Frailty is an inevitability for everyone on some timescale, given the present state of medical technology. It is not, however, an inevitability for early old age. It can be postponed for decades. Further, if someone becomes frail in earlier old age, that frailty may be reversible given sufficient effort put into treatment and lifestyle changes, particularly those involving resistance exercise. A perhaps surprisingly large fraction of the progressive loss of muscle mass and strength with age is a matter of lack of use, a sedentary lifestyle, and other factors that provoke metabolic dysfunction and inflammation. Some fraction of the chronic inflammation of aging can be reduced or evaded.
The study population in today's open access paper is notable for the sizable reduction in risk of mortality and cardiovascular disease exhibited in the cohort that managed to reverse their slide into pre-frailty or outright frailty. For a moment let us set aside the means by which these patients achieved this goal, and why they succeeded where others failed. Just looking at the data, this should be taken as one more compelling reason to fund the development of therapies that can effectively reverse frailty for everyone, not just the fortunate few, by meaningfully targeting the driving factors of failing muscle tissue and and overly-inflammatory immune system.
Few studies have investigated the association between changes in frailty status and all-cause mortality, inconsistent results were reported. What's more, studies that evaluated the effect of changes of frailty on cardiovascular death in older population are scanty. Therefore, the present study aims to investigate the association of such changes with the risk of all-cause mortality and cardiovascular death in older people, using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).
A total of 2,805 older participants from two consecutive waves (i.e. 2011 and 2014) of the CLHLS were included for analysis. Based on the changes in frailty status from wave 2011 to wave 2014, participants were categorized into 4 subgroups, including sustained pre/frailty, robustness to pre/frailty, pre/frailty to robustness, and sustained robustness. Study outcomes were all-cause mortality and cardiovascular death, and Cox regression analysis examined the association of changes in frailty status with outcomes.
From wave 2011 to wave 2014, 33.2% of the participants had frailty transitions. From wave 2014 to wave 2018, there were 952 all-cause mortalities and 170 cardiovascular deaths during a follow-up of 9530.1 person-years, and Kaplan-Meier analysis demonstrated that cumulative incidences of the two outcomes were significantly lower in more robust participants. Compared with the subgroup of sustained pre/frailty, the fully adjusted hazard ratios (HRs) of all-cause mortality were 0.61, in the subgroup of robustness to pre/frailty, 0.51 in the subgroup of pre/frailty to robustness, and 0.41 in the subgroup of sustained robustness, respectively. The fully adjusted HRs of cardiovascular death were 0.79 in the subgroup of robustness to pre/frailty, 0.45 in the subgroup of pre/frailty to robustness and 0.51 in the subgroup of sustained robustness when comparing to the subgroup of sustained pre/frailty, respectively. Stratified analysis and extensive sensitivity analyses revealed similar results.
In conclusion, frailty is a dynamic process, and improved frailty and remaining robust are significantly associated with lower risk of all-cause mortality and cardiovascular death in older people.