Frailty, Nutrition, and Quality of Life in Urban-Dwelling Older Adults Facing Vulnerability: Observational Study in Primary Heath Care

Description

Objective: To analyze the association between vulnerability, nutritional aspects, frailty, and quality of life (QoL) in older adults receiving care from Primary Health Care (PHC) services in an urban area. Methods: This was a cross-sectional study conducted with community-dwelling older adults. The following instruments were used to assess the variables of interest: the Vulnerable Elders Survey (VES-13), Mini Nutritional Assessment (MNA), Edmonton Frailty Scale (EFS), and the Medical Outcomes Study Short Form-36 (SF-36). Statistical procedures included association analyses, Spearman’s correlation, and binary logistic regression to identify predictors of the outcome. Results: A total of 323 individuals participated in the study, of whom 148 (45.8%) were classified as vulnerable according to the VES-13. Vulnerability showed a moderate negative correlation with nutritional status (r = -0.38; p < 0.001). Frailty (EFS) and quality of life (SF-36) showed strong correlations, especially in domains related to physical and functional aspects (r > 0.49; p < 0.050). Binary logistic regression revealed frailty (EFS) as the main predictor of vulnerability (R² = 0.20; p < 0.001; OR = 1.35 [95% CI: 1.24–1.48]), with functional independence (R² = 0.25; p < 0.001; OR = 3.96 [95% CI: 2.74–5.73]) and functional performance (R² = 0.17; p < 0.001; OR = 3.21 [95% CI: 2.21–4.67]) being the domains that most strongly increased the odds of vulnerability. Conclusion: There was a significant association between vulnerability, nutritional status, frailty, and quality of life. More refined analyses highlighted frailty, particularly in its functional domains, as a key predictor of vulnerability among older adults.

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Data collection was conducted from June 2023 to March 2024 through face-to-face interviews in Brazilian Portuguese, carried out by undergraduate and graduate health sciences students who had been previously trained and supervised by the project coordinators. Each interview lasted approximately 60 minutes and took place in Primary Health Care (PHC) units, participants’ homes, or university facilities, depending on prior scheduling. The instruments used included the Older Adult Health Record Booklet, which provided sociodemographic data (sex, age group, skin color, literacy) and health information (polypharmacy and self-reported diseases). Vulnerability was assessed using the Vulnerable Elders Survey (VES-13), with scores ≥3 indicating vulnerable individuals (α=0.62). Nutritional status was evaluated with the Mini Nutritional Assessment (MNA), categorizing participants as “Well-nourished” (≥24 points) or “At risk/Undernourished” (<24 points), with a reliability coefficient of α=0.75. Frailty was measured using the Edmonton Frailty Scale (EFS), dichotomized into “Non-frail” (≤4 points) and “Frail” (≥5 points), with α=0.71. Quality of life (QoL) was assessed with the Short Form 36 (SF-36), classified as “Poor QoL” (<50 points) or “Better QoL” (≥50 points), showing a high reliability score of α=0.84. All instruments were adapted and validated for use in Brazilian Portuguese. Vulnerability was considered the main dependent variable of the study.

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