OBJECTIVES

To identify subgroups of people with distinct frailty trajectories, identify baseline characteristics associated with these trajectories, and determine their coincident clinical outcomes.

DESIGN

This study examined the longitudinal database from the FREEDOM Cohort Study.

SETTING AND PARTICIPANTS

All 497 participants of the FREEDOM (French Acronym for "FRagilitéEtEvaluation àDOMicile" / In English "Frailty and Evaluation at Home") cohort requested a comprehensive geriatric assessment. Community-dwelling subjects over 75 years, or over 65 years with at least two comorbidities were included.

METHODS

Frailty was assessed using Fried's criteria, depression using the Geriatric Depression Scale (GDS) and cognitive function using the Mini Mental State Examination (MMSE) questionnaire. Frailty trajectories were modelled using k-means algorithms. Predictive factors were determined by multivariate logistic regression. Clinical outcomes included incident cognitive deficit, falls and hospitalization.

RESULTS

The trajectory models allowed determine four frailty trajectories: "robust stable" (Trajectory A, 26.8%), "pre-frail worsening to frailty" (Trajectory B, 35.8%), "frail improving to less frailty" (Trajectory C, 23.3%), and "frail worsening to more frailty" (Trajectory D, 14.1%). Trajectory B was associated with age (OR 1.2 (95CI, 1.05 - 1.17)), potential cognitive deficit/dementia (OR 2.01 (95CI, 1.01- 4.05)) and depressive symptoms (OR 2.36 (95CI, 1.36 - 4.12)). Hypertension was distinguishing factor between" trajectory B vs. C and D. Depressive symptoms were two time more associated with D (OR 10.51) vs. C (OR 4.55). The incidence of clinical outcomes was significantly increased in poor frailty trajectories.

CONCLUSIONS AND IMPLICATIONS

This study allowed to determine frailty trajectories among older subjects requested a comprehensive geriatric assessment. The more significant predictive factors associated with poor frailty trajectory were advanced in age, potential cognitive deficit/dementia, depressive symptoms and hypertension. This emphasizes the need for adequate measures to controlled hypertension, depressive symptoms and to maintain or improve cognition in older adults.