title: Determinants of frailty: the added value of assessing medication.
abstract: This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0-4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.
authors.affiliation: Department of Occupational Therapy, School of Allied Health Technologies, Polytechnic Institute of Porto, Vila Nova de Gaia Portugal ; The Research and Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Coelho
authors.affiliation: The Research and Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto Portugal.
authors.forename: Constança
authors.initials: C
authors.lastname: Paúl
authors.affiliation: Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam Netherlands ; Zonnehuisgroep Amstelland, Amstelveen Netherlands.
authors.forename: Robbert J J
authors.initials: RJ
authors.lastname: Gobbens
authors.affiliation: Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto Portugal.
authors.forename: Lia
authors.initials: L
authors.lastname: Fernandes
keywords: comorbidity; determinants; elderly; frailty; medication