239Fax+48322059483Email[email protected]Background:Demographicagingresultsinincreasedincidenceofold-agedisability.Frailtyisamajorfactorcontributingtoold-agedisability.TheaimofthisstudywastoinvestigatetheprevalenceofthefrailtyphenotypeasdefinedbyFriedetalandtoestimatetheneedforassociatedpreventativeinterventionsinearly-oldcommunity-dwellinginhabitantsofthesouthernindustrialregionofPoland,aswellastoinvestigatethedefiningcomponentsofthefrailtyphenotype.Methods:Thestudygroupconsistedof160individualswithanaverageageof66.8±4.2years(arx$]]>±SD),71(44.4%)ofstudyparticipantswerewomen.Thecohortwasrandomizedoutofover843thousandcommunity-dwellingUpperSilesianinhabitantsaged60–74years,whoagreedtoparticipateinthisproject.Acomprehensivegeriatricassessment(CGA),frailtyphenotypetest(asdescribedbyFriedetal)bloodtestsandbioimpedancebodystructureanalysiswascompletedforstudyparticipants.FunctionalassessmentincludedBarthelIndexofActivitiesofDailyLiving(BarthelIndex),InstrumentalActivitiesofDailyLivingScale(IADL),Mini-MentalStateExamination(MMSE),theTimedUpandGo(TUG)test,TinettiPerformance-OrientedMobilityAssessment(POMA),andGeriatricDepressionScale–ShortForm(GDS-SF).Results:Prefrailtywasdiagnosedin24.4%ofthesubjects(95%ConfidenceInterval(CI)=17.7–31.0%;31%inwomenand19.1%inmen,P=0.082)andfrailtyin2.5%subjects(95%CI0.1–4.9%;morefrequentlyinwomen:4.2%versus1.1%inmen,P=0.046).Havingoneormorepositivefrailtycriteriawaspositivelyassociatedwithdepression(oddsratio(OR)=2.85,95%CI=1.08–7.54,P=0.035)andnegativelyassociatedwithMMSEscore(OR=0.72,95%CI=0.56–0.93,P=0.012)andfat-freemass(OR=0.96,95%CI=0.92–0.99,P=0.016)inmultivariatelogisticregressionanalysisadjustedforage,sex,diseaseprevalence,numberofmedications,functionaltests(BarthelIndex,IADL,MMSE,GDS-SF),BMI,bioimpedancebodycompositionscore,andbloodtests.Conclusion:Atleast25%oftheearly-oldcommunity-dwellingpopulationwouldbenefitfromafrailtypreventionprogram.Thefrailtyphenotypereflectsbothphysicalandmentalhealthinthispopulation.Keywords:frailtyphenotype,early-oldcommunity-dwellingpopulation,cognitivefunction,depression,disability,comprehensivegeriatricassessment Introduction Populationagingisaglobalphenomenon.AccordingtotheCentralStatisticalOfficeofPoland(GUS),theproportionofpersonsaged60yearsandolderisprojectedtogrowto29%ofthepopulationofPolandin2030andtoexceed40%bytheyear2050.Asaresult,theincidenceofold-agedisabilityisincreasingalongwiththedemandforcaregiving,nursing,medicalandsocialservices.Old-agedisabilityisoftenmultifactorialandincludesphysical,mental(psychological),sensorial,andsocialdimensions.BasedonGUSdata,itisestimatedthattherequirementforcaregiverassistancewithactivitiesofdailylivingrangesfromover12%insexagenarianstomorethan50%inoctogenarians.Demographictrendsaffectingfamilystructure,whichrepresentstheprimaryeldercareprovidersforseniorsinPoland,andlimitationsinhealthandsocialcareservicesindicateariskforinabilitytomeettheneedsofelderlypersonsinthenearfuture.Thus,strategiestopreventold-agedisabilityshouldbeundertakentoaddressinadequaciesineldercareservices.1,2 Frailtyhasbeenidentifiedamongmajorfactorscontributingtoold-agedisability.3,4AccordingtotheSurveyofHealth,AgingandRetirementinEurope(SHARE),morethan50%oftheEuropeancommunity-dwellingadults50ormoreyearsofageareprefrailorfrail.5Althoughaconsensusregardingthedefinitionoffrailtyhasnotyetbeenachieved,6,7thefrailtyphenotypediagnosticcriteriadevelopedbyFriedandcolleaguesarethemostwidelyusedcriteriaforpopulation-basedstudies.6,8Thesecriteriaconsistoffivecomponents:unintentionalweightloss,exhaustion,lowphysicalactivity,slowwalkingspeedatusualpace,andlowgripstrength,with1–2positivecriteriaindicatingpre-frailty,and3ormorepositivecriteriaindicatingfrailty.9BasedontheCardiovascularHealthStudy,Friedetalnotonlyprovidedastandardizeddiagnosticcriteriaforfrailtyincommunity-dwellingolderadultsbutalsodemonstratedthatdisabilityisanoutcomeoffrailty.9SubsequentstudiesconfirmedthepredictivevalueofFriedfrailtyphenotypedefinitionforadversehealthoutcomesincommunity-dwellingolderadultsinvariouspopulations.10–13 Itisbroadlyacceptedthatfrailtyisasyndromeofage-associateddeclineinphysiologicreserveandfunctionacrossmultipleorgansystems,resultingindiminishedstrengthandendurance.1,2,7–9Inaddition,organinsufficiencymaycompromisefrailtycomponentassessment.Thus,frailtyshouldnotbeconsideredinisolationfromthegeneralhealthstatusofpatients.Frailtyamongolderpersonsisadynamicprocess,characterizedbyfrequenttransitionsbetweenfrailtystatesovertime.14Thereisincreasingevidencethatfrailtyispotentiallyreversible,withphysicalactivitybeingoneofthemosteffectiveinterventions.15 Fewdataonprevalenceoffrailty,asassessedbyfrailtyphenotypecriteria,areavailableinPoland.Thisstudywasdesignedtoevaluatetheprevalenceofprefrailtyandfrailtyinearly-oldcommunity-dwellinginhabitantsofsouthernPolandandtoidentifyconditionsthatmaypotentiallybeimportantforthepreventionandtreatmentoffrailty. PatientsandMethods Patients Thestudygroupconsistedof160subjectsaged66.8±4.2years(±SD),44.4%women.Toachievethisnumberofparticipants,invitationlettersweresentto4963personsrandomizedoutof843,278community-dwelling60–74yearsoldinhabitantsoftheSilesianVoivodeship.DataregardingrelevantinhabitantsoftheVoivodeshipwereobtainedfromtheMinistryofDigitalAffairsofPoland.Aresponsetothestudyinvitation(sentbymail)wasreceivedfrom163invitees(aresponserateof3.28%)ofwhom160personsgavewrittenconsentforparticipationintheproject(Figure1). Figure1Recruitmentofstudyparticipants. Measurements Acomprehensivegeriatricassessment(CGA)wascomplementedwithtestsforfrailtyandbodymassassessment.CGAincludedastructuredinterview,physicalexamination,functionalassessment,electrocardiogram(ECG),andbloodsampling. Astructuredpatienthistorywastakenandincludedindicatorsofmorbidity(suchaspain,weakness,dyspnea,swelling,andweightlossasreportedbythesubject),specificsignsofgeriatricconditions(memoryimpairment,impairmentofvision/glasses,impairmentofhearing/hearingaid,instability,mobilitydisorders/assistivedevicesforwalking,falls,incontinence),chronicdisease(verifiedwithsubject’smedicalrecordsifavailable),pharmacologicaltreatment,alcoholconsumption,smoking,livingconditions,andfamilyorsocialservicesupport. Physicalexaminationincludedgeneralstatus,bodybuild,mentalstatus,speech,vision,hearing,gait,restingbloodpressureofbotharms(highestvaluewasincludedinanalysis),pulse,bodymass,height,andwaistandhipcircumference. BloodtestsarespecifiedinTable1.Serumsampleswerefrozenandcollectedforassessmentofarangeofcytokinesandgrowthfactors–resultswillbepresentedinafuturepaperaftercompletionofanalysis. Table1CohortClinicalandFunctionalCharacteristicsIncludingSexDistributionandDistributionAccordingtothePresenceofOneorMorePositiveFrailtyCriteria(PF)AgainstNoPositiveFrailtyCriteria(NF)–MeanValuesandStandardDeviations(±SD)forQuantitativeVariablesandPercentagesforCategoricalVariables CharlsonComorbidityIndex16wasusedtoassesscomorbidity.BerlinInitiativeStudy(BIS)creatinineequation17wasusedtoestimateglomerularfiltrationrate(eGFR).BarthelIndexofActivitiesofDailyLiving(BarthelIndex)18andInstrumentalActivitiesofDailyLivingScale(IADL)19wereusedtodeterminefunctionalindependence.Mini-MentalStateExamination(MMSE)20wasusedtoassessglobalcognitiveperformance.GeriatricDepressionScale–ShortForm(GDS-SF)wasusedtoscreenfordepression.21BarthelIndexscoresrangefrom0to100,IADL–from9to27,MMSE–from0to30;higherscoresindicatebetterfunctionalstatus.GDS-SFscoresrangefrom0to15withhigherscoresindicatinghigherdepressionprobability.TinettiPerformance-OrientedMobilityAssessment(POMA)22andTimedGet-upandGo(TUG)testwereusedtoevaluatefallrisk.23,24The6-minWalkTest(6MWT)wasusedasanintegratedmeasureofphysicalcapacityandmobilityandconsistedofmeasuringthedistancethesubjecttraversedin6mins.25,26 FrailtywasdiagnosedaccordingtoFriedetal'scriteria.9Body-masschangewascalculatedfromcurrentweightmeasurementandtheweightmeasured12monthsagoasrecalledbythesubject(datawereverifiedwithmedicalrecordsifavailable).AKerndigitaldynamometerwasusedforgripstrengthmeasurement.Thesubjectwasinstructedtosqueezethedynamometermaximallythreetimeswiththedominant,restinginlaphandinthesittingposition.Anaveragegripstrengthvaluefromthreetrialswiththedominanthandwasrecorded.ExhaustionwasassessedusingtwoquestionsfromthemodifiedCenterforEpidemiologicStudiesDepressionScale(CES–D),asdescribedbyFriedetal.9Usualpacewalktimewasassessedbyinstructingthesubjecttotraverseadistanceof4.57mathis/herusualspeed,justasifhe/shewerewalkingdownthestreettogotothestoreandtopassthefinishlinewithoutslowingdown.Theuseofanassistivedeviceforwalkingwasaccepted(butnottheassistanceofanotherperson).Theaverageoftwotrialswasrecorded.Usualpacewalktime(s)wasconvertedtousualpacewalkspeed(m/s).Lowphysicalactivity(weeklyenergyexpenditure)wascalculatedonthebasisofthemodifiedMinnesotaLeisureTimeActivityQuestionnaire.27,28PolishlanguageversionoftheFrailtyAssessmentComponents:StandardizedProtocolswasused.WeusedreferencevaluesproposedbyFriedetalforfrailtycriteria.9MMSE,GDS-SF,TUG,6MWT,andfrailtyassessmentwerealsoconsideredmethodsoffunctionalassessment. Bodymassindex(BMI)andwaist-to-hipratio(WHR)werecalculatedforallsubjects.Bodycompositionanalysiswiththeuseofbioimpedancemethodwasperformedin149subjects.TanitaBC-418MABodyCompositionAnalyzerwasusedtoestimatetotalbodyfatpercentage(thepercentageoftotalbodyweightthatisfat),totalfatmass(totalweightoffatmassinthebody),fat-freemass(allfat-freemassofthebody,includingmuscles,bones,othertissues,andwater),andtotalwatercontent(theamountofwaterretainedinthebody).TanitaViscanAnalyzerAB140wasusedtoestimatetotalabdominalfat(bodyfatpercentageoftrunkfat)andabdominalvisceralfat(expressedasvisceralfatratingfrom1to35,withvalueshigherthan13indicatingexcessivelevelofvisceralfat).Bothdeviceshavebeenpreviouslyvalidatedandemployedinclinicalresearch.29–31 SubjectexaminationwasperformedattheDepartmentofGeriatricsoftheLeszekGiecUpper-SilesianMedicalCentreoftheSilesianMedicalUniversityinKatowiceonanoutpatientbasis.Completehome-basedexamination,performedbyaresearchteamwhichincludedanurse,wasofferedtoparticipantsatascheduleddatewhowereunabletoambulatetoourmedicalfacilities.Only3subjects(1.9%)requestedhomeexamination. Subjectswereaskedtocomefastingforatleast8hrs.Astandardbreakfastwasservedafterpatientinterview,physicalexamination,andbloodsampling.Functionalassessmentwasperformedonehourafterbreakfast.Allsubjectsreceivedtheresultsoftheirbloodtestsforreviewbytheirprimarycareprovider. StatisticalAnalysis DatawereanalyzedusingSTATISTICAversion13(StatSoft,Inc.,Tulsa,OK,USA;StatSoftPolska).ThenonparametricMann–WhitneyU-testforquantitativevariables,andchi-squaretest,V-squaretest,andFisher’sexacttestforcategoricalvariableswereused.ThenonparametricSpearman’srankcorrelationcoefficientwasusedtoassessrelationshipsbetweenfrailtymeasures.Multivariatelinearregressionwasusedtoassessmeasuresassociatedwithgripstrength,usualpacewalkspeed,andphysicalactivity.Multivariatelogisticregressionwasperformedtoassessmeasuresassociatedwithpositivefrailtycomponents.AnalysiswithbackwardeliminationincludedvariablesthatyieldedPvaluesof0.1orlowerintheinitialunivariateanalysis.Collinearityofindependentvariableswaseliminatedbeforeoddsratios(OR)calculation.Pvalues<0.05wereconsideredstatisticallysignificant. Ethics ThisstudywasconductedinaccordancewiththeDeclarationofHelsinki.ThestudyprotocolwasapprovedbytheBioethicalCommitteeoftheMedicalUniversityofSilesiainKatowice,Poland(LetterKNW/0022/KB1/1/14). Results Thestudygroupwascharacterizedbymulti-morbidity(CharlsonComorbidityIndex3.38±1.50).Themostcommondiseaseswereasfollows:osteoarthritis,hypertension,coronaryheartdisease,diabetes,depression,heartfailure,andosteoporosis.Meannumberoforalmedicationswas3.79±3.16andthenumberofallmedicalagents(includingtopicalmedications,supplements,andherbs)was4.29±3.60.Functionalstatuswasfair(BarthelIndex98.1±8.2,MMSEscore29.0±1.5).DetaileddataarepresentedinTable1. Prefrailtywasdiagnosedin24.4%ofthesubjects(95%ConfidenceInterval(CI)=17.7–31.0%;31%inwomenand19.1%inmen,P=0.082)andfrailtyin2.5%subjects(95%CI0.1–4.9%;morefrequentlyinwomen:4.2%versus1.1%inmen,P=0.046).Slownessandlowphysicalactivitywerethemostcommonpositivecriteriaforfrailty.Gripstrengthandphysicalactivitywerelowerinwomen,andprevalenceofslownesscriterionwashigherinwomen(Table2). Table2MeanandMedianValuesofGripStrength,UsualPaceWalkSpeedandPhysicalActivity(±SD;Median)andPrevalenceofPositiveFrailtyComponentsintheStudiedCohort(PercentageofSubjects(95%ConfidenceInterval))asAssessedbyFriedetalCriteria9 Gripstrengthcorrelatednegativelywithfemalesexandosteoporosis,whilepositivelywithserumalbuminconcentrationandMMSEscoreinthemultivariatelinearregressionanalysisadjustedforage,sex,diseaseprevalence,numberofmedications,functionaltests(BarthelIndex,IADL,MMSE,GDS-SF),height,bodymass,BMI,WHR,bioimpedancebodycompositionscores,andbloodtests.Usualpacewalkspeedcorrelatednegativelywithtotalnumberofmedicationsandpositivelywithbloodhemoglobinconcentration,serumtotalproteinlevel,andBarthelIndex.Physicalactivitycorrelatedpositivelywithfat-freemass,MMSEscore,andserumcalciumconcentration(Table3). Table3FactorsAssociatedwithQuantitativeFrailtyMeasures(GripStrength,UsualPaceWalkSpeed,andPhysicalActivity)inMultivariateLinearRegressionAnalysis Noindependentfactorswereassociatedwith12-monthbody-masschange.Unintentionalweightlosswasassociatedwithdepression,whileexhaustionwasnegativelyassociatedwithIADLscoresandpositivelyassociatedGDS-SFscoresinmultivariatelogisticanalysisadjustedforage,sex,prevalentdiseases,numberofmedications,functionaltests(BarthelIndex,IADL,MMSE,GDS-SF),BMI,bioimpedancebodycompositionmeasures,andbloodtests(Table4). Table4FactorsAssociatedwithPositiveFrailtyCriteria(UnintentionalWeightLossandExhaustioninMultivariateLogisticRegressionAnalysis) Comparedtosubjectswhometnofrailtycriteria,subjectswithoneormorefrailtycriterionwereofincreasedage,femalesex,hadahigherlikelihoodofosteoarthritis,depression,osteoporosis,lowerfat-freebodymassandtotalwatercontent,lowerMMSEscoresandhigherGDS-SFscores,lowerTinettiPOMAscoresand6-minWalkTestresultsandlowerserumcreatinineconcentrations(Table1).Gripstrengthcorrelatedpositivelywithusualpacewalkspeed(Spearman’srankcorrelationcoefficientρ=0.258;P=0.001)andphysicalactivity(ρ=0.231;P=0.003).Usualpacewalkspeedwascorrelatedwithphysicalactivity(ρ=0.156;P=0.048). Havingoneormorepositivefrailtycriteriawerepositivelyassociatedwithdepression(OR=2.85,95%CI=1.08–7.54,P=0.035)andnegativelyassociatedwithMMSEscore(OR=0.72,95%CI=0.56–0.93,P=0.012)andfat-freemass(OR=0.96,95%CI=0.92–0.99,P=0.016)inthemultivariatelogisticregressionanalysisadjustedforage,sex,diseaseprevalence,numberofmedications,functionaltests(BarthelIndex,IADL,MMSE,GDS-SF),BMI,bioimpedancebodycompositionscores,andbloodtests. Discussion Thisstudywasdesignedtoestimatetheprevalenceoffrailtyamongearly-oldadults.However,alowinvitationresponseratewasachieved.Frailtyprevalencebasedondatafromthisstudy,althoughsignificant,waslowerthanexpectedincomparisontoothercomparablestudies,evenwhenaccountingfordifferentdiagnosticcriteria.Manfredietalestimatedtheprevalenceofpre-frailtyinPolandat47.3%inadultsaged50–64yearsandat51.1%inadultsaged65–74years,prevalenceoffrailtywasestimatedat2.9%and8.2%,respectively.Pre-frailtyandfrailtyweredefinedintheManfredietalstudyusingtheSHAREoperationalizedversionthatisbasedonthefivefrailtydimensionsdescribedbyFriedetal.5Also,sexdistribution(44.4%women)wasreversedascomparedtoage-matchedsamplesfromthegeneralpopulation.32Finally,thefunctionalstatusofstudyparticipantswasbetterthanwouldbeexpectedfromotherstudies,suchasthePolSeniorStudy.33Theseresultssuggestsamplingbias,despiterandomization.Itwouldseemthathealthy-agingindividualsweremoreinclinedtoparticipateinthestudy,despitenocostexaminationsbeingofferedbothinthehospitalandhomesetting.Thus,thisstudy’spatientpopulationismostlikelynotrepresentativeofearly-oldcommunity-dwellinginhabitantsoftheSilesianregion. Nonetheless,ananalysisofassociationsbetweenfrailtycomponentsanddemographic,clinicalandfunctionalfactorsonthebasisofthissampleseemedreasonable.Ourstudyindicatesthatatleast25%oftheearly-oldcommunity-dwellinginhabitantsofourregionwouldbenefitfromafrailtypreventionprogram.Thestudysampleconsistsofwell-matchedgroupsofwomenandmenwithrespecttoage,BMI,totalnumberofcomorbiditiesandmedications,cognitivefunction(MMSEscores),andfunctionalstatusassessedbyIADLscores. Ourfindingofhigherprevalenceoffrailtyamongwomenwasalsoobservedinotherstudies.Saumetalfoundanincreasedprevalenceoffrailtyincommunity-dwellingwomenascomparedtomenaged59+inGermanyusingtwodifferentfrailtyphenotypediagnosticmethods.10Inaddition,womenweremorelikelytoreportexhaustionandtohaveunintentionalweightloss,lowermeangripstrengthandphysicalactivity.10Meta-analysisofdatafromfivestudiesusingtheFrailtyIndexseemstoconfirmthispatternofsexdifferencesthroughoutvariedpopulationsandolderadultagestrata.Simultaneously,mortalityriskwashigherformenateveryleveloffrailtyandagegroup.34Thisphenomenonhasbeencalleda“male-femalehealth-survivalparadox”,34asfrailtyisariskfactorformortality.35Sex-dependentdifferencesinbodybuildandstructure,whichwereconsistentwithourdata(Table1),promotebetterresultsforfrailtyassessmentcomponentsinmen,especiallywithrespecttogripstrength.Tocompensatethesedifferencesandmakefrailtycriteriauniversalforbothsexes,Friedetaldefinedlowerthresholdvaluesforwomenforthreeoutoffivefrailtycriteria(weakness,slowness,andlowphysicalactivity).9Despiteadjustmentsinfrailtyassessmentcomponentsforsex,higherfrailtyprevalenceisstillobservedinwomeninmoststudies.Thisdiscrepancybetweenincreasedfrailtyprevalenceamongwomenandhighermortalityamongmensuggeststhatthefrailtyphenotypeomitsfactorsimportantforpredictionofadversehealthevents.Studieshaveshownadecreaseinthecontributionoftraditionalcardiovascularriskfactorsonmortalitywithincreasingage.Frailtywasshowntobeastrongriskfactorformortalityinolder-oldsubjects(aged80+years),whiletraditionalcardiovascularriskfactorswerenotassociatedwithincreasedmortalityinthisagestrata.36However,malesex,smoking,highbloodpressure,highglucose,andelevatedcreatininelevels,butnottotalcholesterol,LDLcholesterol,andHDLcholesterollevels,werestillassociatedwithincreased5-yearmortalityriskinthecommunity-dwellingearly-oldadults(aged65+years).37Independentpredictorsof5-yearmortalityinthispopulationincludedalsorelativepoverty,lowphysicalactivity,indicatorsoffrailty,anddisability.37Age,malesex,smoking,andtype2diabetesmellituswereindependentriskfactorsformortalityinpersonsaged70–78years,whiletotalcholesterol,HDL-cholesterol,andsystolicbloodpressurewerenolongerassociatedwithincreasedmortalityinthisagestrata.38Polypharmacyandpatientapathywereidentifiedasnewrelevantpredictorsofmortality.38Ourdatasuggestthatmalesexisassociatedwithhigherprevalenceofever-smoking,higherbloodpressureandhigherprevalenceofdiabetes.Regularalcoholconsumptionwasalsostronglyassociatedwithmalesex,whichconsequentlymayresultinfindingsofnegativeassociationsofalcoholconsumptionwithfrailty.Meta-analysisbyStockwelletaldisputedabeneficialeffectofmoderatealcoholconsumptiononmortalityrisk.39Ontheotherhand,femalesexinoursamplewasassociatedwithhigherprevalenceofdepression,osteoarthritis,andosteoporosis–factorswhichmaycompromiseresultsoftheassessmentoffrailtycomponents,thatarealsoassociatedwithincreasedmortality.40–42 Ourresultsindicatethatincontrasttothefrailtyphenotypeanalyzedinolder-oldadultsinotherstudies,thefrailtyphenotypeinearly-oldadultsdoesnotencompassallsignificantriskfactorsformortalityandthereforemaynotbeconsideredanindexofglobalhealth.Thus,asotherstudieshavealsoconcluded,43,44frailtyphenotypeassessmentaddsimportantinformationtothecomprehensivegeriatricassessment,butitmaynotsubstitutefortheCGAasamethodofglobalhealthassessmentinearly-oldcommunity-dwellingadults.Notably,frailtyriskinoursamplewasassociatedwithdepressionandlowercognitivefunction.Friedfrailtyphenotypeiscommonlyidentifiedwithphysicalfrailty.1,45Ourfindings,alongwithotherstudies,46indicatethatthefrailtyphenotypeisassociatedwithbothphysicalandpsychologicalconditions.Otherstudies,usingdifferentmethodologicalapproaches,demonstratedthatfrailtyisalsorelatedtosocioeconomicfactors.47,48Itispostulatedthatindividuallytailoredinterventionsshouldbedeliveredtopreserveanindividual’sindependence,physicalfunction,andcognition.49 Ourfindingssupporttheopinionthatfrailtypreventionandtreatmentplansshouldincludepsychologicalandsocialsupportalongwithacomprehensivephysicalactivityprogram. Conclusion Atleast25%oftheearly-oldcommunity-dwellingpopulationwouldbenefitfromafrailtypreventionprogram.Thefrailtyphenotypereflectsbothphysicalandmentalhealthinthispopulation. Disclosure Theauthorsreportnoconflictsofinterestinthiswork. 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