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Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data

OBJECTIVES: Frailty is a multidimensional syndrome of loss of reserves in energy, physical ability, cognition and general health. Primary care is key in preventing and managing frailty, mindful of the social dimensions that contribute to its risk, prognosis and appropriate patient support. We studie...

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Autores principales: Mangin, Dee, Lawson, Jennifer, Risdon, Cathy, Siu, Henry Yu-Hin, Packer, Tamar, Wong, Sabrina T, Howard, Michelle
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944661/
https://www.ncbi.nlm.nih.gov/pubmed/36810183
http://dx.doi.org/10.1136/bmjopen-2022-066269
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author Mangin, Dee
Lawson, Jennifer
Risdon, Cathy
Siu, Henry Yu-Hin
Packer, Tamar
Wong, Sabrina T
Howard, Michelle
author_facet Mangin, Dee
Lawson, Jennifer
Risdon, Cathy
Siu, Henry Yu-Hin
Packer, Tamar
Wong, Sabrina T
Howard, Michelle
author_sort Mangin, Dee
collection PubMed
description OBJECTIVES: Frailty is a multidimensional syndrome of loss of reserves in energy, physical ability, cognition and general health. Primary care is key in preventing and managing frailty, mindful of the social dimensions that contribute to its risk, prognosis and appropriate patient support. We studied associations between frailty levels and both chronic conditions and socioeconomic status (SES). DESIGN: Cross-sectional cohort study SETTING: A practice-based research network (PBRN) in Ontario, Canada, providing primary care to 38 000 patients. The PBRN hosts a regularly updated database containing deidentified, longitudinal, primary care practice data. PARTICIPANTS: Patients aged 65 years or older, with a recent encounter, rostered to family physicians at the PBRN. INTERVENTION: Physicians assigned a frailty score to patients using the 9-point Clinical Frailty Scale. We linked frailty scores to chronic conditions and neighbourhood-level SES to examine associations between these three domains. RESULTS: Among 2043 patients assessed, the prevalence of low (scoring 1–3), medium (scoring 4–6) and high (scoring 7–9) frailty was 55.8%, 40.3%, and 3.8%, respectively. The prevalence of five or more chronic diseases was 11% among low-frailty, 26% among medium-frailty and 44% among high-frailty groups (χ(2)=137.92, df 2, p<0.001). More disabling conditions appeared in the top 50% of conditions in the highest-frailty group compared with the low and medium groups. Increasing frailty was significantly associated with lower neighbourhood income (χ(2)=61.42, df 8, p<0.001) and higher neighbourhood material deprivation (χ(2)=55.24, df 8, p<0.001). CONCLUSION: This study demonstrates the triple disadvantage of frailty, disease burden and socioeconomic disadvantage. Frailty care needs a health equity approach: we demonstrate the utility and feasibility of collecting patient-level data within primary care. Such data can relate social risk factors, frailty and chronic disease towards flagging patients with the greatest need and creating targeted interventions.
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spelling pubmed-99446612023-02-23 Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data Mangin, Dee Lawson, Jennifer Risdon, Cathy Siu, Henry Yu-Hin Packer, Tamar Wong, Sabrina T Howard, Michelle BMJ Open General practice / Family practice OBJECTIVES: Frailty is a multidimensional syndrome of loss of reserves in energy, physical ability, cognition and general health. Primary care is key in preventing and managing frailty, mindful of the social dimensions that contribute to its risk, prognosis and appropriate patient support. We studied associations between frailty levels and both chronic conditions and socioeconomic status (SES). DESIGN: Cross-sectional cohort study SETTING: A practice-based research network (PBRN) in Ontario, Canada, providing primary care to 38 000 patients. The PBRN hosts a regularly updated database containing deidentified, longitudinal, primary care practice data. PARTICIPANTS: Patients aged 65 years or older, with a recent encounter, rostered to family physicians at the PBRN. INTERVENTION: Physicians assigned a frailty score to patients using the 9-point Clinical Frailty Scale. We linked frailty scores to chronic conditions and neighbourhood-level SES to examine associations between these three domains. RESULTS: Among 2043 patients assessed, the prevalence of low (scoring 1–3), medium (scoring 4–6) and high (scoring 7–9) frailty was 55.8%, 40.3%, and 3.8%, respectively. The prevalence of five or more chronic diseases was 11% among low-frailty, 26% among medium-frailty and 44% among high-frailty groups (χ(2)=137.92, df 2, p<0.001). More disabling conditions appeared in the top 50% of conditions in the highest-frailty group compared with the low and medium groups. Increasing frailty was significantly associated with lower neighbourhood income (χ(2)=61.42, df 8, p<0.001) and higher neighbourhood material deprivation (χ(2)=55.24, df 8, p<0.001). CONCLUSION: This study demonstrates the triple disadvantage of frailty, disease burden and socioeconomic disadvantage. Frailty care needs a health equity approach: we demonstrate the utility and feasibility of collecting patient-level data within primary care. Such data can relate social risk factors, frailty and chronic disease towards flagging patients with the greatest need and creating targeted interventions. BMJ Publishing Group 2023-02-21 /pmc/articles/PMC9944661/ /pubmed/36810183 http://dx.doi.org/10.1136/bmjopen-2022-066269 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle General practice / Family practice
Mangin, Dee
Lawson, Jennifer
Risdon, Cathy
Siu, Henry Yu-Hin
Packer, Tamar
Wong, Sabrina T
Howard, Michelle
Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
title Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
title_full Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
title_fullStr Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
title_full_unstemmed Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
title_short Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
title_sort association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data
topic General practice / Family practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9944661/
https://www.ncbi.nlm.nih.gov/pubmed/36810183
http://dx.doi.org/10.1136/bmjopen-2022-066269
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