Explaining the association between frailty and mortality in older adults: The mediating role of lifestyle, social, psychological, cognitive, and physical factors

被引:22
作者
de Breij, Sascha [1 ]
Rijnhart, Judith J. M. [1 ]
Schuster, Noah A. [1 ]
Rietman, M. Liset [2 ]
Peters, Mike J. L. [3 ]
Hoogendijk, Emiel O. [1 ]
机构
[1] Amsterdam UMC Locat VU Univ, Amsterdam Publ Hlth Res Inst, Dept Epidemiol & Data Sci, Med Ctr, Amsterdam, Netherlands
[2] Natl Inst Publ Hlth & Environm, Dept Life Course & Hlth, Bilthoven, Netherlands
[3] Amsterdam UMC Locat VU Univ, Dept Internal Med, Med Ctr, Amsterdam, Netherlands
关键词
Mediation analysis; Frailty phenotype; Survival; Epidemiology; VITAMIN-D DEFICIENCY; POLYPHARMACY; DEPRESSION; IMPAIRMENT; HEALTH;
D O I
10.1016/j.pmedr.2021.101589
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Frailty is associated with a higher risk of mortality, but not much is known about underlying pathways of the frailty-mortality association. In this study, we explore a wide range of possible mediators of the relation between frailty and mortality. Data were used from the Longitudinal Aging Study Amsterdam (LASA). We included 1477 older adults aged 65 years and over who participated in the study in 2008-2009 and linked their data to register data on mortality up to 2015. We examined a range of lifestyle, social, psychological, cognitive, and physical factors as potential mediators. All analyses were stratified by sex. We used causal mediation analyses to estimate the indirect effects in single-mediator analyses. Statistically significant mediators were then included in multiplemediator analyses to examine their combined effect. The results showed that older men (OR = 2.79, 95% CI = 1.23;6.34) and women (OR = 2.31, 95% CI = 1.24;4.30) with frailty had higher odds of being deceased 6 years later compared to those without frailty. In men, polypharmacy (indirect effect OR = 1.21, 95% CI = 1.03;1.50) was a statistically significant mediator in this association. In women, polypharmacy, self-rated health, and multimorbidity were statistically significant mediators in the single-mediator models, but only the indirect effect of polypharmacy remained in the multiple-mediator model (OR = 1.16, 95% CI = 1.03;1.38). In conclusion, of many factors that were considered, we identified polypharmacy as explanatory factor of the association between frailty and mortality in older men and women. This finding has important clinical implications, as it suggests that targeting polypharmacy in frail older adults could reduce their risk of mortality.
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页数:7
相关论文
共 45 条
[1]   Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: A narrative review [J].
Ambagtsheer, Rachel C. ;
Beilby, Justin J. ;
Visvanathan, Renuka ;
Dent, Elsa ;
Yu, Solomon ;
Braunack-Mayer, Annette J. .
PREVENTIVE MEDICINE, 2019, 119 :63-69
[2]   DEPRESSIVE SYMPTOMS IN RELATION TO PHYSICAL HEALTH AND FUNCTIONING IN THE ELDERLY [J].
BERKMAN, LF ;
BERKMAN, CS ;
KASL, S ;
FREEMAN, DH ;
LEO, L ;
OSTFELD, AM ;
CORNONIHUNTLEY, J ;
BRODY, JA .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1986, 124 (03) :372-388
[3]   Frailty, Polypharmacy, and Health Outcomes in Older Adults: The Frailty and Dependence in Albacete Study [J].
Bonaga, Beatriz ;
Sanchez-Jurado, Pedro M. ;
Martinez-Reig, Marta ;
Ariza, Gabriel ;
Rodriguez-Manas, Leocadio ;
Gnjidic, Danijela ;
Salvador, Transito ;
Abizanda, Pedro .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2018, 19 (01) :46-52
[4]   Vitamin D deficiency in Europe: pandemic? [J].
Cashman, Kevin D. ;
Dowling, Kirsten G. ;
Skrabakova, Zuzana ;
Gonzalez-Gross, Marcela ;
Valtuena, Jara ;
De Henauw, Stefaan ;
Moreno, Luis ;
Damsgaard, Camilla T. ;
Michaelsen, Kim F. ;
Molgaard, Christian ;
Jorde, Rolf ;
Grimnes, Guri ;
Moschonis, George ;
Mavrogianni, Christina ;
Manios, Yannis ;
Thamm, Michael ;
Mensink, Gert B. M. ;
Rabenberg, Martina ;
Busch, Markus A. ;
Cox, Lorna ;
Meadows, Sarah ;
Goldberg, Gail ;
Prentice, Ann ;
Dekker, Jacqueline M. ;
Nijpels, Giel ;
Pilz, Stefan ;
Swart, Karin M. ;
van Schoor, Natasja M. ;
Lips, Paul ;
Eiriksdottir, Gudny ;
Gudnason, Vilmundur ;
Cotch, Mary Frances ;
Koskinen, Seppo ;
Lamberg-Allardt, Christel ;
Durazo-Arvizu, Ramon A. ;
Sempos, Christopher T. ;
Kiely, Mairead .
AMERICAN JOURNAL OF CLINICAL NUTRITION, 2016, 103 (04) :1033-1044
[5]   Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management [J].
Dent, E. ;
Morley, J. E. ;
Cruz-Jentoft, A. J. ;
Woodhouse, L. ;
Rodriguez-Manas, L. ;
Fried, L. P. ;
Woo, J. ;
Aprahamian, I ;
Sanford, A. ;
Lundy, J. ;
Landi, F. ;
Beilby, J. ;
Martin, F. C. ;
Bauer, J. M. ;
Ferrucci, L. ;
Merchant, R. A. ;
Dong, B. ;
Arai, H. ;
Hoogendijk, E. O. ;
Won, C. W. ;
Abbatecola, A. ;
Cederholm, T. ;
Strandberg, T. ;
Gutierrez Robledo, L. M. ;
Flicker, L. ;
Bhasin, S. ;
Aubertin-Leheudre, M. ;
Bischoff-Ferrari, H. A. ;
Guralnik, J. M. ;
Muscedere, J. ;
Pahor, M. ;
Ruiz, J. ;
Negm, A. M. ;
Reginster, J. Y. ;
Waters, D. L. ;
Vellas, B. .
JOURNAL OF NUTRITION HEALTH & AGING, 2019, 23 (09) :771-787
[6]   Psychosocial Resources: Moderators or Mediators of Frailty Outcomes? [J].
Dent, Elsa ;
Hoogendijk, Emiel O. .
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 2015, 16 (03) :258-259
[7]   Detecting frail, older adults and identifying their strengths: results of a mixed-methods study [J].
Dury, Sarah ;
Dierckx, Eva ;
van der Vorst, Anne ;
van der Elst, Michael ;
Fret, Bram ;
Duppen, Daan ;
Hoeyberghs, Lieve ;
De Roeck, Ellen ;
Lambotte, Deborah ;
Smetcoren, An-Sofie ;
Schols, Jos ;
Kempen, Gertrudis ;
Zijlstra, G. A. Rixt ;
De Lepeleire, Jan ;
Schoenmakers, Birgitte ;
Verte, Dominique ;
De Witte, Nico ;
Kardol, Tinie ;
De Deyn, Peter Paul ;
Engelborghs, Sebastiaan ;
De Donder, Liesbeth .
BMC PUBLIC HEALTH, 2018, 18
[8]   American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults [J].
Fick, Donna M. ;
Semla, Todd P. ;
Steinman, Michael ;
Beizer, Judith ;
Brandt, Nicole ;
Dombrowski, Robert ;
DuBeau, Catherine E. ;
Pezzullo, Lynn ;
Epplin, Jerome J. ;
Flanagan, Nina ;
Morden, Emily ;
Hanlon, Joseph ;
Hollmann, Peter ;
Laird, Rosemary ;
Linnebur, Sunny ;
Sandhu, Satinderpal .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2019, 67 (04) :674-694
[9]   MINI-MENTAL STATE - PRACTICAL METHOD FOR GRADING COGNITIVE STATE OF PATIENTS FOR CLINICIAN [J].
FOLSTEIN, MF ;
FOLSTEIN, SE ;
MCHUGH, PR .
JOURNAL OF PSYCHIATRIC RESEARCH, 1975, 12 (03) :189-198
[10]   Frailty in older adults: Evidence for a phenotype [J].
Fried, LP ;
Tangen, CM ;
Walston, J ;
Newman, AB ;
Hirsch, C ;
Gottdiener, J ;
Seeman, T ;
Tracy, R ;
Kop, WJ ;
Burke, G ;
McBurnie, MA .
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2001, 56 (03) :M146-M156