Short-term frailty fluctuations in later life

This research project focuses on short-term changes in health in late-life. Using a frailty index based on more than 30 health deficits (e.g. chronic diseases, physical and psychological symptoms, limitations in activities of daily living), fluctuations in the overall health status over the course of weeks among older persons aged 75 years and above will be assessed. From the age-eligible community-dwelling population in Austria, 400 randomly-selected individuals will be interviewed up to 14 times in total over the course of two separated three-months observation periods. This project aims (1) to assess how large short-term health fluctuations are, (2) to analyze which factors are associated with short-term fluctuations in health, and (3) to evaluate whether measured short-term fluctuations in health can help predict mid- and long-term health deterioration that results in admissions to hospitals and nursing care homes as well as death. The principal investigator of the project will be Dr. Erwin Stolz, a gerontologist from the Medical University of Graz. As a collaborator, Dr. Emiel Hoogendijk, an epidemiologist from VU University Amsterdam, will join the project in 2023-2024.

The FWF-funded research project Short-term frailty fluctuations in later life (P 33673) focusses on short-term changes in health status across weeks and months in older adults. Specifically, 426 community-dwelling older adults (average age: 77.7 years) in Austria have been interviewed biweekly in person and via telephone between September 2021 and April 2023 regarding potential health problems. On average, these older adults provided information on their health status 13 times. In the first study (https://doi.org/10.1093/gerona/glad227) based on these data, we assessed how reliable a common geriatric instrument (frailty index) is for measuring frailty in old age. We could show that while the instrument was highly reliable when it comes to differentiate between robust and frail older adults - which is important for patient-centered care - it was less suited for clinical monitoring due to existing short-term fluctuations. In the second study, (https://doi.org/10.1093/ageing/afae170) we analyzed if frail older adults have more unstable disability, that is, ups and downs with regard to activities of daily living such as taking a shower or shopping compared to their robust counterparts. We could show that frail older adults were not only more disabled on average, but that they also had more short-term disability fluctuations - that is, more fluctuating care needs - across weeks and months compared to robust older adults. In the third study (https://doi.org/10.1101/2024.10.09.24315145), we analysed short-term fluctuations in older adults' health status in detail. We could show that older adults had, on average, 7 health problems and that this number fluctuated over weeks and months by 2. The older a person was and the more health problems they had, the more short-term fluctuations they showed. Short-term fluctuations in overall health status were more prevalent among individuals with chronic heart or lung disease as well as those with dementia, diabetes, and arthritis, stemmed particularly from fluctuations in physical and cognitive functioning, and were associated with acute health problems. Short-term health fluctuations can be seen as a concomitant phenomenon of the aging process, of which researchers and clinicians should be aware of. In two additional studies based on the data gathered in this research project, we showed that short-term changes in health status among older adults go together with short-term changes in loneliness (https://doi.org/10.1101/2024.10.07.24314990) and that higher loneliness was associated with an accelerated increase in depressive symptoms over weeks in older women but not men (https://doi.org/10.1016/j.archger.2024.105423).