Frailty and 12-month mortality among older adults with type 2 diabetes in nursing homes: A longitudinal study

Abstract

Background Frailty is highly prevalent among older adults with type 2 diabetes mellitus (T2DM) and may contribute to adverse health outcomes, particularly in institutionalized settings. Despite its clinical relevance, the prognostic value of frailty among nursing home residents with T2DM remains underexplored. This study aimed to assess the association between frailty, assessed using the Frailty Index (FI), and 12-month all-cause mortality among older adults with T2DM residing in French Caribbean nursing homes. Methods Data were drawn from the KASEHPAD (Karukera Study on Aging in Nursing Homes) study, a prospective, longitudinal cohort conducted across six nursing homes in Martinique and Guadeloupe. Frailty was assessed at baseline using a 30-item deficit accumulation model to compute the FI (range: 0–1). Mortality data were collected over a 12-month follow-up period. Associations between FI and mortality were analyzed using logistic regression and Cox proportional hazards models. Results The study included 94 participants with T2DM (mean age: 81.1 ± 10.0 years; 42.6% male). The mean FI was 0.30 ± 0.14. Over the 12-month follow-up, 28 participants (29.8%) died. In unadjusted logistic regression models, each 0.01-point increase in FI was associated with a 6% increase in the odds of death (Odd Ratio (OR) = 1.06; 95% CI: 1.02–1.11; p  = 0.002). After adjusting for age and sex, frailty was marginally associated with 1-year mortality (OR = 1.05; 95% CI: 1.00–1.10; p = 0.056), but was not significantly associated with time to death in the Cox model (Hazard Ratio [HR] = 1.03; 95% CI: 0.99–1.07; p = 0.139). Conclusion Frailty measured by the FI showed a tendency to be associated with short-term mortality among older adults with type T2DM living in nursing homes. These findings underscore the need for larger studies to further assess the prognostic utility of the FI in informing care planning and clinical management in this vulnerable population.