Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States
Fecha
2023
Tipo
artículo original
Autores
Santamaría Ulloa, Carolina
Lehning, Amanda J.
Cortés Ortiz, Mónica V.
Méndez Chacón, Ericka
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Resumen
Background Frailty is a common condition among older adults that results from aging-related declines in multiple
systems. Frailty increases older adults’ vulnerability to negative health outcomes, including loss of mobility, falls,
hospitalizations, and mortality. The aim of this study is to examine the association between frailty and mortality in
older adults from Costa Rica and the United States.
Methods This prospective cohort study uses secondary nationally-representative data of community-dwelling
older adults from the Costa Rican Longevity and Healthy Aging Study (CRELES, n=1,790) and the National Health &
Aging Trends Study (NHATS, n=6,680). Frailty status was assessed using Physical Frailty Phenotype, which includes
the following five criteria: shrinking, exhaustion, low physical activity, muscle weakness, and slow gait. We used
Cox proportional hazard models to examine the association between frailty and all-cause mortality, including
sociodemographic characteristics and health behaviors as covariates in the models. Mortality follow-up time was right
censored at 8 years from the date at baseline interview.
Results The death hazard for frail compared to non-frail older adults was three-fold in Costa Rica (HR=3.14, 95% CI:
2.13–4.62) and four-fold in the White US (HR=4.02, 95% CI: 3.04–5.32). Older age, being male, and smoking increased
mortality risk in both countries. High education was a protective factor in the US, whereas being married/in union was
a protective factor in Costa Rica. In the US, White older adults had a lower risk of death compared to all other races
and ethnicities.
Conclusions Results indicate that frailty can have a differential impact on mortality depending on the country.
Access to universal health care across the life course in Costa Rica and higher levels of stress and social isolation in the
US may explain differences observed in end-of-life trajectories among frail older adults.
Descripción
Palabras clave
ADULTS, MORTALITY, FRAILTY, AGING, OLD AGE, COSTA RICA, USA