Frailty is a geriatric syndrome that manifests as functional deterioration due to the systemic decline of physiological resources.[JL1] It causes a heightened incidence of negative outcomes, such as hospitalization, disability and even mortality. Frailty in older adults is a major topic today in the field of aging. Recognition of its development could help detect and identify those at risk of negative outcomes and consequently help plan interventions and preventive care. Despite the importance of the topic, it has not been studied in Israel to date. This study examines the trajectory of frailty among older adults over the course of six years (2008-14) and the relation between frailty and the use of healthcare services and mortality.
The study utilizes data from a 2008 survey of insurees aged 65+ in a large health plan. The survey consisted of 608 older adults living in the community with an average age of 79. In another survey, conducted in 2014, we revisited those same people, locating 281 (46%). Of the remainder, 183 (30%) had passed away and the rest were unavailable for other reasons. In both studies, the participants were interviewed by telephone based on a closed, structured questionnaire containing the measure of the Vulnerable Elders Survey (VES), a common tool to detect frailty.
Survival analysis showed that 86% of the non-frail in 2008 were alive in 2014 compared with 52% of the frail. The hazard ratio was 3.5.
In 2008, 60% were frail; six years later, 80% were frail.
The situation of a third of those who had been frail in 2008 had further deteriorated after 6 years.
Older adults who became frail or remained frail (and whose condition either remained stable or worsened) were far likelier to be hospitalized in the previous 12 months, to receive homecare, and to have a caregiver than those who were not frail.
The study findings showed, for the first time in Israel, that changes in the state of frailty of older adults are common, and any deterioration increases the reliance on health services and the likelihood of mortality. Thus, it is important to broaden acquaintance with the topic and develop ways to diagnose and deal with frailty – from the level of policymakers to that of service providers and individual physicians.
The findings are being widely disseminated to the health plans, national councils, and additional forums, arousing much interest. The Ministry of Health has also recognized the importance of the topic and initiated a dialogue with professionals to find better ways of coping with frailty among older adults.
The study was funded by Maccabi Institute for Health Services Research.