Severity of frailty using modified Thai frailty index, social factors, and prediction of mortality among community-dwelling older adults in a middle-income Country.
Morkphrom, E., V. Srinonprasert, U. Sura-amonrattana, A. Siriussawakul, S. Sainimnuan, R. Preedachitkun and W. Aekplakorn. 2022
Frontiers in Medicine. 9:1060990.
Background: Frailty has been increasingly recognized as a public health
problem for aging populations with significant social impact, particularly in
low- and middle-income countries. We aimed to develop a modified version
of the Thai Frailty Index (TFI) and explore the association between different
frailty statuses, socioeconomic factors, and mortality in community-dwelling
older people from a middle-income country.
Methods: The data from participants aged ≥60 years in the Fourth Thai
National Health Examination Survey were used to construct the 30-item
TFI. Cutoff points were created based on stratum-specific likelihood ratio.
TFI ≤0.10 was categorized as fit, 0.10–0.25 as pre-frail, 0.25–0.45 as mildly
frail, and >0.45 as severely frail. The association of frailty status with mortality
was examined using Cox proportional hazard models.
Findings: Among 8,195 older adults with a mean age of 69.2 years, 1,284
died during the 7-year follow-up. The prevalence of frailty was 16.6%. The
adjusted hazard ratio (aHR) for mortality in pre-frail was 1.76 (95% CI = 1.50–
2.07), mildly frail 2.79 (95% CI = 2.33–3.35), and severely frail 6.34 (95%
CI = 4.60–8.73). Having a caretaker in the same household alleviated mortality
risk for severely frail participants with an aHR of 2.93 (95% CI = 1.92–4.46)
compared with an aHR of 6.89 (95% CI = 3.87–12.26) among those living
without a caretaker.
Interpretation: The severity of frailty classified by the modified TFI can predict
long-term mortality risk for community-dwelling older adults. Identification of
severely frail older people to provide appropriate care might alleviate mortality
risk. Our findings can inform policymakers to appropriately allocate services in
a resource-limited setting.
KEYWORDS
frailty, older, mortality risk, Thailand, caretaker
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