Prognostic impact of main frailty domain trajectories on 5-year mortality in very old adults: results from the PARTAGE cohort study

Abstract

The objectives were to identify trajectories of nutrition, cognitive function and autonomy over time in very old adults and to assess their impact on mortality. A cohort, including subjects aged≥80 years in 2007-2008, who were followed for 5 years, in 72 Italian and French nursing homes, was used for post-hoc analyses. Body mass index (BMI), Mini Mental State Examination (MMSE), and index of activities of daily living (ADL) were assessed at 4 time points. Vital status was collected during the follow-up. Latent trajectory and Cox models were used. In the 710 subjects included, the mean(SD) age at inclusion was 88.0(0.8) years, and 78.9% were female. Seven composite trajectories were identified based on BMI, MMSE, and ADL values. As compared to the reference group (T7—stable overweight, preserved cognitive function and autonomy), two trajectories presented increased relative risk of dying: T1, stable overweight, moderately impaired then declining cognitive function and autonomy (adjusted HR = 1.79, 95%CI: 1.26,2.55), and T6, stable normal BMI, slight cognitive decline, and moderate then degrading loss of autonomy (adjusted HR = 1.67, 95%CI: 1.15,2.44). C-index was 0.81, 95%CI: 0.72,0.88. A repeated monitoring of BMI, MMSE, and ADL in very old adults provides trajectories with higher prognostic information than simple baseline assessment.