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Frailty and Risk of Venous Thromboembolism in Older Adults

¹ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
² Department of Medicine, University of Vermont, Burlington.
³ Department of Epidemiology, University of Washington, Seattle.
⁴ Collaborative Studies Coordinating Center, University of North Carolina, Chapel Hill.
⁵ Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.

Address correspondence to Aaron R. Folsom, MD, MPH, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second St., Minneapolis, MN 55454-1015. E-mail: folsom{at}epi.umn.edu

Background. Frailty is a common risk factor for morbidity and mortality in elderly persons. Recent evidence links frailty to activation of coagulation and inflammatory pathways. We aimed to determine whether frailty in community-dwelling older adults is a risk factor for venous thromboembolism (VTE).

Methods. We conducted a prospective cohort study in four U.S. communities involving 4859 participants 65 years old and older. At baseline, in 1989–1993, we assessed frailty based on weight loss, grip strength, feelings of exhaustion, walk time, and physical activity. Incident VTE (deep vein thrombosis or pulmonary embolus) through 2002 was identified by review of hospital records.

Results. Fifty-two percent of the sample was classified as having intermediate or definite frailty. After adjustment for age, race, sex, body mass index, and diabetes, the relative risk of total VTE (n = 150) for people who were frail compared with no frailty was 1.31 (95% confidence interval [CI], 0.93–1.84). The comparably adjusted relative risk for idiopathic VTE (n = 58) was 1.79 (95% CI, 1.02–3.13).

Conclusions. The incidence rates of idiopathic VTE was higher in community-dwelling older adults with baseline frailty compared with no frailty. Further studies of the clotting process in frailty may allow the development of an improved strategy to determine VTE risk in this vulnerable subset of older adults.

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