Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study

• Published in: BMC public health 2024-08, Vol.24 (1), p.2141-13, Article 2141
• Main Authors: Yang, Mengjiao, Liu, Yang, Miura, Kumi Watanabe, Matsumoto, Munenori, Jiao, Dandan, Zhu, Zhu, Li, Xiang, Cui, Mingyu, Zhang, Jinrui, Qian, Meiling, Huang, Lujiao, Anme, Tokie
• Format: Article
• Language: English
• Subjects: Adults; Aged; Aged, 80 and over; Algorithms; Analysis; Bayes Theorem; Bayesian analysis; Cardiovascular disease; Cognitive ability; Comorbidity; Complications and side effects; Cross-Sectional Studies; Dementia; Diabetes; Discrimination; East Asian People; Empowerment; Exercise; Female; Females; Frail elderly; Frail Elderly - psychology; Frail Elderly - statistics & numerical data; Frailty; Frailty - epidemiology; Geriatric Assessment - methods; Health aspects; Humans; Independent Living; Japan - epidemiology; LASSO regression; Long-term care; Long-term care of the sick; Longitudinal Studies; Male; Medical research; Medicine, Experimental; Mental depression; Musculoskeletal diseases; Network analysis; Normal distribution; Nutritional status; Older people; Performance prediction; Physiological aspects; Physiological effects; Polypharmacy; Prediction model; Risk Factors; Sensitivity analysis; Social aspects; Social behavior; Social factors; Social networks; Social relationships; Sociodemographics; Statistical analysis; Variables; Well being
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-19697-y

Frailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults. We conducted a cross-sectional and longitudinal study using data from the "Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC)," which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs). At baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model's AUC was 0.943 (95%CI 0.913-0.974), indicating good discrimination, with Hosmer-Lemeshow (H-L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model's AUC was 0.722 (95%CI 0.656-0.788), indicating moderate discrimination, with H-L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%. Frailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social re