Factors affecting frailty among community-dwelling older adults: A multi-group path analysis according to nutritional status

Abstract

Background: Frailty is highly prevalent in older adults. Malnutrition is a common problem in older adults and is related to frailty.

Objectives: The aim was to investigate a structural frailty model, to verify the factors which affect the frailty of older adults, and to evaluate the moderating effects of nutritional status on frailty through multi-group analysis.

Design: Secondary analysis as a descriptive survey.

Samples: Data were prospectively collected from 1,374 older adults (age ≥ 70) from the Korean Frailty and Aging Cohort Study in 2017.

Methods: Frailty was measured by the FRAIL scale [robust (score 0), pre-frailty (score 1-2), frailty (score 3-5)], and nutritional status was evaluated by the Mini Nutritional Assessment (MNA) [well-nourished (score ≥ 24), risk of malnutrition (score 17-23.5), malnourished (score < 17)]. Other domains were evaluated with the hand grip strength test, Short Physical Performance Battery (SPPB), short form of the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and ENRICHD Social Support Instrument (ESSI). The frailty model was developed by confirming the relationship among the influencing factors of frailty. To evaluate the different frailty pathways according to nutritional status in multi-group analysis, participants were divided into two subgroups according to the mean MNA score. Subgroups were classified into a well-nourished group (n = 851) for scores equal to or higher than the average score, and a malnourished group (n = 523) for scores lower than the average score. The path analysis was performed using the AMOS 23.0 program.

Results: The frailty model's fit indices were adequate. In the model, the most influential factor for frailty was depression, followed by SPPB, age, polypharmacy, cognitive function, and female sex. In the multi-group analysis according to nutritional status, the malnourished group significantly increased in frailty as SPPB scores decreased. In addition, SPPB scores and cognitive function significantly decreased with increasing age in the malnourished group when compared to the well-nourished group.

Conclusion: Depression, SPPB, age, polypharmacy, cognitive function, and female sex were found to be important factors that affect frailty. Malnourished older adults are more likely to suffer from physical impairment, lower cognitive function, and frailty. Vigorous efforts are needed to improve nutritional status in older adults, which ultimately might improve functional outcomes and frailty.

Keywords: Aged; Frailty; Malnutrition; Nutritional status.