Prognostic impact of frailty on functional autonomy in older adults with hypertension

Objective: To date, few studies have evaluated frailty in older adults with hypertension and the most appropriate tool to quantify frailty in this population has yet to be identified. The present study aimed to investigate the prognostic impact of frailty on decline of functional autonomy in a sample of hypertensive older adults. Design and method: We performed a longitudinal observational study including patients aged 75 or older evaluated at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent a multidimensional geriatric assessment including frailty evaluation using three frailty scales (Fried Frailty Phenotype, Clinical Frailty Scale [CFS], Frailty Index) and two physical performance measures (gait speed and Short Physical Performance Battery [SPPB]). The primary outcome was reduction of autonomy in daily activities according to the Barthel Index (functional decline). The predictive performance of different frailty measures was evaluated based on ROC curve analysis, sensitivity, specificity and accuracy. Results: Among 99 hypertensive older adults (mean age 81, 59% women, median follow-up 13 months), functional decline occurred in 39% of patients. Participants with functional decline had a higher prevalence of cognitive impairment and frailty according to all the frailty scales used and a worse physical performance. Frailty Index and CFS showed the best predictive performance (AUC 0.715 and 0.708, respectively), followed by physical performance measures (AUC 0.691). All frailty measures showed good specificity (66-79%) and moderate sensitivity (54-70%). Gait speed showed the highest accuracy (71%) and achieved 57% sensitivity and 79% specificity, resulting in better predictive performance than the SPPB. Conclusions: The CFS and gait speed - easily applicable even in non-geriatric settings – may represent useful instrument to detect frailty and predict functional decline in hypertensive older adults.