The dynamics of frailty development and progression in older adults in primary care in England (2006 – 2017): a retrospective cohort profile
The dynamics of frailty development and progression in older adults in primary care in England (2006 – 2017): a retrospective cohort profile
Background: frailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to describe the epidemiology of frailty and understand the dynamics of frailty within individuals and across the population. This article describes the structure of the dataset, cohort characteristics and planned analyses.
Methods: retrospective cohort study using electronic health records. Participants were aged ≥50 years registered in practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre between 2006 to 2017. Data include GP practice details, patient sociodemographic and clinical characteristics, twice-yearly electronic Frailty Index (eFI), deaths, medication use and primary and secondary care health service use. Participants in each cohort year by age group, GP and patient characteristics at cohort entry are described.
Results: the cohort includes 2,177,656 patients, contributing 15,552,946 person-years, registered at 419 primary care practices in England. The mean age was 61 years, 52.1% of the cohort was female, and 77.6% lived in urban environments. Frailty increased with age, affecting 10% of adults aged 50–64 and 43.7% of adults aged ≥65. The prevalence of long-term conditions and specific frailty deficits increased with age, as did the eFI and the severity of frailty categories.
Conclusion: a comprehensive understanding of frailty dynamics will inform predictions of current and future care needs to facilitate timely planning of appropriate interventions, service configurations and workforce requirements. Analysis of this large, nationally representative cohort including participants aged ≥50 will capture earlier transitions to frailty and enable a detailed understanding of progression and impact. These results will inform novel simulation models which predict future health and service needs of older people living with frailty. Study registration: Registered on www.clinicaltrials.gov October 25th 2019, NCT04139278.
Adults, Cohort study, Computer simulation modelling, Electronic health records, Frailty, Primary care, Service use, Trajectories
Fogg, Carole
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Fraser, Simon
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Roderick, Paul
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de Lusignan, Simon
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Clegg, Andrew
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Brailsford, Sally
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Barkham, Abigail
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Patel, Harnish
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Windle, Vivienne
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Harris, Scott
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Zhu, Shihua
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England, Tracey
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Evenden, Dave
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Lambert, Francesca
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Walsh, Bronagh
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6 January 2022
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
de Lusignan, Simon
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Clegg, Andrew
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Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Barkham, Abigail
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Patel, Harnish
e1c0826f-d14e-49f3-8049-5b945d185523
Windle, Vivienne
7e59717a-e7be-49e2-b234-3aa6b65d9a3a
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Zhu, Shihua
13511f9c-151c-483c-9dfd-2da13421db5c
England, Tracey
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Evenden, Dave
5cd6f0ab-5269-447c-af32-01edac9c905d
Lambert, Francesca
0e60e1b4-7c8d-4182-9f18-e984a85d1157
Walsh, Bronagh
5818243e-048d-4b4b-88c5-231b0e419427
Fogg, Carole, Fraser, Simon, Roderick, Paul, de Lusignan, Simon, Clegg, Andrew, Brailsford, Sally, Barkham, Abigail, Patel, Harnish, Windle, Vivienne, Harris, Scott, Zhu, Shihua, England, Tracey, Evenden, Dave, Lambert, Francesca and Walsh, Bronagh
(2022)
The dynamics of frailty development and progression in older adults in primary care in England (2006 – 2017): a retrospective cohort profile.
BMC Geriatrics, 22 (1), [30].
(doi:10.1186/s12877-021-02684-y).
Abstract
Background: frailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to describe the epidemiology of frailty and understand the dynamics of frailty within individuals and across the population. This article describes the structure of the dataset, cohort characteristics and planned analyses.
Methods: retrospective cohort study using electronic health records. Participants were aged ≥50 years registered in practices contributing to the Oxford Royal College of General Practitioners Research and Surveillance Centre between 2006 to 2017. Data include GP practice details, patient sociodemographic and clinical characteristics, twice-yearly electronic Frailty Index (eFI), deaths, medication use and primary and secondary care health service use. Participants in each cohort year by age group, GP and patient characteristics at cohort entry are described.
Results: the cohort includes 2,177,656 patients, contributing 15,552,946 person-years, registered at 419 primary care practices in England. The mean age was 61 years, 52.1% of the cohort was female, and 77.6% lived in urban environments. Frailty increased with age, affecting 10% of adults aged 50–64 and 43.7% of adults aged ≥65. The prevalence of long-term conditions and specific frailty deficits increased with age, as did the eFI and the severity of frailty categories.
Conclusion: a comprehensive understanding of frailty dynamics will inform predictions of current and future care needs to facilitate timely planning of appropriate interventions, service configurations and workforce requirements. Analysis of this large, nationally representative cohort including participants aged ≥50 will capture earlier transitions to frailty and enable a detailed understanding of progression and impact. These results will inform novel simulation models which predict future health and service needs of older people living with frailty. Study registration: Registered on www.clinicaltrials.gov October 25th 2019, NCT04139278.
Text
The dynamics of frailty in older people
- Accepted Manuscript
Text
s12877-021-02684-y
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More information
Accepted/In Press date: 8 November 2021
Published date: 6 January 2022
Additional Information:
Funding Information:
AC is part-funded by the National Institute for Health Research Applied Research Collaboration Yorkshire & Humber, and Health Data Research UK, an initiative funded by UK Research and Innovation Councils, National Institute for Health Research and the UK devolved administrations, and leading medical research charities.
Funding Information:
The authors would like to thank patients and practices who are members of the RCGP RSC and who allow data sharing for this and other research; EMIS, TPP, In Practice and Wellbeing for their assistance with the RSC’s pseudonymised data extract; and Filipa Ferreira, John Williams and Julian Sherlock from the RCGP RSC team for their assistance with the data specification and data extraction. AC is part-funded by the National Institute for Health Research Applied Research Collaboration Yorkshire & Humber, and Health Data Research UK, an initiative funded by UK Research and Innovation Councils, National Institute for Health Research and the UK devolved administrations, and leading medical research charities. The views expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.
Funding Information:
This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme, award HS&DR 16/116/43. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2022, The Author(s).
Keywords:
Adults, Cohort study, Computer simulation modelling, Electronic health records, Frailty, Primary care, Service use, Trajectories
Identifiers
Local EPrints ID: 452887
URI: http://eprints.soton.ac.uk/id/eprint/452887
ISSN: 1471-2318
PURE UUID: 28e79f9e-b4ff-48cc-b165-c01727f57ca6
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Date deposited: 06 Jan 2022 17:40
Last modified: 17 Mar 2024 04:05
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Author:
Simon de Lusignan
Author:
Andrew Clegg
Author:
Abigail Barkham
Author:
Harnish Patel
Author:
Vivienne Windle
Author:
Dave Evenden
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