J.CHEW1, J. P. LIM1, S. YEW1, A. YEO1, N. H. ISMAIL1, Y. Y. DING1, W. S. LIM1
Tan Tock Seng Hospital1
Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by identifying subgroups based on frailty criteria and IC domains and studying one-year outcomes.
We studied 200 independent community-dwelling older adults (mean age 67.9±7.9 years). Frailty was defined by modified Fried criteria. Scores (range:0-2) were assigned to individual IC domains (cognition, psychological, locomotion, and vitality) to yield a total IC score of 8. To identify subgroups, two-step cluster analysis was performed with age, frailty and IC domains. Cluster associations with one-year outcomes (frailty, grip strength, Modified Barthel Index(MBI) and EuroQol (EQ)-5D)) were examined using multiple linear regression adjusted for age, gender and education.
Three distinct clusters were identified: Cluster 1 (C1): High IC/Robust (37%); Cluster 2 (C2): Intermediate IC/Prefrail (36.5%); Cluster 3 (C3): Low IC/Prefrail-Frail (26.5%). Comparing between clusters, IC domains, cognition, depressive symptoms, nutrition, strength and physical performance were least impaired in C1, intermediate in C2 and most impaired in C3. At one-year, proportion transitioning to frailty or remaining frail was highest in C3 compared to C2 and C1 (39% vs 6.9% vs 2.8%,P<.001). Compared to C1, C3 experienced greatest declines in grip strength (b=-4.1,P<.001), MBI (b=-1.24,P=.045) and EQ-5D (b=-0.053,P=.005), with C2 intermediate between C1 and C3.
IC is complementary to frailty measures through better risk-profiling of one-year outcomes amongst pre-frail individuals into intermediate and high-risk groups. The intermediate group merits follow-up to ascertain longer-term prognosis.