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The increase in life expectancy has contributed to the aging of the population in many parts of the world. Experts predict that by 2050, 21.3% of the world's 60-year-old population will suffer from fragility, compared with 9.2% in 1990.
Now, a systematic review and meta-badysis of more than 120,000 people has revealed that 1 out of every 6 non-institutionalized adults in 6 over the age of 60 in the world may be at risk of frailty.
The results were published online on August 2 in JAMA Network open now.
"The results of this study suggest that the risk of developing frailty and preferability is high among older people living in community, as such, appropriate interventions are needed," writes author Richard Ofori-Asenso, PhD from Monash University in Melbourne, Australia, and his colleagues. .
The researchers conducted a systematic review and meta-badysis of 46 observational studies of 120,805 robust and non-prefabricated adults over the age of 60 living in 28 countries on five continents, primarily in North America and Europe. In most studies, over 70% of participants were women.
During a median follow-up of 3 years (range of up to 11.7 years), 13.6% of people received a new diagnosis of frailty (grouped incidence rate, 43, 4 cases per 1,000 person-years, 95% confidence interval [CI], 37.3 – 50.4). Taking into account the risk of death lowered the overall incidence rate to 35.9 cases per 1,000 person-years (95% CI, 28.0 – 46.1).
An badysis that included only robust individuals from 21 studies found that 30.9% of the robust individuals had received a new diagnosis of preferability over a median follow-up period of 2.5 years (range up to # 1). 39 to 10 years, combined incidence rate: 150.6 cases per 1000 people). -year; 95% CI, 123.3 – 184.1).
After taking into account the risk of death, the combined incidence of prefiguration dropped to 110.6 cases per 1,000 person-years (95% CI, 84.8 to 144.2).
An badysis of 20 studies including both robust individuals and robust individuals revealed that a significantly higher number of prefrail individuals became fragile over a median of 3 years, compared to robust individuals (18, 5% vs. 4.6%, combined incidence rates, 62.7 cases per 1000 people). -années [95% CI, 49.2 – 79.8] vs 12.0 cases per 1000 person-years [95% CI, 8.2 – 17.5], respectively; P for the difference, <0.001).
In an badysis of 10 studies comparing women with men, during a median follow-up of 4 years, the incidence rates of frailty were significantly higher in women than in men (15.6% vs. 9%). 2%, 44.8 cases per 1,000 person-years). [95% CI, 36.7 – 61.3] vs 24.3 cases per 1000 person-years [95% CI, 19.6 – 30.1] ; P for difference = .01).
Pre-culpability rates were also higher among women than men, but the difference was not statistically significant (40.1% vs. 32.6%, combined incidence rate, 173%). 2 cases per 1000 person-years). [95% CI, 87.9 – 341.2] vs 129.0 [95% CI, 73.8 – 225.0] case per 1000 person-years, respectively; P for difference = .12).
The likelihood of frailty and preferability was significantly lower in high-income countries than in low- and middle-income countries (adjusted odds ratio, 0.63, 95% CI, 0.42-0.95 vs. 0.30; 95% CI, 0.21-0.84, respectively; P = 0.03).
Incidence rates also differed according to the definition by the frailty studies.
"Given its central importance to disease management and population health, the incidence of frailty among robust older adults is a key indicator of health." Therefore, the systematic review and meta Ofori-Asenso et al. badysis are very welcome to provide estimates of the incidence of Steven M. Albert, PhD, University of Pittsburgh, Pennsylvania, in a guest commentary.
It also shares the authors' insistence on the need for more screening and intervention programs to prevent or delay the development of frailty. Such interventions include exercise, nutrition, cognitive training, geriatric badessment, hormone therapy and pre-rehab, explain Ofori-Asenso and colleagues.
However, the appropriate intervention remains uncertain, Albert continues. Referring to a recent review, the authors suggest that strength training and protein supplementation might be the most effective and easiest interventions to implement.
Albert mentions another candidate: weight loss. In the United States, about two-thirds of older adults are overweight or obese. According to him, a recent study found that weight loss alone can help improve walking speed and reduce slowness.
Given the high incidence of frailty and prefabilities in this study, "delaying the onset of frailty is clearly a critical public health challenge," he said.
The limitations of the study include the lack of age-specific fragility incidence rates and the inability to account for individuals who fluctuate between frailty, pre-frailty and robustness. In addition, the studies used different definitions of frailty and the duration of follow-up varied.
Fragility is considered a medical condition and not an expected consequence of aging. The term refers to a decline in function and physiological reserve that diminishes a person's ability to withstand stressful events such as illness. Although there is no universally accepted definition of frailty, the most common definition includes weight loss, exhaustion, weakness, sluggishness and low physical activity. One can also define the prefability with the help of these variables, although individuals in pre-preil have fewer deficits than fragile individuals. There are also other broader definitions of frailty.
Fragility can contribute to various adverse outcomes, including falls, delirium, need for long-term care or retirement home, disability and death. It also increases the risk of poor results after surgery and increases the use and costs of health care.
The study was funded by a grant from the National Institutes of Health. The relevant financial relationships of the authors of the study are listed in the original article. Albert did not reveal any relevant financial relationship.
JAMA Netw Open. Posted online 2 August 2019. Full text, Commentary
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