Physical Frailty, Multimorbidity, and All-Cause Mortality in an Older Population From Southern Italy: Results from the Salus in Apulia Study

Fabio Castellana; Luisa Lampignano; Ilaria Bortone; Roberta Zupo; Madia Lozupone; Chiara Griseta; Antonio Daniele; Giovanni De Pergola; Gianluigi Giannelli; Rodolfo Sardone; Francesco Panza

doi:10.1016/j.jamda.2020.12.026

Physical Frailty, Multimorbidity, and All-Cause Mortality in an Older Population From Southern Italy: Results from the Salus in Apulia Study

J Am Med Dir Assoc. 2021 Mar;22(3):598-605. doi: 10.1016/j.jamda.2020.12.026. Epub 2021 Jan 23.

Affiliations

¹ Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy.
² Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
³ Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁴ Scientific Direction, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
⁵ Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy. Electronic address: f_panza@hotmail.com.

PMID: 33493467
DOI: 10.1016/j.jamda.2020.12.026

Abstract

Objectives: We first estimated the prevalence of physical frailty in older subjects from the population-based Salus in Apulia Study (Apulia, Southern Italy), and its impact on all-cause mortality. Second, we explored the relationship between multimorbidity and physical frailty.

Design: Cross-sectional and longitudinal analyses from a population-based study.

Setting and participants: We analyzed data from the Salus in Apulia study, a population-based sample of 1929 subjects aged 65 years and older.

Methods: These older participants underwent clinical, physical, and laboratory assessments. Physical frailty was operationalized using slightly modified Fried criteria. Multimorbidity status was defined as the co-presence of 2 or more chronic conditions.

Results: The overall prevalence of physical frailty in this older population from Southern Italy was 14.8% [95% confidence interval (CI): 13.26-16.49]. Physical frailty subjects were significantly older (P < .01), had a lower educational level (P < .01), increased executive dysfunction (P < .01), higher serum levels interleukin-6 (P < .01), and white blood cells (P = .01). Multimorbidity status (P < .01), diabetes mellitus (P = .05), peripheral age-related hearing loss (P < .01), cognitive impairment (P < .01), chronic obstructive pulmonary disease (P = .02), and metabolic syndrome (P = .02) were also directly related to physical frailty. Apathy increased according to the severity of physical frailty status (P = .02). There was a significant increased risk of all-cause mortality for physical frailty subjects (hazard ratio: 1.48; 95% CI: 1.03-2.12, adjusted for age and sex) during the observation from the date of enrollment to the date of death (mean ± SD: 55.70 ± 22.19 months, median: 54 months).

Conclusions and implications: Frailty is the consequence of the contributory action of the aging process and some chronic diseases that hasten some of the changes concurrent with aging.

Keywords: Frailty; Italy; biomarkers; multimorbidity; population-based; survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cross-Sectional Studies
Frail Elderly
Frailty* / epidemiology
Humans
Italy / epidemiology
Multimorbidity