Dataset Information

Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

ABSTRACT: To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age, and sex.Cohort study.The Yale Precipitating Events Project, New Haven, Connecticut.Seven hundred fifty-four community-dwelling people aged 70 and older at baseline followed up at 18, 36, and 54 months.Frailty status, assessed at 18-month intervals, was defined using a frailty index (FI) as the number of deficits in 36 health variables. Mobility was defined as time in seconds on the rapid gait test, in which participants walked back and forth over a 20-foot course as quickly as possible. Multistate transition probabilities were calculated with baseline frailty, mobility, age, and sex estimated using Poisson and logistic regressions in survivors and those who died, respectively.In multivariable analyses, baseline frailty status and age were significantly associated with changes in frailty status and risk of death, whereas mobility was significantly associated with the frailty but not with mortality. At all values of the FI, participants with better mobility were more likely than those with poor mobility to remain stable or to improve. For example, at 54 months, 20.6% (95% confidence interval (CI)=16-25.2) of participants with poor mobility had the same or fewer deficits, compared with 32.4% (95% CI=27.9-36.9) of those with better mobility.A multistate transition model effectively measured the probability of change in frailty status and risk of death. Mobility, age, and baseline frailty were significant factors in frailty state transitions.

SUBMITTER: Fallah N

PROVIDER: S-EPMC3125634 | biostudies-literature | 2011 Mar

REPOSITORIES: biostudies-literature

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Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

Fallah Nader N Mitnitski Arnold A Searle Samuel D SD Gahbauer Evelyne A EA Gill Thomas M TM Rockwood Kenneth K

Journal of the American Geriatrics Society 20110301 3

<h4>Objectives</h4>To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age, and sex.<h4>Design</h4>Cohort study.<h4>Setting</h4>The Yale Precipitating Events Project, New Haven, Connecticut.<h4>Participants</h4>Seven hundred fifty-four community-dwelling people aged 70 and older at baseline followed up at 18, 36, and 54 months.<h4>Measurements</h4>Frailty status, assessed at 18-month intervals, was defined using a frailty index ...[more]

PMID: 21391943

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Project description:BackgroundThe use of the multistate Markov chain model is a valuable tool for studying child undernutrition. This allows us to examine the trends of children's transitions from one state to multiple states of undernutrition.ObjectivesIn this study, our objective was to estimate the median duration for a child to first transition from one state of undernutrition to another as well as their first recurrence of undernutrition and also to analyze the typical duration of undernourishment. This involves understanding the central tendency of these transitions and durations in the context of longitudinal data.MethodsWe used a longitudinal dataset from the Young Lives cohort study (YLCS), which included approximately 1997 Ethiopian children aged 1-15 years. These children were selected from five regions and followed through five survey rounds between 2002 and 2016. The surveys provide comprehensive health and nutrition data and are designed to assess childhood poverty. To analyze this dataset, we employed a Markov chain regression model. The dataset constitutes a cohort with repeated measurements, allowing us to track the transitions of individual children across different states of undernutrition over time.ResultsThe findings of our study indicate that 46% of children experienced concurrent underweight, stunting, and wasting (referred to as USW). The prevalence of underweight and stunted concurrent condition (US) was 18.7% at baseline, higher among males. The incidence density of undernutrition was calculated at 22.5% per year. On average, it took 3.02 months for a child in a wasting state to transition back to a normal state for the first time, followed by approximately 3.05 months for stunting and 3.89 months for underweight. It is noteworthy that the median duration of undernourishment among children in the US (underweight and stunted concurrently) state was 48.8 months, whereas those concurrently underweight and wasting experienced a median of 45.4 months in this state. Additionally, rural children (HR = 1.75; 95% CI: 1.53-1.97), those with illiterate fathers (HR = 1.50; 95% CI: 1.38-1.62) and mothers (HR = 1.45; 95% CI: 1.02-3.29), and those in households lacking safe drinking water (HR = 1.70; 95% CI: 1.26-2.14) or access to cooking fuel (HR = 1.95; 95% CI: 1.75-2.17) exhibited a higher risk of undernutrition and a slower recovery rate.ConclusionsThis study revealed that rural children, especially those with illiterate parents and households lacking safe drinking water but cooking fuels, face an increased risk of undernutrition and slower recovery.

Project description:Impairment of physical function is a major indicator of frailty. Functional performance tests have been shown to be useful for identification of frailty in older adults. However, these tests are often not translatable into unsupervised and remote monitoring of frailty status at home and/or community settings.In this study, we explored daily postural transition quantified using a chest-worn wearable technology to identify frailty in community-dwelling older adults.Spontaneous daily physical activity was monitored over 24 h in 120 community-dwelling elderly (age: 78 ± 8 years) using an unobtrusive wearable sensor (PAMSys™, BioSensics LLC, Watertown, MA, USA). Participants were classified as non-frail and pre-frail/frail using Fried's criteria. A validated software package was used to identify body postures and postural transition between each independent postural activity such as sit-to-stand, stand-to-sit, stand-to-walk, and walk-to-stand. The transition from walking to sitting was further classified as quick sitting and cautious sitting based on presence/absence of a standing posture pause between sitting and walking. A general linear model univariate test was used for between-group comparison. Pearson's correlation was used to determine the association between sensor-derived parameters and age. Logistic regression model was used to identify independent predictors of frailty.According to Fried's criteria, 63% of participants were pre-frail/frail. The total number of postural transitions, stand-to-walk, and walk-to-stand were, respectively, 25.2, 30.2, and 30.6% lower in the pre-frail/frail group when compared to the non-frail group (p < 0.05, Cohen's d = 0.73-0.79). Furthermore, the ratio of cautious sitting was significantly higher by 6.2% in pre-frail/frail compared to non-frail (p = 0.025, Cohen's d = 0.22). Total number of postural transitions and the ratio of cautious sitting also showed significant negative and positive correlations with age, respectively (r = -0.51 and 0.29, p < 0.05). After applying a logistic regression model, among tested parameters, walk-to-stand (odds ratio [OR] = 0.997 p = 0.013), quick sitting (OR = 1.036, p = 0.05), and age (OR = 1.073, p = 0.016) were recognized as independent variables to identify frailty status.This study demonstrated that daily number of specific postural transitions such as walk-to-stand and quick sitting could be used for monitoring frailty status by unsupervised monitoring of daily physical activity. Further study is warranted to explore whether tracking the daily number of specific postural transitions is also sensitive to track change in the status of frailty over time.

Project description:BackgroundOne in 20 older adults in the United States is homebound and rarely/never leaves home. Although being homebound decreases the quality of the lived experience of individuals with serious illnesses, little is known about the frequency or likelihood of transitions in or out of homebound status. The objective of this study was to characterize the probability of transitions to and from homebound status among older adults and examine the relationship between dementia status and homebound transitions.MethodsUsing 2011-2018 data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging in the United States, we identified 6375 community-dwelling Medicare beneficiaries. Homebound status (independent, semi-homebound (leaving home but with difficulty or help), homebound (rarely or never leaving home), nursing home resident, dead) was assessed annually via self-report. Transition probabilities across states were assessed using a multistate Markov model.ResultsLess than half of homebound individuals remain homebound (probability = 41.5% [95% CI: 39.2%, 43.5%]) after 1 year. One out of four dies (24% [22.3%, 26.0%]) and there is a low probability (3.2% [2.5%, 4.1%]) of transition to a nursing home. Dementia status was associated with increased risk of progression from independence to homebound status (HR: 1.83 [1.01, 3.34]). Dementia was consistently associated with increased probabilities of transitions to death including a two-fold increased hazards of progression from homebound to death (HR: 2.18 [1.69, 2.81]). Homebound individuals with dementia have a 34.2% [25.8%, 48.1%] probability of death in 5 years, compared with 17.4% [13.7%, 24.3%] among those without dementia.DiscussionDementia is associated with greater risk of transitioning across homebound states. There is a greater need to support home-based care for patients with dementia, especially as the ongoing COVID pandemic has raised concerns about the need to invest in alternative models to nursing home care.

Dataset Information

Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

Publications

Transitions in frailty status in older adults in relation to mobility: a multistate modeling approach employing a deficit count.

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