SEX DIFFERENCES IN THE PREVALENCE OF FRAILTY IN A POPULATION AGED 75 AND OLDER IN SPAIN
Bibliographic record
Abstract
To the Editor: In Spain, a country of 44 million people with a life expectancy of 83.5 for women and 77.0 for men, 17% of the population is aged 65 and older. We report here what, to our knowledge, are the first estimates of the prevalence of frailty in a Spanish population of community-dwelling persons. Data are from the fifth wave of "Aging in Leganés" a cohort of 1,699 persons aged 62 and older started in 1993 in Leganés, a city in the metropolitan area of Madrid.1 On September 1, 2006, there were 450 persons aged 75 and older still surviving who had participated in at least one of the preceding waves. Data were collected through personal home interviews and examinations in September to December 2006. Individuals were classified as "frail" when at least three of the five frailty criteria proposed previously2 were present. Information on education, marital status, comorbidity, and disability in activities of daily living (ADLs) was also collected.1 Logistic regressions were fitted to identify correlates of frailty and its five components. Prevalence of frailty was significantly higher in women (30.9%) than in men (9.3%) (P<.001). Women had a higher prevalence of exhaustion (35.6% vs 9.0%, P<.001), slow walking (57.4% vs 20.9%, P<.001), and low physical activity (39.3% vs 22.5%, P=.003) than men and a similar prevalence of weight loss (6.0% vs 9.3%, P=.31) and grip strength (31.0% vs 26.2%, P=.39). A sharp increase of frailty prevalence after age 85 was observed in men and women (Table 1). Controlling for age, education, comorbidity, and ADL disability, women's odds of frailty were 2.60 (95% confidence interval (CI)=1.13–5.98) compared with men. Women had higher odds of exhaustion (odds ratio (OR)=5.62, 95% CI=2.72–11.62) and slow walking (OR=5.51, 95% CI=3.05–7.46); there were no significant sex differences in low physical activity, weight loss, or grip strength. Prevalence of frailty in people aged 75 and older in Spain was higher than that reported in studies in comparable age groups in men and women,2–4 which is contrary to what could be expected given the high longevity of elderly people in Spain5 but consistent with previous work showing the higher prevalence of disability and lower disability-free life expectancy than other European populations.6,7 The higher frailty of women, even after adjustment for age, education, chronic diseases, and disability, is also puzzling given the 6.5-year sex gap in life expectancy in Spain. Two of the criteria that define the concept of frailty support this sex difference: slow walking speed and exhaustion. It was hypothesized that this excess frailty may be partly due to the marked sex roles still present in this age group of elderly people, for which most women were housewives with a clear domestic role, restrained social life, and little economic independence while men were the providers. We gratefully acknowledge the other members of the current "Aging in Leganés" research team. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. This research was supported in part by the FIS Programme (PI/95/1868 and RETICS 06/13/1013). Author Contributions: AO, VZ, and FB participated in the study concept and design. All authors were involved in analysis and interpretation of data and in preparation of the letter. Sponsor's Role: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".