Associations between lifestyle, physical and social environments and frailty among Chinese older people: a multilevel analysis

Social participation and physical prefrailty in older Japanese adults: The Shimane CoHRE study

As older adults in an early stage (prefrailty) of frailty may return to a healthy state, it is necessary to examine the prevention of prefrailty. In this context, the number and types of social participation activities associated with physical prefrailty in community-dwelling older adults have remained relatively unexplored. This cross-sectional study investigates this issue by analyzing 616 participants living in Okinoshima, Shimane, a rural area of Japan, in 2019. Frailty was assessed using the 5-item frailty phenotype (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity). Data on social participation were obtained using a questionnaire based on participants' level of involvement with volunteer groups, sports clubs/groups, neighborhood associations, religious organizations/groups, and community elderly salons; their answers were categorized as "yes" if they answered "several times per year or more" and "no" if they answered "never." Binominal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) of prefrailty by the number or types of social participation activities, adjusted for gender, age, body mass index, smoking, medication-taking, educational attainment, working status, and living arrangement. Of the 616 participants, 273 (44.3%) and 28 (4.5%) had prefrailty and frailty, respectively. The analysis showed that the number of social participation activities was significantly associated with lower odds of prefrailty (OR = 0.83; 95% CI, 0.74-0.94). Regarding the types of social participation, sports clubs/groups were associated with lower odds of prefrailty (OR = 0.47; 95% CI, 0.31-0.73). Participation in neighborhood associations was associated with prefrailty/frailty (OR = 0.57; 95% CI, 0.37-0.86). These results suggest that increasing the number of social participation activities or involvement in sports clubs/groups and neighborhood associations may be important to prevent physical prefrailty in the older population.

Using the FRAIL scale to compare pre-existing demographic lifestyle and medical risk factors between non-frail, pre-frail and frail older adults accessing primary health care: a cross-sectional study

Background

Few studies in the scientific literature have analyzed frailty status as an ordinal variable (non-frail, pre-frail and frail) rather than as a binary variable (frail vs non-frail). These studies have found that pre-frailty behaves differently from frailty (no ordinality in the variable). However, although the comparison between pre-frail and frail individuals is clinically relevant to understanding how to treat pre-frailty, this comparison was not performed in previous studies.

Materials and Methods

A cross-sectional observational study was designed with 621 older individuals aged ≥60 years in Spain in 2017–2018, determining factors associated with a higher frailty stage (non-frail, pre-frail and frail) and undertaking this comparison, in addition to measuring non-frailty. The factors assessed through a multinominal regression model were: age, sex, living alone, recent loss of the partner, income and total comorbidities.

Results

Of the total participants, 285 were non-frail (45.9%), 210 were pre-frail (33.8%) and 126 were frail (20.3%). Compared to non-frail individuals, pre-frail individuals were older, with more comorbidities and a lower income. Compared to non-frail individuals, frail individuals were more likely to be female, older, with more comorbidities and a lower income. Compared to pre-frail individuals, frail individuals were more likely to be female, older and with more comorbidities.

Conclusion

Comparison between the pre-frail and frail groups showed that frail persons were more likely to have a lower income, be female, older and have a higher number of comorbidities.

Differences in the Association of Neighborhood Environment With Physical Frailty Between Urban and Rural Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)

OBJECTIVE

We examined the difference in the relationship between perceived neighborhood environments and physical frailty between urban and rural older adults.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Urban and rural community in South Korea; a total of 2593 community-dwelling older adults aged 70-84 years (mean age: 76.0 years, 51.0% women) in the Korean Frailty and Aging Cohort Study (KFACS).

METHODS

The neighborhood environment was assessed using the 17-item Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). The IPAQ-E had 7 environmental factors (residential density, access to destinations, neighborhood infrastructure, neighborhood safety, social environment, aesthetic qualities, and street connectivity). Physical frailty was defined using the Fried frailty criteria with modified cutoffs.

RESULTS

The number of participants residing in urban and rural areas was 1902 and 691, respectively. The prevalence of frailty was 5.3% and 12.0% in urban and rural areas, respectively. In urban areas, frailty was associated with the total IPAQ-E score (β = -0.007, P = .009) after adjusting for confounding factors. There was no association in the rural areas (β = -0.003, P = .535). In urban older adults, logistic regression showed that absence of destination [odds ratio (OR) 2.58, 95% confidence interval (CI) 1.36-4.90] and no crime safety at night (OR 2.00, 95% CI 1.12-3.57) were associated with a higher risk of frailty. In rural older adults, poor access to recreational facilities (OR 2.17, 95% CI 1.07-4.40) and no aesthetics (OR 2.49, 95% CI 1.22-5.10) were associated with frailty.

CONCLUSIONS AND IMPLICATIONS

Our study indicated that the presence of destination and crime safety at night was significantly associated with physical frailty among older adults living in urban areas, whereas aesthetics and recreational facilities were significantly associated with physical frailty in rural older adults.

How does ageism influence frailty? A preliminary study using a structural equation model

Background

Based on the Stereotype Embodiment Theory (SET), this study aims to examine the mechanism of ageism on frailty through the proposed framework of “Experiences of Ageism (EA) → Age Stereotypes (AS) → Attitudes to Ageing (AA) → Frailty” using a structural equation model (SEM).

Methods

A community-based study involving 630 participants aged 60 years and older was conducted in Shanghai. EA, AS, AA and frailty status were assessed by validated scales. In particular, EA included three parts in this study, as the first part was the experiences of explicit prejudice or discrimination because of age, another two parts were the experiences of witnessed and encountered implicit negative age-based stereotypes. A SEM was performed to examine whether the proposed paths from EA to frailty were supported.

Results

EA had a significant indirect effect (β’ = .360*-.456*-.576 = .095, p < .001) on frailty through the path of “EA → AS → AA → Frailty” after controlling for covariates. AA had a direct effect (β = −.576, p < .001) on frailty; AS fully mediated the association between EA and AA (indirect effect = .360*-.456 = −.164, p < .001), and AA fully mediated the association between AS and frailty (indirect effect = −.456*-.576 = .263, p < .001).

Conclusions

These findings demonstrated a mechanism from ageism to frailty, and highlighted the potential threat of negative AS on health. Ageism and frailty are both great challenges for the process of healthy ageing.

Associations Between Nutritional Status, Sociodemographic Characteristics, and Health-Related Variables and Health-Related Quality of Life Among Chinese Elderly Patients: A Multicenter Prospective Study

Background: Studies that explore the nutritional status, sociodemographic factors, mental health variables, and physical health variables that affect the health-related quality of life (HRQoL) of elderly patients are scarce in China. Objective: This study aimed to examine the association between health-related quality of life (HRQoL) and nutritional status, sociodemographic characteristics, and health-related variables among Chinese elderly patients. Materials and Methods: Participants were recruited from six tertiary-level hospitals in six provinces or municipalities/cities throughout China from October 2018 to February 2019: a total of 9,996 participants aged 65 years and older were enrolled. The nutritional status and HRQoL were measured using the Mini Nutritional Assessment-Short Form (MNA-SF) and the EuroQoL Five-Dimension Visual Analog Scale, respectively. BMI was taken using standard measurement protocols. Sociodemographic characteristics included age, sex, education, marital status, ethnicity, smoking, alcohol drinking, and current residence. Mental and physical health variables such as frailty and depression were assessed using validated tested instruments. Multiple linear regression analysis was used to analyze whether the nutritional status, sociodemographic characteristics, and health-related variables were associated with HRQoL. Results: According to the MNA-SF scores at the 30- and 90-day follow-up, 9.7% and 9.1% of participants were malnourished, respectively. Higher MNA-SF scores were related to higher HRQoL scores in older patients (regression coefficient; 95% confidence interval) both at the 30-day (0.660; 0.499-0.821) and 90-day (0.622; 0.434-0.809) follow-up. However, there were no significant associations between the body mass index values and HRQoL. Sociodemographic characteristics (such as age, smoking, and current residence), physical health variables (frailty, urinary function, defecation function, sleeping condition, and falling accidents in the past 12 months), and mental health variables (depression) were the main factors influencing HRQoL in this group. Conclusion: There are several factors associated with HRQoL among the population derived from this investigation of a representative sample of the Chinese hospitalized elderly population in tertiary hospitals. These findings could have major importance for the planning of "active aging" policies and programs. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.

Association between cognitive reserve dimensions and frailty among older adults: A structured narrative review

Frailty is a broadly investigated geriatric condition, which is characterized by an increased vulnerability to stressors. It represents an extremely relevant public health issue, increasingly conceptualized in a multidimensional perspective. The concept of cognitive reserve (CR), as originally conceptualized by Stern, has been developed in the past decades as a potential factor able to determine individual differences in cognitive vulnerability and trajectories occurring with aging. Our purpose was to provide a comprehensive review of the literature exploring the relationship between CR dimensions, selected according to the Stern model, and frailty status. A review of the literature on the association between potential CR dimensions and frailty was carried out through PubMed, Web of Knowledge and Scopus. CR expressed in terms of education, occupation, premorbid intelligence quotient and leisure time activities was associated with frailty in both cross-sectional and longitudinal observations. The majority of reviewed evidence suggests a potential protective role of CR factors against the onset and the worsening of frailty among older adults. To the best of our knowledge, this is the first attempt to provide a comprehensive overview regarding the association between CR dimensions and frailty. Education, occupation, premorbid intelligence quotient and leisure time activities are able to interact with the general concept of frailty, rather than simply affecting the cognitive trajectory towards dementia. The lack of a unique and operationalized approach to the assessment of CR, as well as the wide heterogeneity of frailty evaluation tools and criteria, denote some methodological critical issues that need to be overcome. Geriatr Gerontol Int 2020; 20: 1005-1023..

An Artificial Neural Network Model for Assessing Frailty-Associated Factors in the Thai Population

Frailty, one of the major public health problems in the elderly, can result from multiple etiologic factors including biological and physical changes in the body which contribute to the reduction in the function of multiple bodily systems. A diagnosis of frailty can be reached using a variety of frailty assessment tools. In this study, general characteristics and health data were assessed using modified versions of Fried's Frailty Phenotype (mFFP) and the Frail Non-Disabled (FiND) questionnaire (mFiND) to construct a Self-Organizing Map (SOM). Trained data, composed of the component planes of each variable, were visualized using 2-dimentional hexagonal grid maps. The relationship between the variables and the final SOM was then investigated. The SOM model using the modified FiND questionnaire showed a correct classification rate (%CC) of about 66% rather than the model responded to mFFP models. The SOM Discrimination Index (SOMDI) identified cataracts/glaucoma, age, sex, stroke, polypharmacy, gout, and sufficiency of income, in that order, as the top frailty-associated factors. The SOM model, based on the mFiND questionnaire frailty assessment, is an appropriate tool for assessment of frailty in the Thai elderly. Cataracts/glaucoma, stroke, polypharmacy, and gout are all modifiable early prediction factors of frailty in the Thai elderly.

Objective and subjective measures of the neighbourhood environment: Associations with frailty levels

OBJECTIVES

The aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults.

METHODS

A cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents' perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty.

RESULTS

Frail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables.

DISCUSSION

Neighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.

Physical frailty and its associated factors among elderly nursing home residents in China

Background

Evidence is scarce on the trend in prevalence of physical frailty in China; the primary purpose of this study was to identify the prevalence and correlates of physical frailty among older nursing home residents in China.

Methods

Cross-sectional study in 20 nursing homes in Changsha, China. Physical frailty was defined based on the frailty phenotype including weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. Participants with at least three affected criteria were defined as being frail. Participants with one or two affected criteria were considered as pre-frail, and those with no affected criteria were considered as robust. A total of 1004 nursing home residents aged 60 and over were included in this study. A multinomial logistic regression model was used to analyze the associations of physical frailty with its potential risk factors, including age, sex, education levels, marital status, type of institution, living status, current drinking, current smoking, regular exercise, and self-reported health.

Results

The overall prevalence of physical frailty and prefrailty was 55.6, and 38.5%, respectively. The rate of physical frailty substantially increased with age, and was higher in women than in men (69.5% vs. 30.5%). The multinomial logistic regression analysis showed that older age, being women, living in a private institution, living alone or with unknown person, having no regular exercise (≤ 2 times/week), and poor self-reported health were significantly associated with increased odds of being physically frail.

Conclusion

We demonstrated physical frailty is highly prevalent among older residents in nursing homes in China, especially in women. The potential role of those associated factors of physical frailty warrant further investigations to explore their clinical application among elderly nursing home residents.

Independent and Combined Relationships of Perceived Neighborhood Social Cohesion and Physical Frailty on Functional Disability in Community-Dwelling Older Adults

Functional disability and physical frailty (PF) are debilitating geriatric conditions. Previous studies have suggested both perceived neighborhood social cohesion (PNSC) and PF can influence functional disability and may have an interactive effect too. This cross-sectional study aims to examine the independent and combined relationships of PF and PNSC on functional disability in community-dwelling older adults in Shanghai, China. A total of 1616 older adults aged ≥ 75 years were recruited using multistage sampling. Results showed that prefrailty, frailty (using the modified frailty phenotype criteria), and low PNSC (measured by the Neighborhood Cohesion Scale) were independently associated with increased likelihood of functional disability after adjustment of covariates. To evaluate the combined relationships of PF and PNSC, participants were classified into six groups based on their levels of PF and PNSC. The probability of frail older adults with low PNSC having functional disability stood out compared with the robust older adults with high PNSC. Our findings suggest the importance of high PNSC as a protective factor of maintaining functional ability. Future longitudinal studies are needed to identify the role of PNSC in the development of functional disability among frail older adults.

Comparison of alternative full and brief versions of functional status scales among older adults in China

BACKGROUND

Brief assessments of functional status for community-dwelling older adults are needed given expanded interest in the measurement of functional decline.

METHODS

As part of a 2015 prospective cohort study of older adults aged 60-89 years in Jiangsu Province, China, 1506 participants were randomly assigned to two groups; each group was administered one of two alternative 20-item versions of a scale to assess activities of daily living (ADL) and instrumental activities of daily living (IADL) drawn from multiple commonly-used scales. One version asked if they required help to perform activities (ADL-IADL-HELP-20), while the other version provided additional response options if activities could be done alone but with difficulty (ADL-IADL-DIFFICULTY-20). Item responses to both versions were compared using the binomial test for differences in proportion (with Wald 95% confidence interval [CI]). A brief 9-item scale (ADL-IADL-DIFFICULTY-9) was developed favoring items identified as difficult or requiring help by ≥4%, with low redundancy and/or residual correlations, and with significant correlations with age and other health indicators. We repeated assessment of the measurement properties of the brief scale in two subsequent samples of older adults in Hong Kong in 2016 (aged 70-79 years; n = 404) and 2017 (aged 65-82 years; n = 1854).

RESULTS

Asking if an activity can be done alone but with difficulty increased the proportion of participants reporting restriction on 9 of 20 items, for which 95% CI for difference scores did not overlap with zero; the proportion with at least one limitation increased from 28.6% to 34.2% or an absolute increase of 5.6% (95% CI = 0.9-10.3%), which was a relative increase of 19.6%. The brief ADL-IADL-DIFFICULTY-9 maintained excellent internal consistency (α = 0.93) and had similar ceiling effect (68.1%), invariant item ordering (H trans = .41; medium), and correlations with age and other health measures compared with the 20-item version. The brief scale performed similarly when subsequently administered to older adults in Hong Kong.

CONCLUSIONS

Asking if tasks can be done alone but with difficulty can modestly reduce ceiling effects. It's possible that the length of commonly-used scales can be reduced by over half if researchers are primarily interested in a summed indicator rather than an inventory of specific types of deficits.

Falling through the cracks: a case study of how a timely integrated approach can reverse frailty

The article 'Social frailty: the importance of social and environmental factors in predicting frailty in older adults' published in the British Journal of Community Nursing in 2019 reviewed the concept and models of frailty and how the role of social and environmental circumstances interplay. To better inform interventions within the community, the impact of social isolation and environmental disorder on frailty and the wellbeing of an individual patient are further explored. This paper describes the case of a 76-year-old man, Tommy, who was living with frailty and how an individualised care plan was undertaken, evidencing the positive effects that an integrated approach from health, social care, housing and the voluntary sector can offer. Multifaceted interventions are described, which were used to reverse frailty and change Tommy's future for the better.

Impacts of Physical Environment Perception on the Frailty Condition in Older People

Frailty increases the vulnerability of older people who commonly develop a syndrome leading to growing dependence and finally often death. Physical environment conditions may affect the severity of the syndrome positive or negatively. The main objective of this study was to analyse the conditions of different urban physical environments and their relationship with the frailty syndrome in older people. Geographic Information Systems (GIS) analyses were performed to detect global and local geographic clustering. Investigating 284 adults with ages from 60 to 74 years old from Talca City, Chile, we found spatial clustering of frailty conditions registered for older people, with hotspots of high and low values associated with areas of different urban infrastructures and socioeconomic levels into the city. The spatial identifications found should facilitate exploring the impact of mental health programmes in communities exposed to disasters like earthquakes, thereby improving their quality of life as well as reducing overall costs. Spatial correlation has a great potential for studying frailty conditions in older people with regard to better understanding the impact of environmental conditions on health.

Neighborhood Characteristics and Frailty: A Scoping Review

BACKGROUND AND OBJECTIVES

Frailty is highly prevalent in later life and associated with early mortality and adverse health outcomes. The neighborhood has been identified as an important contributor to individual health, and neighborhood characteristics may contribute to frailty development. A scoping review was conducted of the peer-reviewed literature to better understand how physical and social neighborhood characteristics contribute to frailty.

RESEARCH DESIGN AND METHODS

Following an established scoping review methodology, we searched four peer-reviewed databases for relevant studies published from January 1, 2008, to December 31, 2018. Data extracted from studies included study characteristics, operationalization of neighborhood, the conceptual model of the neighborhood-frailty relationship, operationalization of frailty, and study findings for associations among neighborhood variables and frailty indicators.

RESULTS

A total of 522 articles were identified and 13 articles were included in the final data charting. Existing studies suggest that neighborhood characteristics are associated with frailty in later life. Few studies articulated a conceptual model identifying exact mechanisms through which neighborhood factors affected frailty. Studies designs were mostly cross-sectional. Longitudinal studies did not measure neighborhood characteristics over time. Studies varied considerably in how they operationalized the neighborhood. Frailty was most commonly assessed using a 5-point phenotype or a frailty index approach.

DISCUSSION AND IMPLICATIONS

Findings indicate that research on the relationship between neighborhood characteristics and frailty is an emerging area of inquiry. Additional studies are needed to more definitely explicate mechanisms through which neighborhoods contribute to, or protect older adults from, frailty.

The mediating effect of psychological distress on cognitive function and physical frailty among the elderly: Evidence from rural Shandong, China

BACKGROUND

Few studies have explored the underlying mechanism between physical frailty and cognitive function. The aim of this study is to explore the mediating role of psychological distress (PD) for the association between cognitive function and physical frailty among the elderly in rural China.

METHODS

A total of 3,242 rural older adults were included in the analysis. Logistic regression and Bootstrap analyses were employed to explore the association between cognitive function, PD and frailty, and the mediating role of PD.

RESULTS

This study found that the prevalence of frailty and cognitive impairment among the elderly in rural China was 18.0%, 22.4%. After adjusted for controlling variables, cognitive function was significantly associated with high level of PD, and elderly with higher level of PD had a higher probability of suffering from frailty. PD played a partially mediating effect in cognitive function and frailty and the mediating effect of PD can explain the 11.0% of the total effect of cognitive function on frailty.

LIMITATIONS

The data were cross-sectional, thus the causal relationship between variables could not be determined. The main variables in this study were measured by self-report information, which might result in recall bias.

CONCLUSIONS

This study provide evidence that the effect of cognitive function on physical frailty was partially mediated by PD among the elderly in rural China. Primary health care should strengthen the screening of PD characterized by depression and anxiety, and strive to improve the physical and psychological well-being of rural elderly in China.

Changes in frailty among community-dwelling Chinese older adults and its predictors: evidence from a two-year longitudinal study

Background

It 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.

Methods

A 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.

Results

The 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.

Conclusions

The 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.

Prevalence and associated factors for frailty among elder patients in China: a multicentre cross-sectional study

Background

To date, most previous studies of frailty among hospitalized elderly Chinese patients have been conducted based on small samples, which cannot represent the elderly patient population. The aim of this study was to identify the prevalence of and risk factors for frailty among elderly patients in China.

Study design and setting

This cross-sectional study surveyed 9996 elderly patients from 6 tertiary-level hospitals in China. The prevalence of frailty among patients from selected wards was surveyed by trained investigators. A mixed-effects Poisson regression model was used to analyse the factors associated with frailty among elderly patients.

Results

The mean age of all subjects was 72.47 ± 5.77 years. The prevalence rate of frailty in this study was 18.02%. After adjustments were made for the confounding effect of the clustering of hospital wards, a mixed-effects Poisson regression model showed that the associated factors of frailty included the following: age (OR: 1.016, 95% CI: 1.012–1.020), BMI < 18.5 (OR: 1.248, 95% CI: 1.171–1.330), female gender (OR: 1.058, 95% CI: 1.004–1.115), ethnic minority (OR: 1.152, 95% CI: 1.073–1.236), admission to hospital by the emergency department (OR: 1.104, 95% CI: 1.030–1.184), transit from another hospital (OR: 1.159, 95% CI: 1.049–1.279), former alcohol use (OR: 1.094, 95% CI: 1.022–1.171), fall history in the past 12 months (OR: 1.257, 95% CI: 1.194–1.323), vision dysfunction (OR: 1.144, 95% CI: 1.080–1.211), cognition impairment (OR: 1.182, 95% CI: 1.130–1.237), sleeping dysfunction (OR: 1.215, 95% CI: 1.215–1.318), urinary dysfunction (OR: 1.175, 95% CI: 1.104–1.251), and defecation dysfunction (OR: 1.286, 95% CI: 1.217–1.358). The results also showed some of the following protective effects: BMI > 28 (OR: 0.897, 95% CI: 0.856–0.940); higher education level, including middle school (OR: 0.915, 95% CI: 0.857, 0.977) and diploma and above (OR: 0.891, 95% CI: 0.821, 0.966); and current alcohol use (OR: 0.869, 95% CI: 0.815, 0.927).

Conclusion

We identified a relatively high prevalence of frailty among elderly patients, and there are several associated factors among the population derived from this investigation of a large-scale, multicentre, nationally representative Chinese elderly inpatient population.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1800017682, registered 09 August 2018.

Development of frailty subtypes and their associated risk factors among the community-dwelling elderly population

In order to explore frailty subtypes and find their associated risk factors, we conducted cross-sectional surveys of 5,341 seniors aged 60 and over in China using the Frailty Index (FI) scale. We identified four frailty subtypes, namely multi-frail, cognitive and functionally frail, psychologically frail and physiologically frail. Old age and low education level were the common risk factors among the four subtypes. Being widowed, divorced or unmarried was a risk factor for multi-frail, cognitive and functionally frail and psychologically frail, and male sex was a protective factor against cognitive and functionally frail and psychologically frail subtypes. Having a harmonious relationship with family was a protective factor against multi-frail, and fewer visits to the elderly by their children was a risk factor for psychologically frail. Dissatisfaction with their housing was a risk factor for cognitive and functionally frail, psychologically frail and physiologically frail, and a pension being the main source of income was a risk factor for cognitive and functionally frail and psychologically frail. Exercising every day was a protective factor against multi-frail and cognitive and functionally frail, and a lower level of physical activity was a risk factor for all four frailty subtypes. Our findings confirm the heterogeneity of frailty and suggest that different frail elderly individuals need more targeted care interventions.