Frailty and type of death among older adults in China: prospective cohort studyBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1175 (Published 09 April 2009) Cite this as: BMJ 2009;338:b1175
- Matthew E Dupre, sociologist1,
- Danan Gu, demographer2,
- David F Warner, sociologist3,
- Zeng Yi, demographer45
- 1Department of Sociology and Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA
- 2Urban Studies and Planning, Portland State University, 506 SW Mill Street 570M, Portland, OR 97207, USA
- 3Department of Sociology, Case Western Reserve University, Cleveland, OH
- 4Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC
- 5China Center for Economic Research, Peking University, Beijing, China
- Correspondence to: M E Dupre or D Gu
- Accepted 11 December 2008
Objective To examine the association between frailty and type of death among the world’s largest oldest-old population in China.
Design Prospective cohort study.
Setting 2002 and 2005 waves of the Chinese longitudinal healthy longevity survey carried out in 22 provinces throughout China.
Participants 13 717 older adults (aged ≥65).
Main outcome measures Type of death, categorised as being bedridden for fewer than 30 days with or without suffering and being bedridden for 30 or more days with or without suffering.
Results Multinomial analyses showed that higher levels of frailty significantly increased the relative risk ratios of mortality for all types of death. Of those with the highest levels of frailty, men were most likely to experience 30 or more bedridden days with suffering before death (relative risk ratio 8.70, 95% confidence interval 6.31 to 12.00) and women 30 or more bedridden days with no suffering (11.53, 17.84 to 16.96). Regardless of frailty, centenarians and nonagenarians were most likely to experience fewer than 30 bedridden days with no suffering, whereas those aged 65-79 and 80-89 were more likely to experience fewer than 30 bedridden days with suffering. Adjusting for compositional differences had little impact on the link between frailty and type of death for both sexes and age groups.
Conclusions The association between frailty and type of death differs by sex and age. Health scholars and clinical practitioners should consider age and sex differences in frailty to develop more effective measures to reduce preventable suffering before death.
Contributors: MED and DG contributed equally and are listed as the first and corresponding author. Both of them conceived and designed the study and drafted and revised the manuscript. DG prepared the data and did the analyses, had full access to the data, and is guarantor. DFW and ZY revised the manuscript.
Funding: The data used in this study were from the 2002 and 2005 waves of the Chinese longitudinal healthy longevity survey which was funded by the National Institute on Aging, the China Natural Science Foundation, the China Social Science Foundation, the United Nations Population Funds, and the Hong Kong Research Grant Council. DG’s work was partly supported by a National Institute of Aging grant (R01 AG023627, PI: ZY) when he was at Duke University and was partly supported by a provost mini-grant for internationalisation at Portland State University. The work by MED and DFW was partially supported by the Carolina Population Center at the University of North Carolina at Chapel Hill postdoctoral training programme, funded by the National Institute of Child Health and Human Development grant NIH 5-T32-HD07168-28 (MED) and National Institute on Aging grant T32 AG00155 (DFW). ZY’s work was supported by NIA grant R01 AG023627.
Competing interests: None declared.
Ethical approval: This study was approved by the institutional review board of Duke University health system institutional review board.
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