Supplementary Material for: The association between frailty and dementia-free and physical disability-free survival in community-dwelling older adults

Introduction: Frailty is a common geriatric syndrome that adversely impacts health outcomes. This study examined correlates of physical frailty in healthy community-dwelling older adults and studied the effect of frailty on disability-free survival (DFS), defined as survival free of independence-limiting physical disability or dementia. Methods: This is a post hoc analysis of 19,114 community-dwelling older adults (median age 74.0 years, interquartile range or IQR: 6.1 years) from Australia and the United States (US) enrolled in the ‘ASPirin in Reducing Events in the Elderly (ASPREE)’ clinical trial. Frailty was assessed using a modified Fried phenotype and a deficit accumulation Frailty Index (FI) utilizing a ratio score derived from 66 items. Multinomial logistic regression was used to examine the correlates of frailty and Cox regression to analyze the association between frailty and DFS (and its components). Results: At study enrollment, 39.0% were pre-frail, and 2.2% of participants were frail, according to Fried phenotype. Older age, higher waist circumference, lower education, ethno-racial origin, current smoking, depression, and polypharmacy were associated with pre-frailty and frailty according to Fried phenotype and FI. Fried phenotype defined pre-frailty and frailty predicted reduced DFS (pre-frail: HR: 1.67; 95%CI: 1.50, 1.86 and frail: HR: 2.80; 95%CI: 2.27, 3.46), affecting each component of DFS including dementia, physical disability and mortality. Effect sizes were larger according to FI. Conclusion: Our study showed that pre-frailty is common in community-dwelling older adults initially free of cardiovascular disease, dementia or independence-limiting physical disability. Pre-frailty and frailty significantly reduced disability-free survival. Addressing modifiable correlates, like depression and polypharmacy, might reduce the adverse impact of frailty on dementia-free and physical disability-free survival.