Frailty is a condition of reduced health and physical function. It is more common the older people become and increases the risk of falls, disability, hospital admission, the need for long-term care, and risk of dying. General practices in England are asked to look for and measure frailty in those over 65. One NHS-recommended tool is the electronic frailty index(eFI) which can be calculated from GP records.
The best way to manage frailty, prevent it or possibly reverse its progression, is unclear. A combination of muscle strength training and protein supplementation has been found most effective to date. However, not everybody is able or willing to exercise, and frail elderly people, in particular, may struggle.
There is also interest in using medication. Metformin, used to treat diabetes, has been shown to reduce the risk of frailty in older people with diabetes. Statins, used to lower cholesterol, are another type of medication that could affect frailty. They are known to have lots of effects unrelated to cholesterol-lowering. Studies so far looking at statins and frailty have shown mixed results.
We will use data from people over 65 in the large primary care database the clinical practice research database (CPRD) and look at their frailty scores and how these changed over time in a group of people taking statins compared to a group of people not taking statins. This information could then be used to investigate and develop better treatments for frailty.
Aim:
This study will aim to examine the effect of statin use on frailty trajectories. We will calculate and compare the electronic frailty index (eFI) score and severity category (fit, mild, moderate and severe) among patients aged over 65 and prescribed statins, compared to propensity score-matched patients not prescribed statins. The eFI scores will then be measured at 6-monthly intervals until either a change in frailty severity category is seen or the study ends.
Design:
Propensity score-matched cohort study.
Target population:
Adults aged 65 years and above. A cohort with exposure to statins and a cohort without exposure to statins will be identified.
Our objective is to assess frailty progression in people with Read codes indicating statin exposure for a 1-year period prior to inclusion in the study, compared to those who have not been exposed to statins. We will use a propensity score-matched cohort study in a population aged 65 years and older registered with a GP practice inputting data to CPRD GOLD between 1995 and 2020. eFI scores will be calculated using the relevant Read codes. We will use Cox proportional hazards regression to examine the time taken to eFI frailty category change diagnosis adjusting for sociodemographic and other confounding variables.
1) Change in eFI severity category, shown by an increase in score of ≥0.12;
2) eFI score
Eleanor Hathaway - Chief Investigator - University of Birmingham
Eleanor Hathaway - Corresponding Applicant - University of Birmingham
Anuradhaa Subramanian - Collaborator - University of Birmingham
Jennifer Cooper - Collaborator - University of Birmingham
Krishna Gokhale - Collaborator - University of Birmingham
Krishnarajah Nirantharakumar - Collaborator - University of Birmingham
Practice Level Townsend Index