Physical Performance-based Measurements as Predictors of Frailty and Disability Transition in Clients of Geriatric Clinics

Frailty is a common geriatric condition that is multisystem deterioration and loss of physiological reserve. The prevalence of frailty was from 11.0% to 14.9% in Taiwan. Several studies confirmed that frailty was associated with adverse health outcomes. It is becoming recognized that frailty may be a pre-disability state with multidimensional and unstable characteristics in the dynamic progression from robustness to multi-organ functional decline. Many common geriatric syndromes have been proposed to contribute to frailty, such as sarcopenia, malnutrition, osteoporosis, and depressive symptoms etc.With advancing age, physical performance declines in older adults. The assessment of physical performance is a critical component in the evaluation of older persons in both clinical and research, because that can represent the personal health statues. Performance based measures should be included in screening protocol to identify older adults who are at high risk to become frail or transit from frailty to disability, how to early detect and to develop effective intervention on frailty, to reverse the deterioration process is a very important issue.
The aims of this study were (1) to compare the physical performance between different frail states and disabled states, (2) to establish a prediction model for frailty transition and disability transition, furthermore, to predict transition from frailty to disability using physical performance measurements.
This present study employed data from the Division of Geriatric research, Institute of Population Health Sciences, National Health Research Institutes, an ongoing prospective, observational study of 65 years and older adults between May 2007and January 2009. Fried''s phenotype and Barthel index were used to identify frail and disabled older adults in baseline evaluation. Physical performance, including grip strength, timed chair rise up test (3times/10s), walking speed, time up and go test, were evaluated at baseline. Data were analyzed using forward stepwise binary logistic regression model that performance measure as independent variables and frailty, disability, transition from frailty to disability as dependent variables.
Only 188 participants completed all the baseline and follow up tests were reported. 93 (49.47%) male, 95 (50.53%) female. Mean age was 78.78 ± 6.26 years (67-90 years). Non frail, prefrail and frail peoples were 53 (27.53%), 117 (62.43%), 19 (10.05%). No disabled and disabled peoples were 114 (76.2%) and 45 (23.8%). The results showed that: (1) there were significant differences in physical performances between different frail states and diffetent disabled states, (2) Univariate logistic regression analysis showed that, grip strength and walking speed were significant predictors for frailty transition, disability transition and transition from frailty to disability. Timed up and go test was significant predictors for disability transition and transition from frailty to disability during 6months. (3) Multivariate logistic regression analysis showed that, grip strength (β=-0.06, odds ratio =0.94, 95%CI= 0.89-0.98, p=0.005) and walking speed (β=-1.32, odds ratio =0.27, 95% CI= 0.08-0.89, p=0.03) were significant predictors for frailty transition. In the prediction of disability transition, walking speed (β=-3.48, odds ratio =0.03, 95% CI= 0.01-0.01, p<0.001) was the only significant predictor. There hadn’t find any significant predictors in the prediction model of transition from frailty to disability,
Physical performance assessments have the ability to discriminate the high risk frail or disabled older adults among clients of geriatric clinics, and can be used as a screening test. If the screening results are positive, then further for other examinations or interventions to reverse or delay the degradation in the older adults. Grip strength and walking speed are the important indicators for predict the occurrence probability of frailty transition and disability transition. Timed up and go test is the indicator for the short-term disability transition. The presented study failed to identify the most influential physical indicators to predict the transition from frailty to disability. However, univariate logistic regression analysis showed that, grip strength and walking speed can predict transition from frailty to disability.