EXPLORING THE RELATIONSHIP BETWEEN COMORBIDITY

STATUS, FRAILTY, AND FUNCTIONAL STATUS AMONG

ELDERLY ADULT CVD PATIENTS: A HOSPITAL-BASED CROSS-
SECTIONAL STUDY, IN JASHORE, BANGLADESH

Name: Md. Riazuddin, Ezaz Ahmed

Student ID: 170910, 170939
Session: 2017-2018
Department of Nutrition and Food Technology
Jashore University of Science and Technology, Jashore-7408
 RATIONALE OF THE STUDY

Comorbidity in patients with cardiovascular disease in primary

care: a cohort study with routine healthcare data.

 They identified 15 787 patients with CVD from 226 670.

 This comprised 9487 patients with CHD, 3290 patients with heart failure,
3261 patients with stroke, and 2846 patients with PAD.

Cardiovascular risk profile and frailty in a population-based study of

older British men
Global Burden of Cardiovascular Diseases and Risk Factors, 1990–
2019 (Available at: http://ghdx.healthdata.org/.)  Among 1622 men, 303 were frail, and 876 were pre-frail.
 Frail individuals had a worse cardiovascular risk profile with an
increased risk of high heart rate, poor lung function, raised white cell
count (WCC), poor renal function, low alanine transaminase, and low
serum sodium.

Exploring the Relationship between Frailty, Functional Status,

Polypharmacy, and Quality of Life in Elderly and Middle-Aged
Patients with Cardiovascular Diseases: A One-Year Follow-Up Study

 Among all functional statuses, mobility was found to predict frailty in

elderly and middle-aged patients .
Frailty prevalence among the geriatric population group in the
world. (From 2022: Available at: 10.4103/jiaphd.jiaphd_91_21
 OBJECTIVES
General Objective
The general objective of this study is to explore the relationship between frailty, functional status, and
prevalence of comorbidity among older adult patients with CVD.

Specific Objectives

 To determine the prevalence of comorbidity among CVD patients.

 To identify the impact of frailty on CVD patients.
 To determine the relationship between frailty and functional status among CVD patients.
 To assess the relationship between dietary habits and comorbidity.
 To evaluate the relationship between the functional status of CVD patients with the comorbidity
condition.
 MATERIALS AND METHODS

Sample size and sampling procedure

 Data were collected from Jashore Sadar hospital using a simple random sampling procedure to select a
suitable sample from a wider population.
 Initially, 210 data were collected from the Coronary care unit of this hospital.

Data collection procedure

 Primary Source: Primary sources of Data were collected via face-to-face interviews. Primary sources
were respondents.
 Secondary source: Secondary source data was supplied by institutions.

Data entry and analysis

 SPSS 26.0 USA statistical software has been used for data entry, transformation, and statistical analysis.
 P-value <0.05 was considered statistically significant.
 The chi-square test calculated the statistical significance between different categorical variables.
 Charts and graphs have been made using Excel.
 MATERIALS AND METHODS
Assessment of Comorbidity
 Comorbidity Data was collected using the classical Charlson comorbidity indexed (cCCI) question.
 It consists of 19 diseases section.
Frailty Assessment
 Frailty data was collected by using five section questionnaire.
 It consists of Fatigue, Resistance, aerobics, illnesses, and weight loss.
 Each section has been scored 1 for a positive outcome.

Functional status evaluation

 Functional evaluation data was collected using the Barthel Index question, which consists of 10
sections.
Dietary diversity question (Food frequency question)
 Dietary data were collected through a Food Frequency Questionnaire (FFQ)
validated for the elderly adults of the Jashore area.
 The FFQ consists of 10 food items.
 RESULTS
Table1: Relation between socio-demographic characteristics and comorbidity
status
Sd Demographic characteristics Comorbidity status Chi-square
(P-value)
Mild n (%) Moderate n (%) Severe n (%)

Gender Female 15 (7.2) 32 (15.5) 15 (7.2) 5.73 (0.05)*

Male 49 (23.7) 79 (38.2) 17 (8.2)

Age group 55-60 38 (18.4) 60 (29) 16 (7.7) 13.81 (0.03)*

61-65 9 (4.3) 23 (11.1) 2 (1)
66-70 11 (5.3) 10 (4.8) 10 (4.8)
>70 6 (2.9) 19.68 (0.00) 4 (1.9)
Residence Urban 9 (4.3) 13 (6.3) 10 (4.8) 7.4 (0.03)*
Rural 55 (26.6) 98 (47.3) 22 (10.6)
Smoking history No 52 (25.1) 69 (33.3) 30 (14.5) 15.80 (0.00)*

Yes 12 (5.8) 42 (20.3) 2 (1.0)

Current occupation Employee 6 (2.9) 8 (3.9) 2 (1.0) 23.12 (0.00)*

Marchant/ business 8 (3.9) 21 (10.1) 0

Farmer 21 (10.1) 13 (6.3) 9 (4.3)
Housewife 10 (4.8) 17 (8.2) 2 (1.0)
Retired/unemployed 19 (9.2) 52 (25.1) 19 (9.2)
19.60 (0.01)*
Family history No 56 (27.1) 63 (30.4) 17 (8.2)
of CVD Yes 8 (3.9) 48 (23.2) 15 (7.2)
 RESULTS
Table 2: Relation between socio-demographic characteristics and Frailty
status
SD Demographic characteristics Frailty status Chi-square (P-value)
Not frail Pre-frail Frail

Gender Female 32 (15.5) 15 (7.2) 15 (7.2) 6.87 (0.03)*

Male 77 (37.2) 52 (25.1) 16 (7.7)
Age group 55-60 61 (29.5) 40 (19.3) 13 (6.3) 5.02 (0.50)*
(years) 61-65 17 (8.2) 12 (5.8) 5 (2.4)
66-70 16 (7.7) 7 (3.4) 8 (3.9)
>70 15 (7.2) 8 (3.9) 5 (2.4)
Family income (BDT) <10000 24 (11.6) 16 (7.7) 10 (4.8) 8.87 (0.18)
10000-15000 27 (13) 19 (9.2) 9 (4.3)
15000-20000 34 (16.4) 10 (4.8) 5 (2.4)
>20000 24 (11.6) 22 (10.6) 7 (3.4)
Residence Urban 17 (8.2) 7 (3.4) 8 (3.9) 3.82 (0.02)*
Rural 92 (44.4) 60 (29.0) 23 (11.1)
Smoking history Yes 26 (12.6) 27 (13) 3 (1.4) 11.26 (0.00)*
No 83 (40.1) 40 (19.3) 28 (13.5)
Family history (CVD) Yes 29 (14) 28 (13.5) 14 (6.8) 6.16 (0.04)*
No 80 (38.6) 39 (18.8) 17 (8.2)
Mental health Bad 37 (17.9) 17 (8.2) 17 (8.2) 9.09 (0.05)*
Good / Average 71 (34.3) 50 (24.2) 14 (6.8)
 RESULTS
Table 3: Relation between socio-demographic characteristics and functional status

SD Demographic Functional Evaluation Chi-square

(P-value)
characteristics
Total Dependency Severe Dependency Moderate Dependency Slight Dependency Independent

Gender Female 7 7 (3.4) 5 (2.4) 22 (10.6) 0 (0.0) 28 (13.5)

Male 8 (3.9) 29 (14.0) 22 (10.6) 9 (4.3) 77 (37.2) 18.58 (0.00)*
Age group 55-60 3 (1.4) 9 (4.3) 26 (12.6) 6 (2.9) 70 (33.8) 38.33 (0.00)*
(years) 61-65 3 (1.4) 6 (2.9) 9 (4.3) 0 (0.0) 16 (7.7)
66-70 6 (2.9) 7 (3.4) 5 (2.4) 2 (1.0) 11 (5.3)
>70 15 (7.2) 34 (16.4) 44 (21.3) 9 (4.3) 105 (50.7)
Residence Urban 7 (3.4) 5 (2.4) 5 (2.4) 1 (0.5) 14 (6.8) 12.25 (0.01)*
Rural 8 (3.9) 29 (14.0) 39 (18.8) 8 (3.9) 91 (44)
Current occupation Employee 0 (0.0) 1 (0.5) 6 (2.9) 0 (0.0) 9 (4.3) 30.57 (0.01)*
Marchant
2 (1.0) 3 (1.4) 4 (1.9) 0 (0.0) 20 (9.7)
Farmer 2 (1.0) 6 (2.9) 7 (3.4) 4 (1.9) 24 (11.6)
Housewife 0 (0.0) 2 (1.0) 10 (4.8) 0 (0.0) 17 (8.2)
Retired/
11 (5.3) 22 (10.6) 17 (8.2) 5 (2.4) 35 (16.9)
unemployed
Family history
Yes 7 (3.4) 8 (3.9) 24 (11.6) 4 (1.9) 28 (13.5) 13.90 (0.01)*
(CVD)
No 8 (3.9) 26 (12.6) 20 (9.7) 5 (2.4) 77 (37.2)
 RESULTS
Table 4: Relationship between comorbidity status and Frailty, functional
status, and dietary Diversity
Comorbidity status
Mild Moderate Severe Chi-square
n (%) n (%) n (%) (P-value)
Not frail 54 (26.1) 55 (26.6) 0 (0.0)
Frailty 143.01 (0.00)*
Pre-frail 10 (4.8) 50 (24.2) 7 (3.4)
Frail 0 (0.0) 6 (2.9) 25 (12.1)
Functional Total dependency 5 (2.4) 3 (1.4) 7 (3.4) 19.56 (0.01)*
Evaluation
Severe dependency 8 (3.9) 18 (8.7) 8 (3.9)

Moderate dependency 12(5.8) 25 (12.1) 7 (3.4)

Slight dependency 2 (1.0) 6 (2.9) 1 (0.5)

Independent 37 (17.9) 59 (28.5) 9 (4.3)

Dietary diversity Poor (<25) 7(3.4) 14(6.8) 3(1.4) 7.2 (0.98)

Moderate (25-28) 37(17.9) 63(30.4) 17(8.2)

Good (≥29) 20(9.7) 34(16.4) 12(5.8)

 RESULTS
Table 5: Relationship between Frailty and Functional Evaluation
Frailty

Not frail Pre-frail Frail Chi-square

(P-value)
Functional Total dependency 6 (2.9) 2 (1.0) 7 (3.4) 18.63 (0.02)*
Evaluation
Severe dependency 15 (7.2) 11 (5.3) 8 (3.9)

Moderate dependency 24 (11.6) 14 (6.8) 6 (2.9)

Slight dependency 5 (2.4) 4 (1.9) 0 (0.0)

Independent 59 (28.5) 36 (17.4) 10 (4.8)

Dietary diversity Poor 13 (6.3) 10 (4.8) 1 (0.5) 5.061 (0.28)

Moderate 65 (31.4) 36 (17.4) 16 (7.7)

Good 31 (15.0) 21 (10.1) 14 (6.8)

 CONCLUSION

 Among all respondent CVD patients majority percent of respondents were (70%) male.
 There was a significant relationship between the age group (55-60) and the prevalence of
cardiovascular diseases.
 Severe comorbid patients (12.1%) were the most vulnerable to frailty.
 There was a significant relationship (p<0.01) between the functional status and
comorbidity status of CVD patients.
 This study also depicts no significant relationship between dietary diversity and
comorbidity status.
 Findings also demonstrate that most frail CVD patients had lower functional evaluation
scores.
 Among all professional group, the retired population group were the most vulnerable (9.2)
to comorbidity.
 Limitations

 Sample was insufficient to find the actual relationship between different variables.
 In most cases, patients with coronary heart disease remained unstable in expressing
their opinion.
 people can’t inform about their actual dietary habits.
 Sometimes, respondents didn’t inform about smoking and tobacco talking.