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Published on: July 24, 2013
Analysis of frailty determinants in chronic stroke patients
Ioan Chirap-Mitulschi1,2, Sabina Antoniu1
1Department of Medicine II/Nursing-Palliative Care, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania.
Objective:
Frailty is becoming more widely acknowledged as a critical factor that impacts the quality of life and health outcomes of patients with chronic conditions, including those who have experienced a stroke. This study aims to analyze the determinants of frailty in a prospective cohort of chronic stroke patients undergoing rehabilitation via relevant clinical, functional, and quality-of-life measures.
Methods:
In this prospective study, 124 chronic stroke patients (mean age: 63.3 years, SD = 10.5) were assessed for frailty using the Edmonton Frailty Scale (EFS). Variables included age, stroke severity indices, functional status, and quality of life. Descriptive and inferential analyses was performed.
Results:
The majority (81.5%) of patients had ischemic strokes. Frail patients were older (mean age: 64.6 vs. 55.2 years, p < 0.005), had more severe strokes (modified Rankin scale (mRS) 3.87 vs. 2.53, p < 0.005; National Institutes of Health Stroke Scale (NIHSS) 6.08 vs. 3.47, p < 0.005), greater functional impairment (Barthel Index 52.9 vs. 80.6, p < 0.005), and lower quality of life (2.78 vs. 4.02, p < 0.005). Logistic regression showed that advanced age and lower self-efficacy significantly predicted frailty (age: OR = 1.1, 95% CI: 1.01-1.21; Stroke Self-Efficacy Questionnaire (SSEQ): OR = 0.72, 95% CI: 0.55-0.95). The ROC analysis demonstrated that age had an AUC of 0.742 (95% CI: 0.65-0.86, p < 0.001), whereas the AUC for SSEQ was 0.924 (95% CI: 0.86-0.96, p < 0.001).
Conclusions:
In patients with chronic stroke, frailty, as measured with the EFS, is best predicted by age and by the stroke-related impaired self-efficacy. Interestingly, the latter is a stronger frailty predictor, especially in younger patients. These findings indicate that both physiological and disease-related functional declines contribute to the development of frailty. However, additional longitudinal studies are necessary to validate the causal association and to account for potential confounding factors like depression or social support.
