title: Prevalence and incidence of frailty in Aboriginal Australians, and associations with mortality and disability.
abstract: OBJECTIVE
  Frailty represents a loss of homeostasis, markedly increasing the risk of death and disability. Frailty has been measured in several ethnic groups, but not, to our knowledge, in Aboriginal Australians. We aimed to determine the prevalence and incidence of frailty, and associations with mortality and disability, in remote-living Aboriginal people.
  
  
  METHODS
  Between 2004 and 2006, we recruited 363 Aboriginal people aged ≥ 45 years from 6 remote communities and one town in the Kimberley region of Western Australia (wave 1). Between 2011 and 2013, 182 surviving participants were followed-up (wave 2). We assessed frailty with an index, comprising 20 health-related items. Participants with ≥ 4 deficits (frailty index ≥ 0.2) were considered frail. Disability was assessed by family/carer report. Those unable to do ≥ 2 of 6 key or instrumental activities of daily living were considered disabled. We investigated associations between frailty, and disability and mortality, with logistic regression and Cox proportional hazards models.
  
  
  RESULTS
  At wave 1 (W1), 188 participants (65.3%) were frail, and of robust people at W1 who participated in wave 2, 38 (51.4%) had become frail. Frailty emerged at a younger age than expected. A total of 109 people died (30.0%), of whom 80 (73.4%) were frail at W1. Frailty at W1 was not associated with becoming disabled, but was associated with mortality (HR = 1.9; 95% CI 1.2, 3.0).
  
  
  CONCLUSIONS
  Frailty in remote-living Aboriginal Australians is highly prevalent; substantially higher than in other populations. Research to understand the underlying causes of frailty in this population, and if possible, reverse frailty, is urgently needed.
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Zoë
authors.initials: Z
authors.lastname: Hyde
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Leon
authors.initials: L
authors.lastname: Flicker
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Smith
authors.affiliation: Rural Clinical School of WA, University of Western Australia, Perth, Australia; Kimberley Aboriginal Medical Services, Broome, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Atkinson
authors.affiliation: Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fenner
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Skeaf
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Malay
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia; Aged Care Department, Melbourne Health, Melbourne, Australia. Electronic address: dina.logiudice@mh.org.au.
authors.forename: Dina
authors.initials: D
authors.lastname: Lo Giudice
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015995:Prevalence; D016016:Proportional Hazards Models
keywords: Aboriginal; Ageing; Frailty; Indigenous; Older people