Frailty in middle aged linked to higher mortality

Frailty is a condition commonly associated with old age, however new 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.

The study, led by the University of Glasgow’s Institute of Health and Wellbeing and published in The Lancet Public Health, 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 socioeconomically deprived people.

Crucially, the research found that even after accounting for other factors (including socioeconomic status, number of long-term conditions, smoking, alcohol and BMI) 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.

Frailty has been found to be a predictor of mortality, falls, worsening disability, hospitalisation and care home admission in cohorts of elderly people but this is the first research to show that it can be an important issue for younger people too. The researchers defined frailty as the presence of three of more out of five indicators: weakness (reduced grip strength), slowness (gait speed), weight loss, low physical activity, and exhaustion. People with one or two indicators are classified as ‘pre-frail’.

Both the National Institute for Health and Care Excellence (NICE) and British Geriatrics Society emphasise the importance of identifying frailty to highlight multimorbid (the presence of two of more health conditions) patients at risk of adverse outcomes who may benefit from treatment optimisation.

Of the nearly 500,000 participants studied, the researchers identified 16,538 ‘frail’ participants (3·3%) and over 185,000 meeting the criteria for ‘pre-frailty’ (37·5%). The prevalence of frailty was higher in people with long term health conditions. Frailty and pre-frailty were associated with age, female sex, both obesity and underweight, smoking, socioeconomic deprivation and infrequent alcohol intake. 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.

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

rofessor Frances Mair, Norie Miller Professor of General Practice and lead author of the study