title: Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.
abstract: BACKGROUND
  Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic.
  
  
  OBJECTIVE
  To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults.
  
  
  METHODS
  Concurrent cohort study.
  
  
  METHODS
  Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain.
  
  
  METHODS
  Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data.
  
  
  METHODS
  Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3).
  
  
  RESULTS
  287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables.
  
  
  CONCLUSIONS
  In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.
authors.affiliation: Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: de la Rica-Escuín
authors.affiliation: Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: González-Vaca
authors.affiliation: Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: Rosana
authors.initials: R
authors.lastname: Varela-Pérez
authors.affiliation: Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Arjonilla-García
authors.affiliation: Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Silva-Iglesias
authors.affiliation: Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Oliver-Carbonell
authors.affiliation: Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. Electronic address: pabizanda@sescam.jccm.es.
authors.forename: Pedro
authors.initials: P
authors.lastname: Abizanda
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D006233:Persons with Disabilities; D005221:Fatigue; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D005684:Gait; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D009735:Nursing Homes; D057185:Sedentary Behavior; D013030:Spain / Q000453:epidemiology; D015431:Weight Loss
keywords: Disability; Frail elderly; Institutionalization; Mortality; Nursing home