Abstract
BackgroundIt is important to clarify the transitions and related factors of frailty for prevention of frailty. We evaluated the transitions of frailty among community-dwelling older adults and examined the predictors of the transitions.MethodsA cohort study was conducted among 3988 community residents aged ≥60 years during 2015 and 2017. A multiple deficits approach was used to construct the Frailty Index (FI) according to the methodology of FI construction, and sociodemographic characteristics and lifestyles were also collected in 2015. After 2-year follow-up, the transitions of frailty between baseline and were evaluated. Multinomial logistic regressions were used to examine associations between predictors and the transitions of frailty.ResultsThe proportion of robust, prefrail, and frail was 79.5, 16.4, and 4.1% among 3988 participants at baseline, which changed to 68.2, 23.0, and 8.8% after 2 years with 127 deaths and 23 dropped out. Twelve kinds of transitions from the three frailty statuses at baseline to four outcomes at follow-up (including death) significantly differed within each of gender and age group, as well between genders and age groups. Among these, 7.8% of prefrail or frail elders improved, 70.0% retained their frailty status, and 22.2% of robust or prefrail elders worsened in frailty status. In multivariable models, age was significantly associated with changes in frailty except for in the frail group; higher educational level and working predicted a lower risk of robust worsening. Of the lifestyle predictors, no shower facilities at home predicted a higher risk of robust worsening; more frequent physical exercise predicted a lower risk of robust worsening and a higher chance of frailty improvement; more frequent neighbor interaction predicted a lower risk of robust worsening and prefrail worsening; and more frequent social participation predicted a higher chance of prefrail improvement.ConclusionsThe status of frailty was reversible among community-dwelling elderly, and sociodemographic and lifestyle factors were related to changes in frailty. These findings help health practitioners to recognize susceptible individuals in a community and provide health promotional planning to target aged populations.
Highlights
It is important to clarify the transitions and related factors of frailty for prevention of frailty
The status of frailty was reversible among community-dwelling elderly, and sociodemographic and lifestyle factors were related to changes in frailty
The present study showed that frailty status can deteriorate to a worse state (22.2%) but can turn back to a better state (7.8%), though the majority stayed in the same state (70.0%)
Summary
It is important to clarify the transitions and related factors of frailty for prevention of frailty. Frailty is an unstable status with the age-related loss of physiological reserves and disorders in homeostatic systems [1, 2]. The approach of FI represents a continuous status of health, [12] which is more likely to demonstrate the dynamic nature of frailty in the general aged population. Frailty among older adults is generally agreed to be a dynamic status [13,14,15] that is inevitable with increasing age but reversible, [16, 17] and it may represent an intermediate stage between healthiness and the end of life as a biological age [1, 10]. Understanding the characteristics related to frailty transitions will allow for better future health practice and healthcare strategies
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