Frailty: trajectory and transitions and resilience

Frailty is a state of heightened vulnerability and susceptibility to physiologic stressors that increases with age. It has shown increasing utility in predicting a range of adverse health outcomes. We have developed a 67-item deficit-accumulation frailty index (FI) in 19,110 community-dwelling individuals in the ASPREE study. Participants were aged 65 to 98 years when recruited from the U.S. and Australia, and were without diagnosed dementia and cardiovascular disease, and without major physical disability. The Frailty Index (FI) was positively associated with age, and women had significantly higher scores than men at all ages. The FI was negatively correlated with gait speed and grip strength and strongly associated with the Fried frailty phenotype. Frailty was associated with the primary composite outcome in ASPREE, capturing independent life lived free of major disability and dementia, and increased the rate of persistent physical disability. It added significantly to the predictive capacity of these outcomes above age, sex and ethnicity alone. The FI is thus a useful biomarker of aging even among relatively healthy older individuals, and provides important information about an individual’s vulnerability to and risk of disease. This project will extend this work by investigating the trajectories of FI over an 11-year period, including investigating risk factors for progression of frailty, and protective factors which drive backward transitions (e.g. from pre-frail to non-frail). This project will also investigate why women have higher frailty burden at all ages, despite on average living longer than men.