Envejecimiento poblacional y fragilidad en el adulto mayor

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Abstract

El número de personas que en el mundo rebasa la edad de 60 años, aumentó a 700 millones en la década del año 90 del siglo XX, para el año 2025 se estima que existirán alrededor de 1 200 millones de ancianos. En el presente trabajo se expone el proceso de transición demográfica que tiene lugar y su clasificación, así como lo que representa este proceso para la especie humana. Se enuncian los tipos de envejecimiento humano y sus características esenciales. Se incursiona en la evolución histórica de la “fragilidad en el adulto mayor” y “anciano frágil” y se presentan las principales definiciones enunciadas por diversos autores que han tratado el tema. Se anexan los criterios cubanos de fragilidad. El trabajo muestra los diferentes criterios de fragilidad propuestos a nivel mundial agrupados en cuatro categorías: médicos, funcionales, mentales y sociodemográficos. Se presenta en una tabla original todos los criterios de los que se ha tenido conocimiento agrupados según estas categorías y por décadas en las que fueron postulados. Se expone en un gráfico una serie histórica del envejecimiento en Cuba y se alerta que del porcentaje de adultos mayores que hoy viven en el país se desconoce cuantos de ellos son considerados frágiles. El conocimiento de esta información es crucial en la planificación y desarrollo de estrategias de intervención en salud en la población de adultos mayores por parte del Sistema Nacional de Salud, el Gobierno y las propias comunidades

Translated abstract

The number of persons aged over 60 years worldwide increased to 700 millions in the 90´s of the 20 th century; it is estimated that by 2025 there will be around 1.2 billion elders. The present paper set forth the process of demographic transition that is taking place, its classification and meaning for the mankind. The types of human aging and their essential characteristics were stated. The historical evolution of “frailty of the elder” and “frail old man” together with the main definitions issued by several authors, who have addressed the topic, were presented. The Cuban criteria of frailty were also added. This paper presented the different criteria of frailty all over the world grouped into 4 categories -medical, functional, mental and sociodemographic-, and a table containing all these known criteria under these categories up to the present and by decades when they were formulated. A graph reflecting a historical series of aging in Cuba was included. It was warned that the number of frail elders out of the percentage of older people dwelling in Cuba was unknown. Therefore, knowing this information is crucial for the planning and development of health intervention strategies aimed at the older population by the national health system, the government and the communities as well

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Most cited references 94

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Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging.

D Hogan, Réjean Hébert, Kenneth Rockwood … (2004)

Frailty and fitness are important attributes of older persons, but population samples of their prevalence, attributes, and outcomes are limited. The authors report data from the community-dwelling sample (n = 9008) of the Canadian Study of Health and Aging, a representative, 5-year prospective cohort study. Fitness and frailty were determined by self-reported exercise and function level and testing of cognition. Among the community-dwelling elderly population, 171 per 1000 were very fit and 12 per 1000 were very frail. Frailty increased with age, so that by age 85 years and older, 44 per 1000 were very frail. The risk for adverse health outcomes increased markedly with frailty: Compared with older adults who exercise, those who were moderately or severely frail had a relative risk for institutionalization of 8.6 (95% confidence interval, 4.9 to 15.2) and for death of 7.3 (95% confidence interval, 4.7 to 11.4). These risks persist after adjustments for age, sex, comorbid conditions, and poor self-rated health. At all ages, men reported higher levels of exercise and less frailty compared with women. Decreased fitness and increased frailty were also associated with poor self-ratings of health (42% in the most frail vs 7% in the most fit), more comorbid illnesses (6 vs 3), and more social isolation (34% vs 29%). Fitness and frailty form a continuum and predict survival. Exercise influences survival, even in old age. Relative fitness and frailty can be determined quickly in a clinical setting, are potentially useful markers of the risk for adverse health outcomes, and add value to traditional medical assessments that focus on diagnoses.

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Operationalizing a frailty index from a standardized comprehensive geriatric assessment.

David M Jones, Xiaowei Song, Kenneth Rockwood (2004)

To construct and validate a frailty index (FI) that is clinically sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment (CGA) instrument. Secondary analysis of a 3-month randomized, controlled trial of a specialized mobile geriatric assessment team. Rural Nova Scotia. Participants were seen in their homes. Frail older adults, of whom 92 were in the intervention group and 77 in the control group. A standard CGA form that accounts for impairment, disability, and comorbidity burden was scored and summed as a frailty index (FI-CGA). The FI-GCA was stratified to describe three levels of frailty. Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes (institutionalization or mortality, whichever came first). The three levels of frailty were mild (FI-CGA 0-7), moderate (FI-CGA 7-13), and severe (FI-CGA>13). Demographic and social traits were similar across groups, but greater frailty was associated with worse function (r=0.55) and mental status (r=0.33). Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty (unadjusted hazard ratio=1.9 and 5.5, respectively). There was no difference between frailty groups in mean 3-month goal-attainment scaling scores. Intrarater reliability was 0.95. The FI-CGA is a valid, reliable, and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes.