Frailty is a clinical syndrome defined by impaired physiological systems, reduced reserve capacity, and decreased ability to cope with stress. It is associated with complications such as falls, delirium, and death. It is influenced by several factors including demographic factors (age, gender, education, income, marital status), medical history (presence of diseases such as heart failure, heart attack, cancer, diabetes), social status (dissatisfaction with life, poor quality of life, accidents in life, low income) and psychological status. In Iran, few studies have been conducted to investigate the factors associated with frailty syndrome. The aim of this study was to investigate the factors related to frailty syndrome in Khuzestan province of Iran.

The cross-sectional study was conducted on 540 older adults aged ≥60 years in Khuzestan province who were selected by multi-stage random sampling method. Data collection tools were (a) a demographic form surveying age, gender, education, marital status, living arrangements, income, number of used medications, history of hospitalization, and smoking, (b) Deficit accumulation frailty index introduced by Searle et al. in 2008 and expanded by Rockwood et al. in 2011. It has 40 items rated as 0 or 1. The index value is calculated by dividing the sum of deficit scores by the number of deficits. A person with zero score is considered as a healthy older person, and while the score ≥0.75 indicates frailty; (c) Geriatric depression scale developed by Yesavage [21] and has 30 items. The psychometric properties of its Persian version have been evaluated by Rockwood et al. [22]. Based on the cut-off point 8, a score of 1-5 indicates mild depression, 9-11 indicates moderate depression, and 12 or higher indicates severe depression; (d) Social Support scale developed by Wax et al. in 1986. Its Persian version was prepared and localized by Ebrahimi et al. [27]. Data analysis was performed in SPSS v. 22 software. Statistics such as frequency, percentage, mean and standard deviation were used to describe the obtained data. Nonparametric tests such as Chi-square, Spearman correlation and sequential logistic regression were used to examine the relationship between the main variables of the study. Significance level for all tests was set at 0.05.

The Mean±SD age of participants was 72.61±8.72 years. Of 540 participants, 65.6 were women; 64% were married; 79% had a diploma or lower degree, 57% had moderate income level; 57% took less than 5 medications per day; 30% had a history of hospitalization in the past year, and 6.7% were living alone; and 46.7% had no history of smoking. Moreover, 10.6 were frail, 25.6 were pre-frail and 63.1were not frail. Also, the percentage of older women with frailty was higher than that of frail older men. In terms of depression, 59% were in the normal group and 4.8% were in the severe depression group. In terms of social support, 37.4% had poor social support and only 19.4% had high social support. Frailty had a statistically significant relationship with age, gender, history of hospitalization, living arrangements, social support and depression (Table 1).



The prevalence of frailty increases with aging, in females, having lower education, increased hospitalization, living alone, decreased social support, and depression. According to regression analysis results, the level of frailty was lower in older men, younger older adults, the elderly taking less than 5 medications per day, those without depression and with high social support.

In this study, the prevalence of frailty syndrome was higher among older women, those with lower education, without social support, depression, living alone, with a history of taking more medications, and with a history of hospitalization. This group of older people need more and timely care to reduce the social, medical and psychological consequences of frailty syndrome. Screening and early detection of this syndrome among the elderly for early interventions prevent them from entering the full level of frailty. The present study is the first study in Iran that investigates the factors related to frailty in the elderly. It is recommended that national plans for elderly health assessment be performed to identify and screen, treat and care for frail older adults in other provinces of Iran. Moreover, support facilities for frail older adults, especially older women, should be provided by increasing services and access to health facilities for the treatment of their diseases.

This study has an ethical approval obtained from the Ethics Committee of Tehran University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1398.365). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.

All authors contributed equally in preparing this article.

The authors declare no conflict of interest

The authors would like to thank the Vice-Chancellor for Health of Ahvaz Jundishapur University of Medical Sciences, the managers of Health Centers in Ahvaz, Mahshahr Port, Masjed Soleiman, Susangard and Dezful cities, and the participants for their support and cooperation.
 

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