Older adults with metabolic syndrome are at a higher risk of becoming frail, impacting their quality of life
Published: 07 Apr 2021
Research findings from the Healthy Older People Everyday (HOPE) study revealed that frailty greatly diminishes the quality of life in older adults with metabolic syndrome, which highlights the urgent need to put in place screening interventions to detect frailty early as frailty may be reversible.
The study led by Associate Professor Reshma Merchant, from the Department of Medicine at the NUS Yong Loo Lin School of Medicine and her team discovered that frailty may be responsible for the various debilitating outcomes of metabolic syndrome such as cognitive impairment, depression and functional decline which results in a poorer quality of life.
The study included 292 older adults aged 65 years and older with metabolic syndrome ranging from different socio-demographics, lifestyles, education levels, physical and mental health statuses, from the north-west region of Singapore. It was found that those participants who had metabolic syndrome and were categorised as frail were four times likely to have at least one Activities of Daily Living (ADL) impairment, compared to the robust group. Almost 1 in 2 reported moderate to extreme problems with mobility, and 1 in 3 of frail participants reported moderate to extreme pain. 90.5% of frail participants had 2 or more comorbidities, and polypharmacy was 2.5 times more prevalent in this group. The prevalence of poor handgrip strength was almost doubled in this group which signifies possible sarcopenia. Almost 1 in 10 of the older adults with metabolic syndrome in frail group reported moderate or extreme depression or anxiety, 4 times higher than the robust group.
Association Between Metabolic Syndrome and Frailty
Metabolic syndrome affects almost half of older adults in Singapore. As a person gets older, the likelihood of getting metabolic syndrome increases. Metabolic syndrome is a cluster of cardiometabolic risk factors including central obesity, hypertension, elevated fasting plasma glucose, elevated triglycerides, and reduced high-density lipoprotein that is associated with increased morbidity including cognitive and functional impairment, frailty, non-alcoholic fatty liver disease, cerebrovascular disease as well as mortality. Metabolic syndrome and frailty are closely connected. Explained as a decline in physiological reserves, frailty is responsible for negative outcomes of metabolic syndrome, ranging from cognitive impairment, depression to functional decline affecting quality of life.
In Singapore, it is estimated that by 2030, 1 in 4 citizens will be over 65 years old and this will rise to almost one in two by 2050, according to the Population White Paper 2013. With this trend set to increase yearly, this study highlights the urgent need to screen for frailty in older adults with metabolic syndrome, the category of people who are at the highest risk of becoming frail. Early intervention is needed because frailty is reversible with prompt detection and a comprehensive management plan, which includes physical exercise, nutrition and polypharmacy management. This ensures that these older adults can enjoy a good quality of life as they advance into their golden years.
Next Steps
The research findings from this paper has resulted in the implementation of frailty screening in two National University Polyclinics (NUP) that will help in the efforts to detect and reverse frailty in ageing adults, especially those with metabolic syndrome. Additionally, the team has designed a mobile phone application for frailty screening called Rapid Geriatric Assessment which takes less than 5 minutes to complete, will be released on the App Store in the coming months.
