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Frailty even during middle age ‘linked to higher mortality risk’

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Patients who are frail during middle age, especially caused by a long-term condition, are at higher risk of mortality than other people, according to UK researchers.

The research has highlighted the significance of frailty in middle age, especially in those living with chronic illness, and the importance of diagnosing it at an early stage.

“In our study, we applied the test for frailty to a wider, and younger group of people”

Frances Mair

It found that frailty could be identified in both men and women of all ages between 37 and 73 years-old, and was more common in people with multiple long-term health conditions.

The researchers, who looked at 493,737 participants from the UK Biobank, also found that frailty in middle age was more common in socio-economically deprived people.

They identified 16,538 “frail” participants and over 185,000 meeting the criteria for “pre-frailty”. The prevalence of frailty was higher in people with long term health conditions.

The researchers defined frailty as having three of more of five indicators – reduced grip strength, gait speed, weight loss, low physical activity, and exhaustion. Those with one or two were classed as “pre-frail”.

“The hope is, with earlier identification and intervention frailty can be reversed in some patients”

Frances Mair

Frailty and pre-frailty were associated with age, female sex, both obesity and underweight, smoking, socio-economic deprivation and infrequent alcohol intake, according to the study findings.

Even after accounting for other factors – including socio-economic status, number of long-term conditions, smoking, alcohol and body mass index – people with frailty were at an increased risk of mortality.

This was true of men of all ages between 37-73 years-old and women aged 45 and older, said the researchers in the journal The Lancet Public Health.

Specifically, they found frailty was associated with a greater than two-fold risk of mortality in males and females over the age of 45 and males aged 37-45.

They noted that, while frailty had been found to be a predictor of mortality, falls, disability and hospital or care home admission in older people, their study was the first to show it could be an important issue for younger people too.

University of Glasgow

Frances Mair

Frances Mair

Senior study author Professor Frances Mair said: “People with frailty are understood to be at higher risk of adverse health events, but previous research has almost always focused on older people.

“In our study, we applied the test for frailty to a wider, and younger group of people and found that the condition was present in people of all ages,” she noted.

She added: “Interventions to reverse frailty or improve patient outcomes have, almost exclusively, focused on the very elderly or those in long-term care.

“However, our findings indicate that there is a need for a change in focus, to start identifying frailty and intervene much earlier,” said Professor Mair.

“The hope is, with earlier identification and intervention, frailty can be reversed in some patients,” said the primary care expert from the University of Glasgow’s Institute of Health and Wellbeing.

Both the National Institute for Health and Care Excellence and British Geriatrics Society highlight the importance of identifying frailty to highlight multi-morbid patients at risk of adverse outcomes who may benefit from treatment optimisation.

“We suggest that an assessment of frailty should be incorporated into routine monitoring”

Peter Hanlon

Lead study author Dr Peter Hanlon, also from Glasgow University, said: “Although frailty should be a cause for concern when identified in middle to older aged people, it may be reversible, particularly if it is identified at an early stage.

“Identifying frailty may have positive implications for care, planning interventions and a patient’s prognosis, particularly in individuals who have more than one underlying health condition,” he said.

“In light of our findings, we suggest that an assessment of frailty should be incorporated into routine monitoring and assessment of people with multi-morbidity, which may help identification of those at greater risk to ensure more accurate targeting of care,” he added.

The study was funded by the Scottish government’s Chief Scientist Office and a NHS Research Scotland career research fellowship.

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