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Risk Factors of Progression to Frailty: Findings from the Singapore Longitudinal Ageing Study

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To investigate risk factors of incident physical frailty.

Design

A population-based observational longitudinal study.

Setting

Community-dwelling elderly with age 55 years and above recruited from 2009 through 2011 in the second wave Singapore Longitudinal Ageing Study-2 (SLAS-2) were followed up 3–5 years later.

Participants

A total of 1297 participants, mean age of 65.6 ±0.19, who were free of physical frailty.

Measurements

Incident frailty defined by three or more criteria of the physical phenotype used in the Cardiovascular Health Study was determined at follow-up. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological factors, and biochemical markers.

Results

A total of 204 (15.7%) participants, including 81 (10.87%) of the robust and 123 (22.28%) of the prefrail transited to frailty at follow-up. Age, no education, MMSE score, diabetes, prediabetes and diabetes, arthritis, ≥5 medications, fair and poor self-rated health, moderate to high nutritional risk (NSI ≥3), Hb (g/dL), CRP (mg/L), low B12, low folate, albumin (g/L), low total cholesterol, adjusted for sex, age and education, were significantly associated (p<0.05) with incident frailty. In stepwise selection models, age (year) (OR=1.07, 95%CI=1.03–1.10, p<0.001), albumin (g/L) (OR=0.85, 95%CI=0.77–0.94, p=0.002), MMSE score (OR=0.88, 95%CI=0.78–0.98, p=0.02), low folate (OR=3.72, 95%CI=1.17–11.86, p=0.03, and previous hospitalization (OR=2.26, 95%CI=1.01–5.04,p=0.05) were significantly associated with incident frailty.

Conclusions

The study revealed multiple modifiable risk factors, especially related to poor nutrition, for which preventive measures and early management could potentially halt or delay the development of frailty.

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Acknowledgments

We thank the following voluntary welfare organizations for their support: Geylang East Home for the Aged, Presbyterian Community Services, St Luke’s Eldercare Services, Thye Hua Kwan Moral Society (Moral Neighbourhood Links), Yuhua Neighbourhood Link, Henderson Senior Citizens’ Home, NTUC Eldercare Co-op Ltd, Thong Kheng Seniors Activity Centre (Queenstown Centre) and Redhill Moral Seniors Activity Centre.

Funding

Declaration of Sources of Funding: The study was supported by research grants from the Agency for Science Technology and Research (A*STAR) Biomedical Research Council (BMRC) [Grant: 08/1/21/19/567] and from the National Medical Research Council [Grant: NMRC/1108/2007].

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Authors and Affiliations

  1. Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore

    C. Y. Cheong

  2. Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    M. S. Z. Nyunt, Q. Gao, X. Gwee & Tze-Pin Ng

  3. Geriatric Education and Research Institute, Singapore, Singapore

    C. Y. Cheong, R. W. M. Choo, S. L. Wee & Tze-Pin Ng

  4. Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore, Singapore

    K. B. Yap

  5. Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore

    S. L. Wee

  6. Gerontology Research Programme, National University of Singapore, Department of Psychological Medicine, NUHS Tower Block, 9th Floor, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Tze-Pin Ng

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Contributions

Author contributions: CYC, RWMC and NTP analysed the data. CYC and TPN reviewed the literature, designed the study, drafted and revised the manuscript. MSZN, QG, XYG, KBY, PY, SLW contributed to the study design, data collection, reviewed the results and drafts of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tze-Pin Ng.

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Declaration of Conflict of interest: The authors declare that they have no conflicts of interest.

Ethical standards: Ethics approval was obtained from the National University of Singapore Institutional Review Board.

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Role of the Sponsors: The sponsors had no role in the conduct of the study or preparation of this manuscript.

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Cheong, C.Y., Nyunt, M.S.Z., Gao, Q. et al. Risk Factors of Progression to Frailty: Findings from the Singapore Longitudinal Ageing Study. J Nutr Health Aging 24, 98–106 (2020). https://doi.org/10.1007/s12603-019-1277-8

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