Frailty Levels and Predisposing Factors among Older Adults with Coronary Artery Disease: A cross-sectional study

Year 2026, Volume: 10 Issue: 1, 4 - 12, 31.01.2026

Ayşe Buket Doğan Aktaş , Özlem Canbolat

https://doi.org/10.30621/jbachs.1594820

Abstract

Purpose: This study was conducted to evaluate frailty levels, and predisposing factors among older adults with coronary artery disease.
Material and Methods: In this descriptive cross-sectional study was completed by 107 patients. Data were collected via the introductory information questionnaire and the Edmonton Frail Scale. Descriptive statistics, multiple linear regression analyses, and pearson's correlation were used in the data analysis.
Results: The prevalence of frailty (mild, moderately, and severely) was 44%, and “apparently vulnerable” frailty was 15,9%. Participants who was ≥75 aged had a higher mean EFS score than those who was 65-74 aged (ß= 0.317, p=0.001). Participants who used ≥4 number of medications had a higher mean EFS score than those who used ≤3 number of medications (ß= 0.196, p=0.031). Female participants had a higher mean EFS score than male counterparts (ß=-0.253, p=0.008).
Conclusion: The current study show that the overall prevalence of frailty was 44.4% among older adults with CAD. Age, polypharmacy, and gender were found determinants of fragility among older adults with CAD. Nurses should routinely evaluate the older adults with CAD regarding fragility, and their treatment and care could be addressed holistically. Nurses should consider variables that affect frailty when meeting older adults with CAD' needs.

Keywords

Coronary artery disease , frailty , frail elderly , nursing , older adults

Frailty Levels and Predisposing Factors among Older Adults with Coronary Artery Disease: A cross-sectional study

Abstract

References

• United Nations. World Social Report 2023: Leaving no one behind in an ageing world. United Nations. 2023.
• Vermunt N, Harmsen M, Westert GP, Olde Rikkert MGM, Faber MJ. Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review. BMC Geriatr. 2017;17:167-179.
• World Health Organization. Cardiovascular diseases (CVDs). World Health Organization. 2025.
• Guo J, Huang X, Dou L, et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Signal Transduct Target Ther. 2022;7(1):391.
• World Health Organization. Ten threats to global health in 2019. World Health Organization. 2019.
• Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
• Deng Y, Yamauchi K, Song P, Karako T. Frailty in older adults: a systematic review of risk factors and early intervention pathways. Intractable Rare Dis Res. 2025;14(2):93-108.
• Fogg C, Fraser SDS, Roderick P, et al. The dynamics of frailty development and progression in older adults in primary care in England (2006-2017): a retrospective cohort profile. BMC Geriatr. 2022;22(1):30.
• Khan KT, Hemati K, Donovan AL. Geriatric physiology and the frailty syndrome. Anesthesiol Clin. 2019;37(3):453-474.
• Viña J, Tarazona-Santabalbina FJ, Pérez-Ros P, et al. Biology of frailty: modulation of ageing genes and its importance to prevent age-associated loss of function. Mol Aspects Med. 2016;50:88-108.
• Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Dir Assoc. 2008;9(2):71-72.
• Cai S, Li J, Fang Y, et al. Frailty and pre-frailty prevalence in community-dwelling elderly with multimorbidity: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2025;132:105782.
• Kojima G, Liljas AEM, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk Manag Healthc Policy. 2019;12:23-30.
• Ofori-Asenso R, Chin KL, Mazidi M, et al. Global incidence of frailty and prefrailty among community-dwelling older adults: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(8):e198398.
• Atkins JL, Jylhävä J, Pedersen NL, et al. A genome-wide association study of the frailty index highlights brain pathways in ageing. Aging Cell. 2021;20(9):e13459.
• Veronese N. Frailty as cardiovascular risk factor (and vice versa). Adv Exp Med Biol. 2020;1216:51-54.
• Uchikado Y, Ikeda Y, Ohishi M. Current understanding of the role of frailty in cardiovascular disease. Circ J. 2020;84(11):1903-1908.
• He YY, Chang J, Wang XJ. Frailty as a predictor of all-cause mortality in elderly patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2022;98:104544.
• Ratcovich H, Joshi FR, Palm P, et al. Prevalence and impact of frailty in patients ≥70 years old with acute coronary syndrome referred for coronary angiography. Cardiology. 2024;149(1):1-13.
• Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. Eur Heart J. 2014;35:1726-1731.
• Ekerstad N, Swahn E, Janzon M, et al. Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction. Eur J Prev Cardiol. 2014;21(10):1216-1224.
• Myers V, Drory Y, Gerber Y; Israel Study Group on First Acute Myocardial Infarction. Clinical relevance of frailty trajectory post myocardial infarction. Eur J Prev Cardiol. 2014;21(6):758-766.
• Yalınkılıç M, Kılıçaslan K, Uysal H, Bilgin S, Enç N. Determination of frailty status in elderly individuals with heart failure. Turk J Cardiovasc Nurs. 2020;11:51-59.
• Joyce E. Frailty and cardiovascular disease: a two-way street? Cleve Clin J Med. 2018;85(1):65-68.
• Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526-529.
• Aygör HE, Fadıloğlu Ç, Şahin S, et al. Validation of Edmonton Frail Scale into elderly Turkish population. Arch Gerontol Geriatr. 2018;76:133-137.
• Li T, Shi W, Wang G, Jiang Y. Prevalence and risk factors of frailty in older patients with coronary heart disease: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2025;130:105721.
• Lisiak M, Uchmanowicz I, Wontor R. Frailty and quality of life in elderly patients with acute coronary syndrome. Clin Interv Aging. 2016;11:553-562.
• Alonso Salinas GL, Sanmartín Fernández M, Pascual Izco M, et al. Frailty is a short-term prognostic marker in acute coronary syndrome of elderly patients. Eur Heart J Acute Cardiovasc Care. 2016;5(5):434-440.
• Kang L, Zhang SY, Zhu WL, et al. Is frailty associated with short-term outcomes for elderly patients with acute coronary syndrome? J Geriatr Cardiol. 2015;12(6):662-667.
• White HD, Westerhout CM, Alexander KP, et al. Frailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: insights from the TRILOGY ACS trial. Eur Heart J Acute Cardiovasc Care. 2016;5:231-242.
• Atakul E, Akyar İ. Frailty prevalence and characteristics in older adults with hematologic cancer: a descriptive study. Asia Pac J Oncol Nurs. 2019;6(1):43-49.
• Coughlin SS, Vernon M, Hatzigeorgiou C, George V. Health literacy, social determinants of health, and disease prevention and control. J Environ Health Sci. 2020;6(1):3061.
• Raghupathi V, Raghupathi W. The influence of education on health: an empirical assessment of OECD countries for the period 1995-2015. Arch Public Health. 2020;78:20.
• Matsue Y, Kamiya K, Saito H, et al. Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail. 2020;22(11):2112-2119.
• Jujo K, Kagiyama N, Saito K, et al. Impact of social frailty in hospitalized elderly patients with heart failure: a FRAGILE-HF registry subanalysis. J Am Heart Assoc. 2021;10(17):e019954.
• Bozkurt C, Yildirim Y, Şenuzun Aykar F. The effect of frailty level on acceptance of illness in older people with chronic obstructive pulmonary disease. Turk J Geriatr. 2021;24:244-254.
• Puyané M, Chabrera C, Camón E, Cabrera E. Uncovering the impact of loneliness in ageing populations: a comprehensive scoping review. BMC Geriatr. 2025;25(1):244.
• Donovan NJ, Blazer D. Social isolation and loneliness in older adults: review and commentary of a National Academies report. Am J Geriatr Psychiatry. 2020;28(12):1233-1244.
• Sherman DW, Alfano AR, Alfonso F, et al. A systematic review of the relationship between social isolation and physical health in adults. Healthcare (Basel). 2024;12(11):1135.
• Misu Y, Katayama O, Lee S, et al. Reciprocal relationship between physical and social frailty among community-dwelling older adults. Arch Gerontol Geriatr. 2023;114:105066.
• Kojima G, Taniguchi Y, Kitamura A, Fujiwara Y. Is living alone a risk factor of frailty? A systematic review and meta-analysis. Ageing Res Rev. 2020;59:101048.
• Zanjari N, Momtaz YA, Kamal SHM, Basakha M, Ahmadi S. The influence of providing and receiving social support on older adults' well-being. Clin Pract Epidemiol Ment Health. 2022;18:e174501792112241.
• Graham MM, Galbraith PD, O'Neill D, Rolfson DB, Dando C, Norris CM. Frailty and outcome in elderly patients with acute coronary syndrome. Can J Cardiol. 2013;29(12):1610-1615.
• Gagesch M, Chocano-Bedoya PO, Abderhalden LA, et al. Prevalence of physical frailty: results from the DO-HEALTH study. J Frailty Aging. 2022;11(1):18-25.
• To TL, Doan TN, Ho WC, Liao WC. Prevalence of frailty among community-dwelling older adults in Asian countries: a systematic review and meta-analysis. Healthcare (Basel). 2022;10(5):895.
• Dong P, Zhang XQ, Yin WQ, et al. The relationship among socioeconomic status, social support and frailty: is there a gender difference? Aging Clin Exp Res. 2025;37(1):111.
• Park C, Ko FC. The science of frailty: sex differences. Clin Geriatr Med. 2021;37(4):625-638.
• Zeidan RS, McElroy T, Rathor L, et al. Sex differences in frailty among older adults. Exp Gerontol. 2023;184:112333.
• Chen LJ, Sha S, Brenner H, Schöttker B. Longitudinal associations of polypharmacy and frailty with major cardiovascular events and mortality among more than half a million middle-aged participants of the UK Biobank. Maturitas. 2024;185:107998.
• Saum KU, Schöttker B, Meid AD, et al. Is polypharmacy associated with frailty in older people? Results from the ESTHER cohort study. J Am Geriatr Soc. 2017;65(2):e27-e32.
• Schoufour JD, Echteld MA, Bastiaanse LP, Evenhuis HM. The use of a frailty index to predict adverse health outcomes in people with intellectual disabilities. Res Dev Disabil. 2015;38:39-47.
• Bhattarai U, Bashyal B, Shrestha A, Koirala B, Sharma SK. Frailty and chronic diseases: a bi-directional relationship. Aging Med (Milton). 2024;7(4):510-515.