Prevalence and factors associated with frailty among Peruvian older adults
Introduction
Aging in Latin American countries is changing. The population aged 60 years and older is projected to increase at an annual rate of 3.5% during the first quarter of this century and represents three times the rate of increase of the total population (McNicoll, 2002). The percent of persons 60 years is currently 8% and is projected to increase to 14% in the year 2025 and to 23% in 2050 in these countries (McNicoll, 2002). Latin American adults are reaching old age with more chronic diseases, more disability, and fewer resources than older people in developed countries. It is estimated that about one million older adults will be added to the region's population each year during the next ten years (Kinsella and Wan, 2009, PAHO, 2002). Thus, by 2025, one in ten older adults will be aged 80 or older in Latin American countries (Kinsella and Wan, 2009, PAHO, 2002).
In Perú, 8.8% of the total population was 60 years or older in 2004 and chronic diseases were among the most important causes of death (PAHO, 2002). Projections for the year 2025 suggest that the older adult population in Perú will represent 12.4% of the total population, a similar demographic transition to the one observed in other Latin American countries (Kinsella and Wan, 2009, Varela, 2004). This growth will come with increases in prevalence of medical conditions and disability that will increase their risk of becoming frail. Frailty has been shown to decrease quality of life and further impair functional ability (Bortz, 2002, Fried et al., 2001).
Defined as “a physiologic state of increased vulnerability to stressors that results from decreased physiologic reserves, and even dysregulation, of multiple physiologic systems,” (Hamerman, 1999) frailty is considered a highly prevalent syndrome and an important health problem associated with mortality, institutionalization and other adverse outcomes like falls, cognitive impairment and disability (Al Snih et al., 2009, Boyle et al., 2010Ensrud et al., 2007, Fried et al., 2001, Fried et al., 2004, Rothman et al., 2008, Samper-Ternent et al., 2008). This condition is believed to be increasing rapidly among older adults in Latin American countries (Alvarado et al., 2008, Avila-Funes et al., 2009). The number of studies that have examined the prevalence of frailty in older Latin American populations is limited. Few studies have analyzed this problem following commonly accepted methodologies making the data difficult to compare with data from other countries (Lawrence & Jette, 1996). One study of aging in Latin America and the Caribbean reports a prevalence of frailty between 30 to 48% in women, and between 21 to 35% in men (Alvarado et al., 2008). Conversely, findings from recent systematic review reported a prevalence of frailty between 4.5 to 59.1% (Borges and Menezes, 2011, Collard et al., 2012). Disability, falls, cognitive impairment, cardiovascular diseases, mood disorders, and inflammation were identifying as factors associated with frailty (Borges & Menezes, 2011).
Additionally, findings from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) reported a prevalence of pre-frail and frail older adults of 55% among the largest minority group in the United States, Mexican-Americans (Ottenbacher et al., 2005). Diabetes, arthritis, smoking status, body mass index, cognition, and negative affect were significant predictors increasing the risk of frailty over time (Ottenbacher et al., 2009). Studies on frailty in Perú, like the rest of the region, are limited. Varela et al. in a sample of older adults reported a prevalence of frailty of 7.7% and found that disability and cognitive impairment were associated to frailty (Varela, Ortiz-Saavedra, & Chavez-Jimeno, 2008).
The objective of this study was to examine the prevalence and factors associated with frailty among Peruvian Navy Veteran's older adults and family members using a modified version of a validated frailty index (Fried et al., 2001) from the Geriatrics Service of the Peruvian Navy Medical Center (Centro Médico Naval “Cirujano Mayor Santiago Távara”) that provides care for military personnel and their families.
Section snippets
Sample
Participants are from a hospital-based study cohort, assessed between May and October 2010. Sample size was calculated using a common prevalence formula (Bowers, 2008). For this study, patients from the Geriatrics Service of Centro Médico Naval “Cirujano Mayor Santiago Távara” (Peruvian Navy Medical Center) that had been seen as outpatients in the previous month were considered for our study. All participants were aged 60 years and older and resided either in Lima or Callao, Perú. Most of them
Results
The mean age was 76.1 years [Standard Deviation (SD) = 8.3], 59.5% of the sample were males (n = 185) and 51.8% of the sample (n = 183) were retired personnel from the Peruvian Navy Military Service. A total of 74.3% (n = 231) of participants were married, 88.4% (n = 275) had 12 or more years of education, 64% (n = 199) reported a fall in the last year and 55% (n = 171) were hospitalized in the last year. The most prevalent comorbidities were: cardiovascular diseases (66.8% (n = 208)), geriatric syndromes
Discussion
The present study examined the prevalence and factors associated with frailty among older navy personnel and their family members aged 60 years and older living in Perú. We found that 27.8% of the participants were frail. Older age, being married and falls in the last year were found to be significantly associated with being frail, and those with better function were less likely to be frail.
The prevalence of frailty found in this study is comparable to previously published rates in other
Conclusions
The prevalence of frailty in Peruvian Navy Veterans and family members is high and it is associated with age, marital status, falls, and disability. The findings of this study are very useful to understand the factors associated with frailty in this unique population and provide useful information that will help us design comprehensive geriatric interventions to benefit our patients.
Conflict of interest
The authors disclose no conflict of interest.
Role of funding sources
This study was supported in part by the National Institute on Aging of the National Institutes of Health (P30-AG024832 Older Americans Independence Center, R03-AG029959 and R24-HD065702). Infrastructure support provided by the WHO/PAHO Collaborating Center on Aging and Health in the Sealy Center on Aging at the University of Texas Medical Branch. Study sponsors had no role in the study design, data collection, analysis or interpretation of the data. Study sponsors did not have any role in the
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