Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017
Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017
Introduction: frailty is common in older adults and is associated with increased health and social care use. Longitudinal information is needed on population-level incidence, prevalence and frailty progression to plan services to meet future population needs. Methods: retrospective open cohort study using electronic health records of adults aged ≥50 from primary care in England, 2006–2017. Frailty was calculated annually using the electronic Frailty Index (eFI). Multistate models estimated transition rates between each frailty category, adjusting for sociodemographic characteristics. Prevalence overall for each eFI category (fit, mild, moderate and severe) was calculated. Results: the cohort included 2,171,497 patients and 15,514,734 person-years. Frailty prevalence increased from 26.5 (2006) to 38.9% (2017). The average age of frailty onset was 69; however, 10.8% of people aged 50–64 were already frail in 2006. Estimated transitions from fit to any level of frailty were 48/1,000 person-years aged 50–64, 130/1,000 person-years aged 65–74, 214/1,000 person-years aged 75–84 and 380/1,000 person-years aged ≥ 85. Transitions were independently associated with older age, higher deprivation, female sex, Asian ethnicity and urban dwelling. Mean time spent in each frailty category decreased with age, with the longest period spent in severe frailty at all ages. Conclusions: frailty is prevalent in adults aged ≥50 and time spent in successive frailty states is longer as frailty progresses, resulting in extended healthcare burden. Larger population numbers and fewer transitions in adults aged 50–64 present an opportunity for earlier identification and intervention. A large increase in frailty over 12 years highlights the urgency of informed service planning in ageing populations.
ageing population, frailty, incidence, older people, prevalence, transitions
1-9
Walsh, Bronagh
5818243e-048d-4b4b-88c5-231b0e419427
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
de Lusignan, Simon
ff8f6923-47a6-4c8e-8f12-c0517e6e3724
England, Tracey
8f99b32a-1670-4e20-b6c6-30ae96940ca2
Clegg, Andrew
5a338a9b-4a35-4de1-8f32-5cb5166f3745
Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
2 May 2023
Walsh, Bronagh
5818243e-048d-4b4b-88c5-231b0e419427
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
de Lusignan, Simon
ff8f6923-47a6-4c8e-8f12-c0517e6e3724
England, Tracey
8f99b32a-1670-4e20-b6c6-30ae96940ca2
Clegg, Andrew
5a338a9b-4a35-4de1-8f32-5cb5166f3745
Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Walsh, Bronagh, Fogg, Carole, Harris, Scott, Roderick, Paul, de Lusignan, Simon, England, Tracey, Clegg, Andrew, Brailsford, Sally and Fraser, Simon
(2023)
Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017.
Age and Ageing, 52 (5), , [afad058].
(doi:10.1093/ageing/afad058).
Abstract
Introduction: frailty is common in older adults and is associated with increased health and social care use. Longitudinal information is needed on population-level incidence, prevalence and frailty progression to plan services to meet future population needs. Methods: retrospective open cohort study using electronic health records of adults aged ≥50 from primary care in England, 2006–2017. Frailty was calculated annually using the electronic Frailty Index (eFI). Multistate models estimated transition rates between each frailty category, adjusting for sociodemographic characteristics. Prevalence overall for each eFI category (fit, mild, moderate and severe) was calculated. Results: the cohort included 2,171,497 patients and 15,514,734 person-years. Frailty prevalence increased from 26.5 (2006) to 38.9% (2017). The average age of frailty onset was 69; however, 10.8% of people aged 50–64 were already frail in 2006. Estimated transitions from fit to any level of frailty were 48/1,000 person-years aged 50–64, 130/1,000 person-years aged 65–74, 214/1,000 person-years aged 75–84 and 380/1,000 person-years aged ≥ 85. Transitions were independently associated with older age, higher deprivation, female sex, Asian ethnicity and urban dwelling. Mean time spent in each frailty category decreased with age, with the longest period spent in severe frailty at all ages. Conclusions: frailty is prevalent in adults aged ≥50 and time spent in successive frailty states is longer as frailty progresses, resulting in extended healthcare burden. Larger population numbers and fewer transitions in adults aged 50–64 present an opportunity for earlier identification and intervention. A large increase in frailty over 12 years highlights the urgency of informed service planning in ageing populations.
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Accepted/In Press date: 25 February 2023
Published date: 2 May 2023
Additional Information:
Funding Information:
This project is funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme, award HS&DR. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
The authors would like to thank: the patients and practices of the Oxford-RCGP RSC who allowed sharing of pseudonymised data for research and disease surveillance; EMIS, TPP and Wellbeing for assistance with the extraction of pseudonymised data; and F.F., J.W. and J.S. from the RCGP RSC team for their assistance with the data specification and data extraction. The RSC is supported by UK Health Security Agency (UKHSA).
Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Keywords:
ageing population, frailty, incidence, older people, prevalence, transitions
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Local EPrints ID: 476672
URI: http://eprints.soton.ac.uk/id/eprint/476672
ISSN: 0002-0729
PURE UUID: d3c60ce7-97b4-4bca-9eb3-bc15930b4ef4
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Date deposited: 11 May 2023 16:30
Last modified: 18 Jun 2024 02:00
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Author:
Simon de Lusignan
Author:
Andrew Clegg
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