Professor Fiona Matthews is Professor of Epidemiology at Newcastle University, Newcastle-upon-Tyne, UK. In this blog, she shares a recent Age and Ageing publication looking at data collected since the 1990s on how much frailty exists in the population and whether it is more or less related to dying now than 30 years ago.
Most doctors involved in the care of older people would claim to know a frail patient when they see one. Being able to detect this frailty is crucial to ensure that treatment is appropriate, proportionate and likely to produce positive outcomes wherever possible. The measurement of frailty has become important recently with the inclusion of frailty within the requirements of an assessment in general practice, and tools to assist doctors in emergency departments evaluate frailty quickly. The most popular method for these investigations has been the frailty index, where diseases and impairments are added all together to give a score. The relationship between this frailty index and mortality has been seen across the world, giving rise to suggestions that it is one measure that is consistent across time and place.
In our article in Age and Ageing we use two large studies of older people in England, conducted 20 years apart to test whether the amount of frailty has changed over time, and whether the relationship between frailty and death has changed too.
What did we find?
We found that the older population now has very similar levels of frailty to the older population in the early 1990s, if anything the levels of frailty now are higher than then. When investigating death, we found that despite death rates now being much lower than in the 1990s, the relationship of higher levels of frailty and mortality has remained stable. The benefit of reduction in death rates appears to be focused on those with little frailty, leaving those with most frailty not benefiting from changes in death rates.
Although we have seen increases in life expectancy since the 1990’s, those with severe frailty have not benefited, indicating a group still in need of appropriate consideration for mortality reduction.
- Read the Age and Ageing Paper: Is frailty a stable predictor of mortality across time? Evidence from the Cognitive Function and Ageing Studies
- View the Press Release: Lower deaths overall but frailty is still ‘fatal’, say researchers
An interesting article and not surprising. The counter argument to more interventions may rationally conclude that more effort should definitely be spent on the pre-frail and only moderately frail in order to improve their condition and prevent further deterioration. “Severe frailty” may indicate a natural process or more simply tell us that it is time for palliation. Geriatricians and gerontologists have probably known this all along; the bigger question is how do we accurately and consistently classify people and how do we precisely quantify the appropriate level of intervention.