Multiple Chronic Conditions Accumulating Over Time Lead To Frailty Interview with:

Alanna Chamberlain, PhD Assistant Professor of Epidemiology Mayo Clinic College of Medicin

Dr. Alanna Chamberlain

Alanna Chamberlain, PhD
Assistant Professor of Epidemiology
Mayo Clinic College of Medicine What is the background for this study?

Dr. Chamberlain: The number of elderly individuals in the US will double by the year 2050 and these individuals will become increasingly frail as they get older. Frailty has been recognized by doctors and researchers as an important contributor to poor health and declines in quality of life among older adults. However, it is difficult to measure frailty because it’s not due to a single condition. Instead, multiple health problems tend to accumulate over time until a person becomes increasingly frail. It is important to understand how frailty develops as patients age and how changes in frailty are related to outcomes. To address these questions, we followed individuals over 8 years to identify changes in frailty over time, to describe how people cluster (follow similar trajectories of frailty over time), and to examine how these changes relate to emergency department visits, hospitalizations, and death in a large population from Olmsted County, MN. What are the main findings?

Dr. Chamberlain: We created a simple frailty index that incorporated 32 deficits available in the electronic health record: body mass index, 17 chronic diseases, and problems with 14 activities of daily living. The frailty index was calculated as the proportion of deficits present and was calculated once a year for 8 years. We found that the frailty index increased with older age, equating to 1 extra deficit for those aged 70-79 and 2.5 extra deficits among those aged 80-89 compared to 60-69 year olds. We also observed greater variability in frailty in the youngest age group (60-69 at baseline), with 3 different clusters (frailty trajectories) observed, whereas only 2 frailty trajectories were observed in the 70-79 and 80-89 year olds. Within each age group, those in the highest frailty trajectory had the highest rates of hospitalization, emergency department visits, and death. What should clinicians and patients take away from your report?

Dr. Chamberlain: We observed that different people in our study had different patterns of frailty. Over time, patients acquired additional chronic conditions and more problems with activities of daily living, but some patients became frail more rapidly than others. In addition, individuals in the highest frailty trajectory had a lot of cardiovascular conditions, including hypertension, hyperlipidemia, arrhythmias, and coronary artery disease, as well as diabetes and arthritis. Thus, it is important to both manage existing conditions and to increase prevention efforts to reduce the accumulation of additional conditions at all ages. Since cardiovascular conditions were the most common conditions in our population, intervening to manage these conditions and to prevent the development of new cardiovascular conditions could reduce frailty. What recommendations do you have for future research as a result of this study?

Dr. Chamberlain: Future research is needed to better understand if there are other factors associated withthe development of frailty, including social and behavioral factors. The identification of factors predicting frailty may inform the design of interventions aimed at reducing frailty or slowing the progression of frailty. Thank you for your contribution to the community.


J Am Geriatr Soc. 2016 Feb;64(2):285-92. doi: 10.1111/jgs.13944.

Frailty Trajectories in an Elderly Population-Based Cohort.

Chamberlain AM1, Finney Rutten LJ1,2, Manemann SM1, Yawn BP3, Jacobson DJ1,2, Fan C1, Grossardt BR1, Roger VL1,2,4, St Sauver JL1,2.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Alanna Chamberlain, PhD (2016). Multiple Chronic Conditions Accumulating Over Time Lead To Frailty