The Improvement of Frail Index and Geriatric Syndromes after One-Year Follow-Up will Predict Next Year'S Improvement in Outpatient Older People with Chronic Diseases

Objectives: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Early intervention for preventing frailty is important. However, few studies have examined the predictors of better transition of frailty. In order to know that, we conducted a study to compare the second-year improvement of frailty with first-year transitions of different frailty index and geriatric assessment items in older people with chronic diseases. Methods: The elderly outpatients were recruited for a 2-year comprehensive geriatric assessment (CGA) study in a medical center. The frailty was evaluated by Fried Frailty Index (FFI) and Comprehensive Geriatric Assessment-Frailty index (CGA-FI). The CGA were done by structured questionnaire. The improvement of frailty by transition of different parameters was done by Chisquare test. Multivariate logistic regression will be done. Results: A total of 189 outpatients aged 65 and over were enrolled in this study. Total of 124 (65.6%) patients completed the study and 65 (34.4%) patients withdrew, including 12 (6.3%) deaths, and 5 (2.6%) were excluded for unable to complete the frailty index assessments. During the study period, 26 (21%) patients’ frailty improved (total score of FFI decreased more than 1 point) and 98 (79%) were maintained or became worse (total score of FFI not decreased or increased more than 1 point). The improvement of frailty was not associated with the severity of FFI or CGA-FI at baseline, but it was associated with the improvement of CGA-FI (P＜0.01) and each items of FFI separately, including improved weight loss (p＜0.01), improved self-report exhaustion (p＜0.01), improved physical activity (defined by increasing 20% total Kcals spent per week, p＜0.01), not decreased walking time (usual gait speed compared to baseline ＜ 1.0 m/s, p＜0.05), and not decreased grip strength (defined by not decreasing 20% total Kgs of grip strength compared to baseline, p＜0.01). The baseline severity or transition of Mini-Mental Status Examination score, Mini Nutritional Assessment score, Brief Symptom Rating Scale-5 score, Geriatric Depression Scale-15 score, and WONCA-COOPS score could not be used for prediction of next-year's improvement of frailty. Conclusions: Among the older people with chronic diseases, the second-year improvement of frailty is significantly associated with first-year improved CGA-FI scores and each items of FFI. The improvement of frailty is not associated with the baseline severity of CGA-FI or FFI, neither with the baseline severity or transition of MMSE, MNA, BSRS-5, GDS-15, or WONCA-COOPS. Further studies were needed to determine how effectiveness of better frailty transition for outcome prediction.