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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
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
1471-2318
30
Fogg, Carole
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Fraser, Simon
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Roderick, Paul
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de Lusignan, Simon
ff8f6923-47a6-4c8e-8f12-c0517e6e3724
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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Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
de Lusignan, Simon
ff8f6923-47a6-4c8e-8f12-c0517e6e3724
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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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, [30]. (doi:10.1186/s12877-021-02684-y).

Record type: Article

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.

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The dynamics of frailty in older people - Accepted Manuscript
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Accepted/In Press date: 8 November 2021
Published date: 6 January 2022
Additional Information: Funding 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.
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
ORCID for Carole Fogg: ORCID iD orcid.org/0000-0002-3000-6185
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Sally Brailsford: ORCID iD orcid.org/0000-0002-6665-8230
ORCID for Harnish Patel: ORCID iD orcid.org/0000-0002-0081-1802
ORCID for Dave Evenden: ORCID iD orcid.org/0000-0002-6798-648X
ORCID for Francesca Lambert: ORCID iD orcid.org/0000-0003-0327-4325
ORCID for Bronagh Walsh: ORCID iD orcid.org/0000-0003-1008-0545

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Date deposited: 06 Jan 2022 17:40
Last modified: 10 Jun 2022 01:53

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Contributors

Author: Carole Fogg ORCID iD
Author: Simon Fraser ORCID iD
Author: Paul Roderick ORCID iD
Author: Simon de Lusignan
Author: Andrew Clegg
Author: Abigail Barkham
Author: Harnish Patel ORCID iD
Author: Vivienne Windle
Author: Scott Harris
Author: Shihua Zhu
Author: Tracey England
Author: Dave Evenden ORCID iD
Author: Bronagh Walsh ORCID iD

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