Association of frailty and pre-frailty with increased risk of mortality among older Canadians

Frailty is a complex syndrome that is associated with aging but not synonymous with the normal aging process. It has been associated with all-cause mortality, but less is known about frailty and mortality from specific causes.

Data from the 2013 and 2014 Canadian Community Health Survey (CCHS) linked to the Canadian Vital Statistics - Death Database were used to estimate the prevalence of frailty among Canadians aged 65 or older. Levels of frailty were based on validated cut-points for the 30-item frailty index. The relationship of frailty to mortality risk during the period of three to five years following the CCHS interview was assessed with Cox proportional hazards models adjusted for sociodemographic factors and health behaviours. Associations between frailty and mortality from neoplasms, circulatory diseases and disease of the respiratory system were examined in separate models.

An estimated 1.1 million (22%) community-dwelling older adults were frail in 2013 and 2014, and another 1.6 million (32%) were considered pre-frail. Frailty was more common among females than males and among those in older age groups. The risk of mortality increased significantly with increasing levels of frailty, even after accounting for sociodemographic factors and health behaviours. This was the case for all-cause mortality, as well as for death from three major underlying causes-neoplasms, and diseases of the circulatory and respiratory systems.

Even individuals who were classified as pre-frail had an increased risk of mortality overall and from three leading causes compared with those who were robust, demonstrating the importance of screening community-dwelling older adults for frailty.