Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study

Frailty transitions and risk of chronic kidney disease: insights from the China Health and Retirement Longitudinal Study

BACKGROUND

Frailty is increasingly recognized as a critical factor in the risk of chronic kidney disease (CKD), and it is also a condition that can undergo transitions. However, the relationship between frailty transitions and CKD risk in aging populations remains underexplored. This study aims to investigate the association between frailty transitions and CKD risk in middle-aged and older adults using data from the China Health and Retirement Longitudinal Study.

METHODS

Frailty was assessed using a 40-item Frailty Index (FI), with participants categorized into three groups: robust (FI ≤ 0.10), pre-frail (0.10 < FI ≤ 0.21), and frail (FI > 0.21). Frailty transitions were tracked between the first and second waves of the study. Data on CKD incidence were obtained from self-reported physician-diagnosed kidney disease. Cox proportional hazards models were employed to evaluate the risk of CKD, with adjustments made for potential confounders.

RESULTS

Among 12,050 participants (52.60% female, mean age 58.37), those who progressed to frailty or pre-frailty had an increased risk of CKD compared with stable participants (HR 1.74, p < 0.001). In contrast, individuals who recovered from frailty to robust or pre-frail status had a reduced CKD risk (HR 0.71, p = 0.023). The results of the sensitivity analysis, which showed consistent findings, support the reliability of the results.

CONCLUSION

Frailty transitions are significantly associated with the risk of CKD. Worsening frailty is linked to an increased risk of CKD, while improvement in frailty is associated with a lower risk of CKD.

Air pollution increases the risk of frailty: China Health and Retirement Longitudinal Study (CHARLS)

The longitudinal association between multiple air pollutants and frailty risk remains unexplored, and it is unclear which factors may modify this relationship. Using data from 10,584 Chinese adults aged 45 years and older in the 2011-2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), we investigated whether exposure to PM1, PM2.5, PM10, O3, and NO2 affects frailty over a median follow-up of seven years. Air pollutant data were obtained from the China High Air Pollutants (CHAP) dataset, and frailty was assessed using a 44-item Frailty Index (FI ≥ 0.25). Time-varying Cox proportional hazards models, adjusted for demographic, socioeconomic, and behavioral factors, indicated that each 10 μg/m³ increase in PM1, PM2.5, PM10, and NO2 corresponded to a 7.8 %, 4.2 %, 3.8 %, and 12.9 % higher risk of frailty, respectively, while O3 showed no significant association. Individuals who were sufficiently active appeared less affected by pollution, whereas those with no formal education were more vulnerable. Implementing future policies and interventions to reduce air pollution can potentially decrease the risk of frailty and promote healthy ageing.

Association between frailty and the progression trajectories of stroke and dementia comorbidity: insights from observational and genetic analyses

BACKGROUND

The relationship between frailty and the progression trajectories of stroke-dementia comorbidity remains inconclusive. This study aimed to determine whether there are associations between frailty and the progression trajectories of stroke-dementia comorbidity, including the transitions from enrollment to incident stroke/dementia, progression to stroke-dementia comorbidity, and ultimately to mortality.

METHODS

This prospective study was conducted based on the UK Biobank cohort. Frailty was assessed using the frailty index (FI) and categorized as robust (FI ≤ 0.10), prefrail (0.10 < FI ≤ 0.25), or frail (FI > 0.25). We used multi-state models and one-sample Mendelian randomization (MR) to investigate the relationships between frailty and the progression trajectories of stroke-dementia comorbidity. Population attributable fraction (PAF) analyses were conducted to assess the attributable risks of frailty and its components.

RESULTS

The final analysis included 459,924 participants. In comparison to the robust, the frail group significantly elevated the risk of transitioning from enrollment to stroke [HR(95 %CI): 2.32(2.19-2.45)], from enrollment to dementia [2.56(2.31-2.83)], from enrollment to mortality [2.32(2.23-2.42)], from stroke to stroke-dementia comorbidity [1.59(1.23-2.05)], from dementia to stroke-dementia comorbidity [1.79(1.29-2.48)], and from stroke to mortality [1.25(1.11-1.40)]. MR analyses revealed that genetically predicted FI was causally associated with higher risks of stroke-dementia comorbidity. PAF analyses indicated that hypertension, diabetes, lung disease, and visual impairment were significant contributors to the risk of progression to stroke-dementia comorbidity.

CONCLUSION

Our findings revealed that frailty status increases the risk of post-stroke dementia, offering important insights for the clinical management and public health strategies.

Joint association of frailty index and biological aging with all-cause and cause-specific mortality: a population-based longitudinal cohort study

BACKGROUND

The role of frailty in all-cause, cardiovascular, and cancer mortality is debatable, and the modification effect of biological aging remains unclear. Therefore, we aimed to evaluate the joint association of frailty index and biological aging with all-cause and cause-specific mortality.

METHODS

In this population-based cohort study, data were obtained from the National Health and Nutrition Examination Survey (NHANES) and National Death Index (NDI). Demographic variables were extracted, frailty index was constructed, and biological aging was calculated. All-cause deaths, cancer deaths, and cardiovascular disease (CVD) deaths were extracted as outcomes. Cox proportional hazards regression models were used to estimate the correlations, stratified subgroup analyses were used to figure out effect modifiers, and sensitivity analyses were used to confirm the robustness.

RESULTS

A total of 22,729 NHANES participants were included in this study, with 6786 all-cause deaths, 1830 CVD deaths, and 1396 cancer deaths occurred during an average follow-up of 8.5 years over a total of 192,601 person-years. The hazard ratios (HRs) of delayed aging group for all-cause mortality, CVD mortality, and cancer mortality were 0.45 (95 % CI: 0.41-0.49), 0.39 (95 % CI: 0.34-0.45), and 0.54 (95 % CI: 0.46-0.63), respectively, compared to accelerated aging group (P for all comparisons < 0.001). Likewise, the frailty index score was positively associated with all-cause mortality (HR, 1.06 [95 % CI, 1.06-1.06] per 0.01 increase in the frailty index), cardiovascular (CVD) mortality (HR, 1.07 [95 % CI, 1.06-1.07] per 0.01 increase in the frailty index), and cancer mortality (HR, 1.04 [95 % CI, 1.03-1.04] per 0.01 increase in the frailty index). The associations of frailty index with all-cause mortality and CVD mortality were modified by biological aging (P for interaction = 0.044), but cancer mortality was not (P for interaction = 0.482).

CONCLUSIONS

Accelerated biological aging is associated with higher frailty index, whereas delayed biological aging is inversely associated with risk of all-cause mortality, CVD mortality, and cancer mortality. Biological aging is effect modification among the associations of frailty index with all-cause mortality and CVD mortality, but not for cancer mortality. These findings suggest that for people with high frailty index and acceleration biological aging, to lower frailty degree and decrease biological aging acceleration by approaches such as lifestyle modifications might be beneficial for individual's longevity and lifespan.

Association between physical frailty and social support in community-dwelling older adults: A systematic review

INTRODUCTION

Older adults with frailty have an increased likelihood of unmet care needs, falls and fractures and so on, which brings serious burdens to society. By evaluating the association between physical frailty and social support in community-dwelling older adults, we will provide reference for preventing the occurrence of frailty.

METHODS

Cross-sectional and longitudinal studies on association between frailty and social support in community-dwelling older adults were mainly searched from the database of Medline, Embase, PsycINFO, CINAHL Plus and Web of Science from their establishment to February 16, 2024. After literature screening, two researchers completed data extraction, and the risk of bias was assessed using the 8-item Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies for cross-sectional studies and the Newcastle-Ottawa Scale for Cohort Studies for longitudinal studies.

RESULTS

The study included a total of 14 articles, including 9 cross-sectional studies and 5 longitudinal studies. There was no clear consensus on the correlation between social support and frailty among community-dwelling older adults. The overall quality of the included studies was very high.

CONCLUSION

Although the correlation between social support and frailty among community-dwelling older adults needs further verification, given the important role of social support, it is still recommended that family members provide multi-faceted social support, especially subjective support, for older adults.

Nucleotides as an Anti-Aging Supplementation in Older Adults: A Randomized Controlled Trial (TALENTs study)

Aging impairs nutrient metabolism and accelerates biological aging, negatively affecting health and longevity. The Targeting Aging and Longevity with Exogenous Nucleotides (TALENTs) trial (ClinicalTrials.gov: NCT05243108) aimed to explore whether nucleotides (NTs) supplementation can delay biological aging and improve health outcomes in the elderly. The trial is a 19-week, double-blind, randomized, placebo-controlled study in Chengdu, China, with 121 participants (60-70 years). Participants are randomly assigned to either NTs (1.2 g day-1) or placebo group (1:1). The results of primary outcomes showed that NTs had significantly greater reduction in median DNA methylation age compared to placebo over 19 weeks (β = -3.08 years, 95% CI: -5.07 to -1.10, P = 0.0023), with a trend toward reduction observed over 11 weeks (β = -1.94 years, 95% CI: -4.32 to 0.45, P = 0.11); whereas no significant difference changes of leukocyte telomere length are showed between groups (week 11: β = 0.09, 95% CI: -0.10 to 0.29, P = 0.36; week 19: β = 0.12, 95% CI: -0.05 to 0.28, P = 0.18). Insulin sensitivity improved in the NTs group, with a significant reduction in HOMA-IR over 19 weeks (β = -0.45, 95% CI: -0.86 to -0.04, P = 0.033). No severe adverse events or significant changes in safety indicators are reported. Together, our findings establish that NTs may delay biological aging and improve insulin sensitivity with a well-tolerated safety profile.

Association between frailty with kidney stones disease among adults aged 20 years and older population: a cross-sectional study of NHANES 2007-2020

PURPOSE

Kidney stones (KS) disease is a growing global health concern, increasing prevalence. Its well-established associations with metabolic disorders such as diabetes and hypertension, but the relationship between frailty and KS remains underexplored. This study aims to investigate the association between KS and frailty among adults aged 20 years and older population.

METHODS

This study investigates the relationship between frailty and KS prevalence using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. Frailty was assessed using the Frailty Index (FI), a continuous variable based on 49 health deficits, and categorized into robust, pre-frail, and frail states. Weighted logistic regression and restricted cubic splines (RCS) were used to assess the association between KS and frailty.

RESULTS

A total of 28,113 people were included in the study, and the overall prevalence of KS occurrence was 9.576%. The FI in the KS group was higher than that in the no KS group [0.142(0.094-0.216) vs 0.112(0.073-0.172), p < 0.0001]. Furthermore, the rate of frail status (17.691% vs 9.791%, p < 0.0001) and pre-frail status (54.267% vs 46.929%, p < 0.0001) in the KS group were higher than that in the no KS group. Multivariate logistic regression models revealed a significant positive association between frailty and KS prevalence, with frail individuals showing a 1.731-fold increased likelihood compared to robust individuals (95% CI 1.406-2.131, p < 0.0001). A nonlinear relationship was observed between the FI and KS occurrence, with likelihood increasing as frailty levels rose. Subgroup analyses indicated that frailty had the greatest impact on KS likelihood in individuals under 60 years, of normal weight, and without hypertension.

CONCLUSIONS

In adults in the United States, increased frailty is strongly associated with a higher likelihood of developing KS. Early identification and targeted management of frailty could play a crucial role in reducing the prevalence and recurrence of KS.

Joint association of frailty index and biological age with chronic obstructive pulmonary disease: a cohort study from CHARLS

Chronic Obstructive Pulmonary Disease (COPD) is associated with frailty and ageing, but there is insufficient evidence from existing longitudinal studies. This research explored the longitudinal association between frailty, ageing and COPD. We used the China Health and Retirement Longitudinal Study (CHARLS) data to perform a cohort study. The study population was non-COPD patients in wave 1 (2011), and the outcome was the occurrence of COPD at the end of follow-up (wave 4-wave 5). Frailty was assessed using the CHARLS modified frailty index (CMFI), and ageing was evaluated using the biological age (BA). We used multivariate logistic regression to examine the longitudinal associations between CMFI and BA with COPD. Fitted curves were used to analyze the dose-response relationship of CMFI and BA with COPD. A 3D surface diagram was used to analyze the association between BA and CMFI with COPD. In addition, subgroup and sensitivity analyses were performed. 6452 non-COPD patients were enrolled in the study, and after follow-up, 616 participants were diagnosed with COPD. Logistic regression and fitted curves showed a positive correlation between CMFI and BA and the development of COPD. The risk of COPD increased by 19% for every one standard deviation (SD) increase in BA and 32% for every one SD increase in CMFI. A 3D surface diagram shows a joint association between CMFI and BA with the COPD. Subgroup and sensitivity analysis results are stable. This study found a joint association between CMFI and BA with COPD, suggesting that CMFI and BA are risk factors for the development of COPD.

Association of frailty and its trajectory with the risk of cancer: evidence from the China health and retirement longitudinal study (CHARLS)

BACKGROUND

Frailty can be identified in both middle-aged and older adults. However, longitudinal studies that examine whether frailty is associated with incident cancer are currently lacking. This study aimed to comprehensively examine the impact of baseline frailty levels and their changing trajectories over time on the risk of cancer.

METHODS

We assessed frailty status using the frailty index based on data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020. First, the association between baseline frailty and cancer risk was analyzed using the Cox proportional hazards model. Second, based on the CHARLS data from 2011 to 2020, we used Group-based trajectory modeling (GBTM) to identify trajectories of frailty development during the four follow-up periods from 2011 to 2020. Cox proportional hazards model was used to analyze the association between frailty trajectories and the risk of cancer incidence during the follow-up period.

RESULTS

A total of 17,708 participants were involved at the baseline survey in CHARLS 2011. During a mean follow-up period of 8.05 years, 248 cancer events occurred. Compared with non-frailty individuals, participants in pre-frailty and frailty states had a 34% (hazard ratio [HR]: 1.34, 95% confidence interval [CI]: 1.03-1.75) and 66% (HR: 1.66, 95% CI: 1.07-2.56) increased risk of overall cancer incidence, respectively. Based on repeated measurements from 2011 to 2018, three trajectories of frailty were identified among 9,173 participants. Compared to the low-level stable group, the high-level increase group had the highest risk of cancer, with an associated HR (95% CI) of 5.43 (1.07-5.73). This was followed by the medium-level increase group, with an associated HR (95% CI 2.86 (1.27-6.43). When stratified by sex and age, participants aged ≥ 60 years and female participants in the high-level increase frailty group had a higher risk of developing cancer.

CONCLUSION

Frailty is associated with cancer risk. Medium and high levels of the frailty index are significantly associated with an increased risk of cancer incidence. In addition, more attention should be paid to the risk of cancer in people aged ≥ 60 years and in women with high levels of frailty.

Cross-sectional association between hs-CRP/HDL-C ratio and physical frailty among middle-aged and older adults: findings from a population-based study

Background

Frailty, characterized by functional decline and disability, is an emerging public health concern in aging populations. Chronic inflammation and low high-density lipoprotein cholesterol (HDL-C) levels are key contributors to the progression of frailty. This study aims to examine the association between the ratio of high-sensitivity C-reactive protein (hs-CRP) to HDL-C and frailty among middle-aged and older adults in the United States.

Methods

Our study included participants aged 45 years and older from the 2015-2020 National Health and Nutrition Examination Survey (NHANES). Logistic regression and restricted cubic spline (RCS) analysis were utilized to assess the relationship between the hs-CRP/HDL-C ratio and frailty, adjusting for potential confounding covariates. Mediation analysis was performed to determine whether plasma proteins mediated this association. Least absolute shrinkage and selection operator (LASSO) regression was employed to identify variables strongly correlated with frailty, and a nomogram was subsequently developed based on these variables.

Results

Our study included 3,626 middle-aged and older participants, among whom 787(21.7%) were identified as frailty. After adjusting for all covariates, a high hs-CRP/HDL-C ratio was identified as a significant risk factor for frailty (OR = 1.736, 95% CI: 1.009-2.988). RCS analysis disclosed a nonlinear correlation between the hs-CRP/HDL-C ratio and frailty incidence. Furthermore, mediation analysis suggested that albumin and globulin partially mediated this association, accounting for 37.82% and 11.23% of the indirect effect, respectively. A nomogram, constructed using variables selected via LASSO regression, exhibited promising discriminative ability, with an area under the curve (AUC) of 79.7% (95% CI: 77.7-81.75%).

Conclusion

Our findings suggest that a higher hs-CRP/HDL-C ratio is associated with an increased risk of frailty among middle-aged and older adults. Albumin and globulin partially mediate this relationship. Additionally, the nomogram developed in our study shows strong predictive ability for identifying individuals at high risk of frailty in this population.

The Association Between Urbanization and Frailty Status in China

Background: A frailty index (FI) can identify individuals with frailty in a population of interest. Previous literature suggests a need for frailty assessment methods for older adults in China and that urbanization may impact frailty status. We used a FI to examine the association between frailty and urbanization as living in a less urbanized area may put older adults at a higher risk frailty and poor healthcare outcomes. Methods: We included adults aged 55 years and older (n = 7695) from the China Health and Nutrition Survey (2018). The FI was based on health outcomes correlating with a deficit score divided by number of health items: robust (<0.08), pre-frail (0.08-0.24), and frail (≥0.25). We used multinomial logistic regression models to examine associations between urbanization tertile (low, medium, and high) and frailty, using our novel FI. We also conducted sub-analyses examining how urbanization level modifies the relationship between frailty status and region of residence, and education and income levels. Results: Living in an area of low versus high urbanization was associated with higher odds of frail versus robust (1.5; 1.2-2.0), and pre-frail versus robust (1.6; 1.4-2.0) status in the fully adjusted model. Generally, higher odds of worse frailty status (e.g., pre-frail or frail) was associated with lower tertiles of urbanization for region, income, and education when compared to the highest urbanization tertile. Conclusions: A FI can help identify specific characteristics that may benefit from individualized interventions to counteract frailty. Living in less urbanized areas was associated with higher odds of pre-frailty and frailty. Inclusion of urbanization level, geographic residence, and social determinants of health in FI development can help identify older adults most at risk of frailty and contribute to individual and policy-level frailty prevention interventions.

Genetic and phenotypic associations of frailty with cardiovascular indicators and behavioral characteristics

INTRODUCTION

Frailty Index (FI) is a common measure of frailty, which has been advocated as a routine clinical test by many guidelines. The genetic and phenotypic relationships of FI with cardiovascular indicators (CIs) and behavioral characteristics (BCs) are unclear, which has hampered ability to monitor FI using easily collected data.

OBJECTIVES

This study is designed to investigate the genetic and phenotypic associations of frailty with CIs and BCs, and further to construct a model to predict FI.

METHOD

Genetic relationships of FI with 288 CIs and 90 BCs were assessed by the cross-trait LD score regression (LDSC) and Mendelian randomization (MR). The phenotypic data of these CIs and BCs were integrated with a machine-learning model to predict FI of individuals in UK-biobank. The relationships of the predicted FI with risks of type 2 diabetes (T2D) and neurodegenerative diseases were tested by the Kaplan-Meier estimator and Cox proportional hazards model.

RESULTS

MR revealed putative causal effects of seven CIs and eight BCs on FI. These CIs and BCs were integrated to establish a model for predicting FI. The predicted FI is significantly correlated with the observed FI (Pearson correlation coefficient = 0.660, P-value = 4.96 × 10-62). The prediction model indicated "usual walking pace" contributes the most to prediction. Patients who were predicted with high FI are in significantly higher risk of T2D (HR = 2.635, P < 2 × 10-16) and neurodegenerative diseases (HR = 2.307, P = 1.62 × 10-3) than other patients.

CONCLUSION

This study supports associations of FI with CIs and BCs from genetic and phenotypic perspectives. The model that is developed by integrating easily collected CIs and BCs data in predicting FI has the potential to monitor disease risk.

Investigation of the association between the triglyceride-glucose index and the incidence of frailty among middle-aged and older adults: evidence from the China health and retirement longitudinal study

Aim

Limited researches have investigated the association between the Triglyceride-glucose index (TyG) and frailty vulnerability in middle-aged and older Chinese populations. This study aims to strengthen the scientific foundation for frailty prevention and management by analyzing the correlation between TyG and frailty, ultimately providing more targeted intervention strategies.

Methods

This study included middle-aged and older individuals who participated in the China Health and Retirement Longitudinal Study (CHARLS) from 2015. A multiple logistic regression model was constructed to assess the correlation between the TyG index and frailty. Additionally, restricted cubic spline (RCS) analysis was employed to evaluate the dose-response correlation between the two variables.

Results

Among the 3,978 participants included in the study, 667 individuals (16.8%) were identified with frailty. After adjusting for multiple factors in a logistic regression model, it was determined that individuals in the highest quartile group of the TyG index had a 1.43 times higher risk of frailty compared to those in the lowest quartile group (OR = 1.43, 95% CI: 1.10 ~ 1.85, p = 0.007). The RCS analysis further revealed a positive dose-response relationship, indicating that a higher TyG index was associated with an increased risk of frailty in middle-aged and older adults.

Conclusion

Research has shown a significant positive linear relationship between an increased TyG index and a higher prevalence of frailty in middle-aged and older individuals. Elevated TyG index levels could signal an increased vulnerability to frailty among individuals.

Temporal association between chronic pain and frailty occurrence, and the modifiable role of a healthy lifestyle in Chinese middle-aged and older population: a community based, prospective cohort study

BACKGROUND

While western studies suggest a temporal association between chronic pain and frailty, as well as the impacts of healthy lifestyle interventions, these relationships remain underexplored in the Chinese population.

METHODS

We conducted a longitudinal study with 13,601 participants from the China Health and Retirement Longitudinal Study, covering 2011-2018. Pain was assessed via self-report, and frailty was evaluated using a 29-item deficit-accumulation frailty index. Five lifestyle factors, such as physical activity, alcohol consumption, smoking, body mass index, and sleep duration, were assessed, and the participants were categorized into favorable, intermediate, and unfavorable lifestyle groups.

RESULTS

During the 7-year follow-up, 3,356 cases of frailty were discerned. Participants who reported pain at baseline assessment had a higher risk of developing frailty compared to those without pain (hazard ratio [HR] = 1.10; 95%confidence interval [CI], 1.03-1.19). This association was particularly evident in middle-aged individuals (HR = 1.13; 95% CI, 1.01-1.26). Participants with severe pain at baseline assessment had a 1.16-fold higher risk of frailty (95%CI, 1.05-1.28, Ptrend= 0.0067). Among the participants with mild or moderate pain at baseline assessment, the risk of developing frailty was significantly reduced by a favorable lifestyle (HR = 0.62; 95% CI, 0.51-0.76) or intermediate lifestyle (HR = 0.83; 95% CI, 0.70-0.98). Additionally, a favorable lifestyle was significantly associated with a decreased risk of developing frailty in the participants with severe pain at baseline assessment (HR = 0.75; 95%CI, 0.59-0.96). Mediation analysis indicated that a healthy lifestyle could mitigate 2.97% of frailty risk associated with chronic pain.

CONCLUSIONS

Chronic pain is strongly associated with an increased risk of developing frailty in Chinese older population, but the implementation of healthy lifestyles can significantly reduce this risk.

Longitudinal changes in frailty and incident diabetes in middle-aged and older adults: evidence from CHARLS

OBJECTIVES

To investigate how changes in frailty affect diabetes risk and whether sex and age influence this relationship.

STUDY DESIGN

This prospective cohort study, based on the China Health and Retirement Longitudinal Study (CHARLS), included 11,221 adults aged 45 and over without diabetes before the second survey. The frailty index (FI), with scores ranging from 0 to 1, was administered at baseline (2011) and during the second survey (2013), categorizing participants as robust (FI ≤ 0.10), pre-frail (FI 0.10-0.25), or frail (FI ≥ 0.25). Frailty changes were determined from the two assessments.

MAIN OUTCOME MEASURES

The primary outcome was incident diabetes. Cox regression was used to assess the association of frailty changes with diabetes and whether this association differed by sex and age (≤65 years and >65 years).

RESULTS

During a median 7-year follow-up, 1197 developed diabetes. Those remaining pre-frail/frail had nearly double the risk of diabetes (HR 1.99, 95 % CI 1.70-2.33) compared with those remaining robust. Progressing from robust to pre-frail/frail increased risk (HR 1.80, 95 % CI 1.48-2.19), and improving from pre-frail/frail to robust still had an elevated risk (HR 1.32, 95 % CI 1.06-1.66). Higher FI tertile changes were linked to increased diabetes risk (HR 1.44, 95 % CI 1.24-1.67), with a significant trend (P < 0.001). Women were at higher risk (P = 0.004), but age did not significantly modify the association (P = 0.972).

CONCLUSIONS

Frailty progression is strongly linked to increased risk of diabetes, especially in women, highlighting the need for targeted frailty management in diabetes prevention.

Development and validation of a predictive model for frailty risk in older adults with cardiovascular-metabolic comorbidities

Background

With the rapid progression of population aging, the number of frail individuals is steadily rising, making frailty a pressing public health issue that demands urgent attention. Compared to individuals with a single cardiovascular-metabolic disease, patients with cardiovascular-metabolic multimorbidity (CMM) are more prone to developing frailty. This study aimed to develop and validate a predictive model for assessing frailty risk in older adult patients with CMM.

Methods

The data came from participants in the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS). The study population comprised individuals aged 60 years and older with CMM and complete frailty scale measurements. Frailty status was evaluated using the Fried Frailty Scale. 26 indicators, including socio-demographic characteristics, lifestyle factors, overall health condition, and psychological well-being. The entire sample was randomly allocated into training and validation sets at a 7:3 ratio. LASSO regression and logistic regression was conducted to evaluate factors associated with frailty. A nomogram was constructed using the identified predictors to predict outcomes. The discrimination, accuracy, and clinical effectiveness of the model were evaluated by the area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis (DCA).

Results

The study included 2,164 older adult CMM participants, with 387 (17.88%) displaying frailty symptoms. Binary logistic regression analyses revealed that depression, social activity, history of falls, life satisfaction, ADL scores, cognitive function, age and the number of CMDs were significantly associated with frailty. These eight factors were incorporated into the nomogram model, and the AUC values for the predictive model were 0.816 (95% CI = 0.787-0.848) and 0.816 (95% CI = 0.786-0.846) for the training and validation sets, respectively, indicating effective discrimination. Hosmer-Lemeshow test results showed p = 0.073 and p = 0.245 (both > 0.05), with calibration curves indicating strong alignment between the model's predictions and actual outcomes. The DCA demonstrated the model's substantial clinical utility.

Conclusion

The nomogram prediction model developed in this research is a reliable and effective tool for assisting clinicians in identifying frailty in older adult CMM patients at an early stage, providing a scientific foundation for individualized health management and intervention.

The national and subnational burden of falls and its attributable risk factors among older adults in Iran from 1990 to 2021: findings from the global burden of disease study

BACKGROUND

Falls among older adults (individuals aged 60 and above) are a substantial health issue worldwide. This study aimed to analyze the burden of falls and its attributable risk factors among older adults at the national and subnational levels in Iran over 32 years.

METHODS

Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 data, we estimated the incidence, prevalence, death, and disability-adjusted life-years (DALYs) of falls and its attributable risk factors among older adults by sex, age groups, and socio-demographic index (SDI) in Iran and its provinces. We reported the estimates with their 95% uncertainty intervals (UIs). Rates were reported per 100,000 population.

RESULTS

In 2021 in Iran, the incidence rate of falls among older adults was 1674.0 (95% UI: 1454.9-1897.3), the prevalence rate was 11302.5 (10504.7-12095.7), the death rate was 16.9 (12.9-21.0), and the DALYs rate was 736.3 (647.6-825.4). In 2021, at the subnational level, Qazvin had the highest incidence, death, and DALYs rates for falls with values at 2329.5 (2008.8-2652.1), 24.2 (19.5-29.0), and 965.9 (856.2-1074.6), respectively, while Kohgiluyeh and Boyer-Ahmad had the highest falls prevalence rate at 16043.1 (14918.4-17149.0). In 2021, males had higher prevalence, death, and DALYs rates of falls compared to females, while females had a higher incidence rate. Among the age groups, the 90-94 age group had the highest rates of incidence, prevalence, death, and DALYs from falls. Low bone mineral density was the primary risk factor attributable to the burden of falls. There were significant positive associations between SDI and both the incidence and prevalence rates of falls. Conversely, a significant inverse association was found between SDI and the death rate.

CONCLUSIONS

From 1990 to 2021, the incidence rate of falls has increased significantly among older adults in Iran, necessitating urgent interventions. Implementing nationwide, cost-effective strategies such as exercise programs to improve strength and balance, home hazard modifications, medication reviews to reduce fall-related risks, and routine screening programs for osteoporosis and fall risk assessment can help protect and support older people, minimizing their risk of falls.

Cross-sectional and longitudinal trajectory analyses of sleep duration and frailty among middle-aged and older Chinese adults

The relationship between sleep duration and frailty remains unclear, particularly regarding their bidirectional nature and temporal dynamics in the Chinese population. This study aimed to investigate the cross-sectional association, developmental trajectories, and interactions between sleep duration and frailty in Chinese middle-aged and older adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which included 12,942 participants for cross-sectional analysis and 11,192 participants for the longitudinal trajectory study. Latent growth models and cross-lagged panel models were utilized to explore the temporal effects of sleep duration on frailty and vice versa. Participants' mean age was 59.29 ± 9.48 years, comprising 47.73% men and 52.27% women. Cross-sectional analysis revealed that, compared with participants with normal sleep duration (6-8 h), both Q1 (≤ 5 h, OR = 1.99, 95% CI 1.64-2.41, P < 0.001) and Q4 (> 8 h, OR = 1.50, 95% CI 1.12-2.02, P = 0.01) showed increased risks of frailty. The parallel latent growth model demonstrated that the initial level of sleep duration significantly negatively predicted the initial level of frailty (β = - 0.34, P < 0.001), while the rate of change in sleep duration negatively predicted the rate of change in frailty (β = - 0.61, P < 0.001). Conversely, the initial level of frailty significantly negatively predicted the initial level of sleep duration (β = - 0.36, P < 0.001), and the rate of change in frailty negatively predicted the rate of change in sleep duration (β = - 0.71, P < 0.001). Cross-lagged analysis indicated a bidirectional causal association between sleep duration and frailty, with the negative predictive effect of frailty on sleep duration being relatively stable, while sleep duration had a short-term effect on frailty. Our study revealed a U-shaped correlation between sleep duration and frailty risk in cross-sectional analysis and established a bidirectional relationship through longitudinal investigation. These findings underscore the importance of balanced sleep patterns and early screening for both conditions in middle-aged and older adults.

The mediating and joint effects of depression in the association between cardiovascular health and frailty in middle-aged and elderly people: evidence from NHANES

Objective

This study investigates the correlation between Life's Essential 8 (LE8), a cardiovascular health (CVH) metric, and frailty in middle-aged and elderly individuals in the United States, also examining how depression mediates this relationship.

Methods

Participants from the NHANES 2005-2018 were analyzed for correlations between LE8 and frailty, along with the combined effects of LE8 and depression using multiple logistic regression. Dose-response relationships were assessed using restricted cubic splines (RCS), and mediation analysis explored depression's role. Sensitivity and subgroup analyses were conducted for result stability.

Results

The study included 8,982 participants, with 3,103 frailty events. A higher LE8 score was significantly associated with a reduced risk of frailty, with adjusted odds ratios for the medium and high CVH groups at 0.49 (95% CI: 0.40-0.58, p < 0.001) and 0.21 (95% CI: 0.13-0.33, p < 0.001), respectively. The RCS model showed a negative dose-response relationship. No significant association was found between LE8 and frailty in the depressed population, where depression mediated 32.13% of the relationship.

Conclusion

Maintaining good cardiovascular health, as measured by LE8, is key to reducing frailty risk in middle-aged and elderly individuals. This underscores the importance of cardiovascular health assessments and targeted health programs to improve quality of life.

Relationship between the laboratory test-based frailty index and overall mortality in critically ill patients with acute pancreatitis: a retrospective study based on the MIMIC-IV database

Background and aims

The frailty index, based on laboratory assessments, helps identify individuals at risk for adverse health outcomes. However, its relationship with overall mortality in acute pancreatitis patients in ICUs remains unclear. This study aims to investigate the association between the frailty index and all-cause mortality and assess its prognostic value for these patients.

Methods

We carried out a retrospective observational investigation utilizing data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database. Extract data from the database for all ICU patients (first-time ICU admissions, age ≥ 18 years) who meet the diagnostic criteria for acute pancreatitis. The frailty index derived from laboratory tests (FI-lab) encompassed three vital sign indicators and 30 laboratory test indicators. Patients were categorized into four groups based on quartiles of the FI-lab score. To assess the differences in 28-day all-cause mortality among these groups, we employed Kaplan-Meier analysis, whereas the relationship between FI-lab scores and 28-day mortality was explored through Cox proportional hazards analysis. In addition, we applied Harrell's C statistic, Integrated Discrimination Improvement (IDI), and Net Reclassification Improvement (NRI) to assess the additional predictive capability of FI-lab scores compare to traditional disease severity metrics.

Results

The study included a total of 741 patients (all age ≥ 18 years, 19.84% age > 75 years, 41.16% Female). The Kaplan-Meier analysis demonstrated that individuals with elevated FI-lab scores exhibited a significantly heightened risk of all-cause mortality (log-rank p < 0.0001). The multivariate Cox regression analysis suggested that treating FI-lab as a continuous variable (per 0.01 increment) was linked to an increased risk of 28-day all-cause mortality [hazard ratio (HR) 1.072, 95% confidence interval (CI) (1.055-1.089), p < 0.001]. Moreover, when FI-lab was analyzed as a categorical variable, patients in the fourth quartile of FI-lab had a notably greater risk of 28-day all-cause mortality in comparison to those in the first quartile [HR 9.933, 95% CI (4.676-21.104), p < 0.001]. Additionally, the integration of FI-lab scores with conventional disease severity scores improved the predictive performance for 28-day mortality.

Conclusion

In patients in the ICU who have been diagnosed with acute pancreatitis, the FI-lab score functions as a reliable indicator of short-term mortality. Early detection of patients at high risk for acute pancreatitis through the implementation of the FI-lab score, along with prompt interventions, is essential for enhancing these individuals' prognoses.

Association of frailty index with incidence of chronic kidney disease: China Health and Retirement Longitudinal Study

AIM

Frailty is an important risk factor for a wide range of chronic diseases and for mortality risk. This study aims to explore the relationship between frailty and incidence of chronic kidney disease (CKD), particularly on the change and accumulation of frailty.

METHODS

Frailty status was assessed using the frailty index (FI, constructed by 31 items) and categorized as robust, pre-frail, and frail. The accumulation and change in frailty were assessed on the basis of frailty status at baseline and a second survey 4 years after baseline. Logistic regression was used to estimate the association between frailty and developing CKD.

RESULTS

A total of 3597 participants (mean age: 59.08 ± 8.94 years old, male: 49.9%) from CHARLS were included. Participants with pre-frailty or frailty status had a higher risk of developing CKD compared with robust participants (pre-frail vs robust, OR 1.78, 95% CI 1.37-2.32, p < 0.001; frail vs robust, OR 2.52, 95% CI 1.67-3.79, p < 0.001). Participants who had a robust status in the two surveys had a significantly lower risk of developing CKD (OR 0.51, 95% CI 0.36-0.75, p < 0.001) compared with those who never had a robust status.

CONCLUSION

Frailty status is significantly associated with the incidence of CKD. The risk of CKD was lower in those who ever had a robust status than in participants who never had a robust status.

Association of childhood and adulthood socioeconomic status with frailty index trajectories: Using five-wave panel data from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

The relationship between childhood and adulthood socioeconomic status (SES) and long-term frailty trajectories is unclear. We aimed to assess the frailty index (FI) dynamic trajectories and examine the associations between childhood and adulthood SES and frailty trajectories.

METHODS

We included 7321 participants aged 45 and older from the 2011-2020 China Health and Retirement Longitudinal Study (CHARLS). Six childhood SES factors and four adulthood SES factors were included. Group-based trajectory modelling was used to identify frailty trajectories and multinomial logistic regression was used to assess the association between SES and frailty trajectories.

RESULTS

Three frailty trajectory groups were identified: low-increase trajectory (LT, 59.9 %), moderate-increase trajectory (MT, 31.7 %) and high-increase trajectory (HT, 8.4 %). With the LT group as reference, for childhood SES, participants with an illiterate mother (relative-risk radio [RRR]=1.67, 95 % confidence interval [CI]: 1.10-2.52), having not enough food (1.67, 1.34-2.09), with family's financial situation (2.35, 1.61-3.42) and childhood health status (2.72, 2.09-3.53) worse than others had higher odds of being in the HT group. For adulthood SES, rural residence (1.86, 1.50-2.31), with an educational level of less than middle school (2.75, 1.83-4.15), had higher odds of being in the HT group. Similar results were found for people of different ages, genders, and residences.

CONCLUSIONS

Participants with lower SES, including maternal and self- low education, childhood hunger, worse family financial and childhood health status are more likely to experience a high-increase FI trajectory, i.e. aging faster. Attention should be paid to reduce early-life social inequalities thus to promote later-time healthy aging.

Plasma proteomics-based organ-specific aging for all-cause mortality and cause-specific mortality: a prospective cohort study

Individual's aging rates vary across organs. However, there are few methods for assessing aging at organ levels and whether they contribute differently to mortalities remains unknown. We analyzed data from 45,821 adults in the UK Biobank, using plasma proteomics and machine learning to estimate biological ages for 12 major organs. The differences between biological age and chronological age, referred to as "age gaps," were calculated for each organ. Partial correlation analyses were used to assess the association between age gaps and modifiable factors. Adjusted multivariable Cox regression models were applied to examine the association of age gaps with all-cause mortality, cause-specific mortalities, and cancer-specific mortalities. We reveal a complex network of varied associations between multi-organ aging and modifiable factors. All age gaps increase the risk of all-cause mortality by 6-60%. The risk of death varied from 5.54 to 29.18 times depending on the number of aging organs. Cause-specific mortalities are associated with certain organs' aging. For mental diseases mortality, and nervous system mortality, only brain aging exhibited a significant increased risk of HR 2.38 (per SD, 95% CI: 2.06-2.74) and 1.99 (per SD, 95% CI: 1.84-2.16), respectively. Age gaps of stomach were also a specific indicator for gastric cancer. Eventually, we find that an organ's biological age selectively influences the aging of other organ systems. Our study demonstrates that accelerated aging in specific organs increases the risk of mortality from various causes. This provides a potential tool for early identification of at-risk populations, offering a relatively objective method for precision medicine.

Predicting cardiovascular morbidity and mortality with SCORE2 (OP) and Framingham risk estimates in combination with indicators of biological ageing

BACKGROUND AND OBJECTIVE

Previous research assessing whether biological ageing (BA) indicators can enhance the risk assessment of cardiovascular disease (CVD) outcomes beyond established CVD risk indicators, such as Framingham Risk Score (FRS) and Systematic Coronary Risk Evaluation (SCORE2)/SCORE2-Older Persons (OP), is scarce. We explored whether BA indicators, namely the Rockwood Frailty Index (FI) and leukocyte telomere length (TL), improve predictive accuracy of CVD outcomes beyond the traditional CVD risk indicators in general population of middle-aged and older CVD-free individuals.

METHODS

Data included 14 118 individuals from three population-based cohorts: TwinGene, Health 2000 (H2000), and the Helsinki Birth Cohort Study, grouped by baseline age (<70, 70+). The outcomes were incident CVD and CVD mortality with 10-year follow-up. Risk estimations were assessed using Cox regression and predictive accuracies with Harrell's C-index.

RESULTS

Across the three study cohorts and age groups: (i) a higher FI, but not TL, was associated with a higher occurrence of incident CVD (P < .05), (ii) also when considering simultaneously the baseline CVD risk according to FRS or SCORE2/SCORE2-OP (P < .05) (iii) adding FI to the FRS or SCORE2/SCORE2-OP model improved the predictive accuracy of incident CVD. Similar findings were seen for CVD mortality, but less consistently across the cohorts.

CONCLUSIONS

We show robust evidence that a higher FI value at baseline is associated with an increased risk of incident CVD in middle-aged and older CVD-free individuals, also when simultaneously considering the risk according to the FRS or SCORE2/SCORE2-OP. The FI improved the predictive accuracy of CVD outcomes beyond the traditional CVD risk indicators and demonstrated satisfactory predictive accuracy even when used independently.

Association between urbanization levels and frailty among middle-aged and older adults in China: evidence from the CHARLS

BACKGROUND

Rapid urbanization is underway in China. However, the impact of urbanization on frailty remains unclear. This study aims to investigate the relationship between urbanization and frailty among middle-aged and older adults.

METHODS

We analyzed nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018. After applying inclusion and exclusion criteria, 10,758 non-frail individuals at baseline were analyzed. The exposure of interest was the comprehensive urbanization level. Urbanization level (0.072-0.689) was assessed using the entropy method. Frailty was assessed using the frailty index (FI), which ranges from 0 to 100. Frailty was defined as FI ≥ 25, and the urbanization-frailty association was assessed using - the restricted cubic spline (RCS) expressions and Cox proportional hazards models. Least absolute shrinkage and selection operator (LASSO) regression were employed to evaluate major factors associated with frailty.

RESULTS

The results revealed a U-shaped nonlinear association between urbanization level and frailty incidence, with a turning point at 0.3 (Pnonlinear < 0.001). In the Cox model, for urbanization scores below 0.3, each ten-percentile increase was associated with an HR of 0.871 (95% CI 0.843-0.900, P < 0.05). Conversely, scores at or above 0.3 had an HR of 1.178 (95% CI 1.053-1.319, P < 0.05) per ten-percentile increase. In the subgroup analysis of participants with urbanization scores below 0.3, there was a significant interaction between current work status and subgroups with dyslipidemia. LASSO regression showed that, for urbanization scores < 0.3, total retail sales (coefficient =  - 0.129) and per capita income (coefficient =  - 0.071) were most protective against frailty. For scores ≥ 0.3, key urbanization factors associated with increased frailty risk included the number of college students per 10,000 people (coefficient = 0.080) and the proportion of built-up land in the urban area (coefficient = 0.060).

CONCLUSIONS

Urbanization level had U-shaped association with frailty incidence. Factors such as total retail sales of consumer goods per capita, per capita disposable income of urban residents, and the number of college students per 10,000 people may be key in formulating a strategy for frailty prevention.

Longitudinal association between frailty and pain in three prospective cohorts of older population

BACKGROUND AND OBJECTIVES

As the global population ages, frailty and pain have become two significant health issues that impact the quality of life in older adults. Previous studies have not thoroughly explored the relationship between them. This study aims to investigate the longitudinal association between frailty and pain using data from prospective cohorts in China (CHARLS), the United Kingdom (ELSA), and the United States (HRS).

METHODS

This study utilized data from three prospective cohort studies: the China Health and Retirement Longitudinal Study (CHARLS), the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study (HRS). Frailty status was assessed using the Rockwood frailty index and categorized into robust, pre-frail, and frail. Pain was evaluated by self-reports. Pain degrees were categorized into mild, moderate and severe. Pain areas were grouped into four main areas: head and neck, trunk, limbs, oral. Generalized linear mixed-effects models were employed to analyze the longitudinal relationship between frailty and pain while adjusting for covariates, including gender, age, marital status, education level, sleep quality, smoking, drinking, hypertension, and diabetes.

RESULTS

According to the inclusion and exclusion criteria, 10,624 participants from CHARLS (47% female, mean age: 60.76 years), 4945 participants from ELSA (52.2% female, mean age: 70.05 years), and 11,439 participants from HRS (55.8% female, mean age: 69.28 years) were included in the subsequent analysis. Compared to robust individuals, those in pre-frail and frail states showed a significantly increased risk of experiencing pain. In all three cohorts, pre-frail individuals had a 3.82-fold increased likelihood of pain compared to robust individuals (OR = 3.82, 95%CI = 3.51-4.15, p-value < 0.001, CHARLS), 4.29-fold (OR = 4.29, 95%CI = 3.74-4.93, p-value < 0.001, ELSA), and 4.17-fold (OR = 4.17, 95%CI = 3.81-4.57 p-value < 0.001, HRS). Frail individuals had a 10.44-fold increased likelihood of pain (OR = 10.44, 95%CI = 9.05-12.04, p-value < 0.001, CHARLS), 10.14-fold (OR = 10.14, 95%CI = 8.05-12.76, p-value < 0.001, ELSA), and 13.27-fold (OR = 13.27, 95%CI = 11.71-15.03, p-value < 0.001, HRS).

CONCLUSION

This study demonstrates that frailty significantly impacts the risk of pain, the degree of pain, and the areas of pain. And this association is consistently observed across older populations in different countries. Future pain management strategies should incorporate frailty assessments to mitigate the adverse effects of pain on the health of older adults.

The Relationships Between Subjective Well-Being and Frailty: Staying With a Positive Mind, Stepping Away From Accelerated Aging

BACKGROUND

Subjective well-being (SWB) is a crucial measure of life quality in older adults. Understanding its relationship with frailty may inform strategies to promote healthy aging.

METHODS

We analyzed data for older adults aged ≥60 years old from Waves 3 and 4 of the China Health and Retirement Longitudinal Study. SWB was measured based on participants' self-reported overall satisfaction with life. A frailty index was developed using the deficit accumulation approach. We conducted a cross-sectional Poisson regression to investigate the relationship between SWB and counts of frailty deficits. Additionally, we conducted a longitudinal analysis to determine the 3-year relative risk of clinically significant frailty progression or mortality for different levels of SWB. The analyses were adjusted for individual weights, including adjustments for household nonresponse.

RESULTS

The cross-sectional analysis included 9 702 individuals. After adjusting for covariates, lower baseline life satisfaction was associated with higher counts of frailty deficits (mean deficit counts ratio [95% confidence interval]: 1.66 [1.54, 1.78] for "not satisfied" and 1.06 [1.02, 1.10] for "somewhat satisfied" relative to the reference "very satisfied"). The longitudinal analysis included 8 599 individuals. Participants who were "not satisfied" with life at baseline were at a greater risk of frailty progression compared with those who were "very satisfied" (risk ratio: 1.16 [1.00, 1.35]).

CONCLUSIONS

Our study finds that a lower level of SWB is associated with more severe frailty. It is also associated with frailty progression or death. These results emphasize that both psychological well-being and physical health are essential components of healthy aging.

Impact of living patterns and social participation on the health vulnerability of urban and rural older persons in Jiangsu Province, China

BACKGROUND

This study analyzes the influence of living patterns and social participation on the health vulnerability of older people in urban and rural areas and provides a reference for addressing this vulnerability.

METHODS

A total of 3500 participants aged 60 years and above from Jiangsu Province, China, were surveyed. The vulnerability index, which evaluates self-rated health, risk of falling, general pain or discomfort, chronic diseases, emotional characteristics, depression, anxiety, is used to measure health vulnerability. A multiple linear regression model is used to evaluate the effects of living patterns and social participation on health vulnerability.

RESULTS

A certain level of health vulnerability exists among Chinese urban and rural older people. Living with family members has a positive effect on their health. Individuals who live alone have worse health and lower subjective well-being. Social participation significantly reduces the comprehensive levels of general health vulnerability, physical health vulnerability, and mental health vulnerability of older people. For urban older people, living with families reduces the level of physical and mental health vulnerability, whereas living alone significantly increases health vulnerability. Living patterns significantly affect the psychological vulnerability of rural older people. Social participation has an important impact on the health of older people who live alone, especially on the mental health vulnerability of older people who live alone in urban areas.

CONCLUSION

Living patterns and social participation are important factors that affect the health vulnerability of older people in both urban and rural areas. Social participation has a significant effect on the health of older people who live alone. In particular, for older people who live alone in cities, being socially active can help change their "sedentary" lifestyle, thereby promoting physical and mental health and reducing vulnerability.

Association of clinical biomarker-based biological age and aging trajectory with cardiovascular disease and all-cause mortality in Chinese adults: a population-based cohort study

BACKGROUND

Evidence on the association of clinical biomarker-based biological age (BA) with cardiovascular disease (CVD) and mortality remains insufficient, particularly concerning aging trajectories' relationship with these two outcomes.

METHODS

Seventy-five thousand five hundred thirty-seven Chinese adults from the Kailuan study who participated in the first checkup (2006-2007) were included. BA was predicted by 32 clinical indicators using deep neural networks models. Aging status was divided into decelerated, accelerated, and normal aging based on BA in the first checkup. Six aging trajectories were developed in the initial three checkups. CVD and mortality were followed up till December 31, 2021.

RESULTS

After adjusting for chronological age, sex, education level, occupation, physical activity, smoking status, alcohol consumption, salt consumption habit, history of hypertension, diabetes, and dyslipidemia, as well as the use of antihypertensive, antidiabetic, and lipid-lowering drugs, Cox proportional hazard models showed that relative to normal aging, accelerated aging was a risk factor for CVD (adjusted hazard ratio [aHR], 1.17 [95% CI 1.11-1.23]) and mortality (aHR, 1.17 [1.12-1.22]), while participants with decelerated aging had a lower risk for CVD (aHR, 0.85 [0.80-0.90]) and mortality (aHR, 0.86 [0.82-0.90]). Relative to low-stable trajectory, other aging trajectories associated with higher risk of CVD and death, and high-stable trajectory associated with the highest risk of CVD (aHR, 1.62 [1.45-1.81]) and mortality (aHR, 1.55 [1.41-1.71]). Relative to high-stable trajectory, high-decreasing trajectory was associated with lower risk of CVD (aHR, 0.76 [0.67-0.86]) and death (aHR, 0.78 [0.70-0.87]), and decreasing-increasing trajectory was associated with lower risk of death (aHR, 0.86 [0.75-0.98]).

CONCLUSIONS

Accelerated BA aging is associated with a higher risk of CVD and mortality, whereas decelerated aging is associated with a lower risk compared to normal aging. Those persistently at high aging levels are at the highest risk for both CVD and death; conversely, it is the act of lowering and continually maintaining a reduced aging state that effectively mitigates these risks.

Analysis of the relationship between abdominal aortic calcification and frailty in the middle-aged and older US population

Background and Objective: Abdominal aortic calcification (AAC) is a marker of cardiovascular disease and is associated with increased mortality in middle-aged and older populations. However, its relationship with frailty remains unclear. Methods: Data were obtained from the 2013-2014 National Health and Nutrition Examination Survey. AAC was quantified using the Kauppila scoring system based on dual-energy X-ray absorptiometry. Frailty was assessed using the frailty index. Multivariable logistic regression models examined the association between AAC and frailty. Results: A total of 2987 adults aged ≥40 years were included. Compared to individuals with an AAC-8 score of 0, low-risk (AAC-8 score = 1-2; OR: 1.24; 95 % CI, 1.00-1.53) and high-risk AAC (AAC-8 score ≥ 3; OR: 1.83; 95 % CI, 1.03-3.23) were associated with higher odds of frailty. Similarly, mild to moderate AAC (0 < AAC-24 score ≤ 6; OR: 1.26; 95 % CI, 1.03-1.54) and severe AAC (AAC-24 score > 6; OR: 1.79; 95 % CI, 1.07-2.99) showed positive associations with frailty. Conclusions: Among middle-aged and older populations in the United States, there exists a positive correlation between AAC and frailty. Our findings suggest that the AAC score holds promise as a valuable tool for the early identification of frailty.

Comparative Study of Frailty Assessment Measures in Predicting All-Cause Mortality: Insights From NHANES

OBJECTIVES

The 3 most frequently utilized frailty assessment measures are the Fried criteria, FRAIL scale, and Frailty Index (FI). This study aimed to compare predictive capabilities of these 3 measures regarding all-cause mortality in the United States and to identify the key predictive variables.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

From the National Health and Nutrition Examination Survey (NHANES) 2005-2018 cycles, a total of 39,631 participants aged 20 and older were included.

METHODS

Fried status, FRAIL status, and FI status were determined for each individual based on the cutoff values from the continuous scores of their respective scales. Univariate and multivariate models, incorporating 11 covariates-sex, age, body mass index, ethnicity, education, marital status, smoking status, alcohol intake, employment status, poverty-to-income ratio, and total energy intake-were fitted using Cox proportional hazards and 2 machine learning models. Model performance was assessed through Integrated Brier Score (IBS), concordance index (C-index), and area under the curve (AUC) values from 10-fold cross-validation. Key variable analysis was performed using permutation importance and C-index increment. Subgroup analysis was developed according to age.

RESULTS

In univariate analyses, FI consistently outperformed Fried and FRAIL, showing significantly lower IBS, and higher C-index and AUC values. In multivariate analyses, few significant differences were found. Permutation importance analysis identified age as the most important variable, followed by Fried status and FI status. Similarly, in C-index increment analysis, age was the top one variable. Subgroup analyses showed that FI status consistently performed best in all metrics across univariate analyses at least in 40-59 and 60-79 age groups. FI status consistently emerged as the most important variable in permutation analysis across all age groups.

CONCLUSIONS AND IMPLICATIONS

FI demonstrated the best performance as a single predictor in predicting all-cause mortality, with age being crucial for enhancing predictive performance. Future research should explore the applicability of FI in different populations and its relationship with cause-specific mortality.

The development and application of the mobile frailty management platform for Chinese community-dwelling older adults

Objectives

This study aimed to develop a mobile frailty management platform for Chinese community-dwelling older adults and evaluate its effectiveness, usability and safety.

Methods

Based on literature research, the research team combined the frailty cycle and integration models, self-determination theory, and technology acceptance models and determined the frailty interventions through expert discussion, then transformed it into multimedia resources, finally, engineers developed the mobile management platform. A cluster sampling, parallel, single-blind, controlled quasi-experimental trial was conducted. Sixty older adults from two community health service centers were recruited from March to August 2023. The control group received routine community care, while the intervention group used the mobile frailty management platform. The incidence of frailty, scores of quality of life, depression, sleep quality, and grip strength within 12 weeks were compared between the two groups, and the availability and safety of the platform were assessed.

Results

A total of 52 participants completed the study, 27 in the intervention group and 25 in the control group. At 12 weeks after the intervention, the frailty state of the intervention group was reversed to pre-frailty. There were no significant differences in the scores of quality of life, depression, sleep quality, and grip strength between the two groups before and 4 weeks after intervention. At 8 weeks and 12 weeks after the intervention, the quality of life, depression, and grip strength of the intervention group were improved with statistical significance (P < 0.05). Sleep quality was statistically significant only 12 weeks after the intervention (P < 0.05). System Usability Scale score for the platform was (87.96 ± 5.88), indicating a highly satisfactory user experience. Throughout the intervention, no adverse events were reported among the older adults.

Conclusions

The mobile frailty management platform effectively improved frailty status, depressive mood, sleep quality, grip strength, and quality of life for Chinese community-dwelling older adults. It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.

Development and validation of a prediction model of frailty risk in community-dwelling older adults: From a national longitudinal survey

OBJECTIVES

This study aimed to develop and validate a risk prediction model for frailty in elderly using a nationally representative longitudinal survey database.

STUDY DESIGN

Longitudinal study based on public databases.

METHODS

Three continuous cohorts of elderly aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey, with the 2008-2018 cohort as the development cohort. 2005-2014 and 2002-2011 cohort as validation sets. Frailty was assessed using the FI constructed from 46 indicators of health deficits, with FI ≥ 0.25 considered frailty. Prediction models were constructed using Cox regression model. We assessed the predictive performance of the models using the concordance statistic and calibration accuracy.

RESULTS

4,878 participants from the development cohort were enrolled with a median follow-up of 65 months. The prediction model contained 9 predictors: age, BMI, cognitive function, gender, ethnicity, education, natural teeth status, smoking status, and occupation. In the development cohort, the AUCs were 0.74, 0.78, and 0.80 at 36, 60, and 96 months. The AUCs were 0.68, 0.84, 0.85, and 0.70, 0.72, and 0.76 for two validation sets, respectively. Calibration performed well in the development and two validation sets, with a Brier score of <0.25. The prediction models constructed using machine learning algorithms showed similar predictive performance.

CONCLUSIONS

We developed and validated a model to predict the risk of incident frailty in elderly. The model provides insights to enable early screening and risk stratification for frailty in elderly, and to frame the development of individualized prevention of frailty.

Associations of estimated glucose disposal rate with frailty progression: results from two prospective cohorts

BACKGROUND

Frailty is a common geriatric syndrome associated with many adverse health outcomes. Identifying the risk factors of frailty is crucial and the insulin resistance (IR) is considered as a potential target. The estimated glucose disposal rate (eGDR) is a simple and reliable surrogate marker of IR. Associations of eGDR with frailty have not been explored. This study aimed to investigate the associations of eGDR with frailty progression.

METHODS

We used data from two prospective cohorts of the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The eGDR was calculated as follows: eGDR (mg/kg/min) = 21.158 - (0.09×waist circumference) - (3.407×hypertension) - (0.551×glycosylated hemoglobin A1c) [waist circumference (cm), hypertension (yes = 1/no = 0), and glycosylated hemoglobin A1c (%)]. Participants were divided into three categories by tertiles of eGDR. Frailty index (FI) was calculated every two years and used to assess the degree of frailty which ranged from 0 to 100. Frailty progression was assessed by repeated measurements of FI during follow-up. Linear mixed-effect models were used to analyze the associations of eGDR with frailty progression.

RESULTS

8872 participants from CHARLS (mean age: 58.9 years, female: 53.3%) and 5864 participants from HRS (mean age: 67.0 years, female: 59.0%) were included. The median follow-up periods were 7.0 years in the CHARLS and 12.8 years in the HRS, respectively. Compared to participants with lower tertile (T1) of eGDR, those with upper tertile (T3) of eGDR showed decelerated FI progression (CHARLS, β: -0.294, 95%CI -0.390 to -0.198, P < 0.001; HRS, β: -0.378, 95%CI -0.474 to -0.281, P < 0.001). Continuous eGDR was also associated with FI progression for significant deceleration in FI progression with per 1 SD increase in eGDR (CHARLS, β: -0.142, 95%CI -0.181 to -0.103, P < 0.001; HRS, β: -0.170, 95%CI -0.209 to -0.130, P < 0.001). These associations were still observed after excluding baseline frail participants. Furthermore, the associations of eGDR with FI progression were consistent among participants with and without diabetes.

CONCLUSION

Regardless of diabetes or not, a higher level of eGDR was associated with the decelerated frailty progression. Our findings highlight the role of eGDR in frailty progression and recommend taking effective interventions to improve eGDR for preventing frailty progression.

Development and validation of a generalizable electronic frailty index: a prospective study in China

BACKGROUND

Frailty is a multidimensional geriatric syndrome recognized as a critical public health challenge in 771 million aging population worldwide. Although electronic frailty index (eFI) is successfully adopted for frailty screening in developed countries, such a tool is still absent in China. Furthermore, for facilitate early illness prevention, China offers annual physical examinations for the elderly which offers a potential opportunity for the early detection of frailty. This study aimed to develop a new eFI algorithm leveraging routinely collected healthcare data and validated it within both the development and an independent external cohort.

METHODS

Individuals aged 65 or older from the development and external validation cohort were enrolled in this study. Data were extracted from the annual physical examinations and medical records. Based on the cumulative deficit model, a tailored eFI calculation algorithm was developed. The eFI's validity was assessed through correlation with the established FRAIL scale, and its predictive utility for hospitalization and mortality was prospectively evaluated.

RESULTS

A set of 30 variables across 13 functional domains was selected to calculate the eFI. It demonstrated a strong correlation with the FRAIL scale (P < 0.001). In the development cohort, individuals categorized as prefrail and frail had higher (62% and 137% respectively) risk of hospitalization compared to the robust group. Regarding all-cause mortality, the risk was also higher (59% and 117% respectively) for prefrail and frail participants. Similar associations were observed in the external validation cohort.

CONCLUSION

Utilizing standardized healthcare records, this study successfully developed and validated an eFI algorithm that can offer a reliable and scalable tool for early frailty screening in China and populations with similar preventive physical examination data.

The development and validation testing of a comprehensive frailty assessment in women with breast cancer

BACKGROUND

Women with breast cancer are known to suffer from disease and treatment, and the generic measurement tools may underestimate their frailty. A specific instrument comprehensively measuring frailty among women with breast cancer has not yet been developed. This study aims to develop and validate the tool of breast cancer comprehensive frailty scale (BCCFS).

METHODS

A descriptive and explorative study design was used. We collected the data through systematic literature and modified Delphi method. After an initial search and screening process, a total of 33 articles were included for review and consideration in the item design. Ten experts were invited to generate and validate initial items. The validity was assessed using a sample of 205 women with breast cancer in Taiwan. Its validity was then tested using item analysis, exploratory factor analysis, confirmatory factor analysis, criterion-related validity and areas under the receiver-operating characteristic, while its reliability was evaluated through internal consistencies and test-retest analyses.

RESULTS

A three-factor solution with 16 items was chosen and accounted for approximately 58.57% of the total variance by exploratory factor analysis (KMO = 0.85; Bartlett's Test of Sphericity: χ2 = 2881.34, p < 0.001). The factors were interpreted as (1) deterioration of body and mobility, (2) negative emotions, and (3) cognitive impairment. The goodness of fit indices of the confirmatory factor analysis were as follows: chi-square = 234.498 (p < 0.01), normed chi-square = 2.322, SRMR = 0.055, RMSEA = 0.08, CFI = 0.930, and LI = 0.917. The Cronbach's alpha calculated for the BCCFS (16 items) was 0.91 (95% confidence interval: 0.89 to 0.93), and the test-retest reliability coefficient was 0.60. Using the G8 screening tool as a standard indicator of frailty, analysis of receiver operating characteristic curve showed that 31.5 was the best cut point (area under curve = 0. 816, 95% confidence interval: 0.757 to 0.874) with a sensitivity of 63.5% and specificity of 84.4%.

CONCLUSION

The instrument exhibited acceptable psychometric properties, proving it to be a valuable tool for evaluating frailty in women with breast cancer. Further assessments of its reliability, validity, and generality from health providers' views in different contexts and cultures are recommended.

Association of Cognitive Frailty With Subsequent All-Cause Mortality Among Middle-Aged and Older Adults in 17 Countries

OBJECTIVES

Cognitive frailty refers to the co-occurrence of cognitive impairment and frailty without concurrent Alzheimer's disease or dementia. Studies of cognitive frailty and mortality have been limited to single country or older people. However, frailty and cognitive decline may occur much earlier. We aimed to examine the association between different cognitive frailty status and subsequent all-cause mortality among middle-aged and older people in 17 countries.

METHODS

Participants aged 50 and over were drawn from six prospective cohorts of aging. We classified participants according to their cognitive impairment and frailty status into the following groups: none, only cognitive impairment, only frailty and cognitive frailty. Competing-risks regression models were used to evaluate the association of different cognitive frailty status at baseline with subsequent all-cause mortality.

RESULTS

The cognitive frailty group had a higher mortality risk compared to those without cognitive impairment and frailty groups. Meta-analysis results showed participants with cognitive frailty (pooled subhazard ratio [SHR] = 2.34, 95% confidence interval [CI]: 2.01-2.72, I2 = 68.0%) had a higher mortality risk compared with those with only cognitive impairment status (pooled SHR = 1.36, 95% CI: 1.25-1.48, I2 = 3.0%) or only frailty status (pooled SHR = 1.83, 95% CI: 1.72-1.95, I2 = 31.0%). The association between cognitive frailty and mortality were stronger among those who were aged 70 years and older, males, single and nonconsumers of alcohol.

CONCLUSIONS

Cognitive frailty, frailty or cognitive impairment alone, is associated with an increased risk of all-cause mortality in Asian, European and American countries. Physical and cognitive function screening should be conducted as early as possible in middle-aged and older people, and targeted intervention approaches should be developed to reduce the incidence of adverse health outcomes.

Is a higher body mass index associated with longer duration of survival with disability in frail than in non-frail older adults?

BACKGROUND/OBJECTIVES

This study investigated the hitherto unclear association of body mass index (BMI) with age at overall, disability, and disability-free survival in older adults with and without frailty.

METHODS

This prospective cohort study enroled 10232 Japanese adults aged ≥65 years, who underwent follow-up for adverse events, from the Kyoto-Kameoka Study conducted from 2011-2016. BMI, calculated based on self-reported height and body weight, was classified into five categories: <18.5, 18.5-21.4, 21.5-24.9, 25.0-27.4, and ≥27.5 kg/m2. Frailty was assessed using the validated Kihon Checklist. The relationships between BMI and disability and mortality were analysed using multivariate Cox proportional hazards models and Laplace regression.

RESULTS

During the 5.3-year median follow-up period (45472 person-years), 2348 (22.9%) incidences of disabilities occurred. After adjusting for confounders, including medical history and lifestyle, individuals in the lowest and highest BMI categories had a higher hazard ratio (HR) of disability [<18.5 kg/m2: HR: 1.31, confidence interval (CI): 1.16-1.49; ≥27.5 kg/m2: HR: 1.27, 95% CI: 1.08-1.49, p for non-linearity <0.001] compared with that of those with BMI = 21.5-24.9 kg/m2. In the 50th percentile differences in age at overall and disability-free survival, participants with BMI < 18.5 kg/m2 were more likely to die before disability incidence [survival with disability (overall survival - disability-free survival): -10.2 months]; those with BMI ≥ 27.5 kg/m2 had longer survival with disability (12.5 months). These relationships were more marked in the frailty-stratified model, where in the BMI ≥ 27.5 kg/m2 group, individuals with frailty survived longer with disability (27.2 months) than did individuals without frailty (6.2 months).

CONCLUSION

Higher BMI is associated with a longer duration of survival with disability among older adults, especially in those with frailty. Therefore, reversing frailty should be prioritised because individuals with frailty have a shorter probability of disability-free survival than do individuals without frailty, regardless of BMI.

Joint Physical-Psychosocial Frailty and Risks of All-Cause and Cause-Specific Premature Mortality

BACKGROUND

The importance of integrating physical and psychosocial factors in assessing frailty -health outcomes has been increasingly acknowledged, while the related evidence is lacking. We sought to investigate the associations of joint physical-psychosocial frailty with risk of premature mortality and evaluate the relative importance of individual physical and psychosocial factors.

DESIGN

A total of 381,295 participants with no history of cancer or cardiovascular disease (CVD) were recruited from the UK Biobank cohort. The physical-psychosocial frailty was evaluated based on seven indicators including weight loss, exhaustion, physical activity, walking pace, grip strength, social isolation, and loneliness. The outcomes were premature mortality from all causes, cancer, CVD, and other causes. Cox proportional hazards models were used to assess the associations between the physical-psychosocial frailty and premature mortality.

KEY RESULTS

During a median follow-up period of 12.7 years, we recorded 20,328 premature deaths. Each additional increment in the physical-psychosocial frailty index was associated with a 26% (HR 1.26, 95% CI 1.24-1.28), 10% (HR 1.10, 95% CI 1.08-1.12), 30% (HR 1.30, 95% CI 1.26-1.33), and 44% (HR 1.44, 95% CI 1.41-1.47) higher risk of all-cause, cancer, cardiovascular, and other-cause premature mortality, respectively. Compared with participants with the physical-psychosocial frailty index of 0, those with the index ≥ 4 had a 2.67 (95% CI 2.49-2.87)-fold higher risk of all-cause premature mortality. Slow walking pace and social isolation were the top two strongest predictors for all-cause premature mortality. In addition, we found that lower body mass index (BMI), age, smoking status, and dietary quality modified the associations of physical-psychosocial frailty with all-cause premature mortality (P-interaction < 0.05).

CONCLUSIONS

In this cohort study of UK Biobank participants, joint physical-psychosocial frailty is significantly associated with risks of all-cause and cause-specific premature mortality, highlighting the importance to jointly assess physical and psychosocial factors in determining aging-related health.

Association between non-insulin-based insulin resistance indicators and frailty progression: a national cohort study and mendelian randomization analysis

BACKGROUND

Insulin resistance (IR) is linked to an increased risk of frailty, yet it remains unclear whether the non-insulin-based IR indicators are associated with frailty trajectories and physical function decline. It aimed to examine the associations of triglyceride-glucose (TyG) index, metabolic score for insulin resistance (METS-IR), estimated glucose disposal rate (eGDR) and with long-term deficit-accumulation frailty trajectories and physical function decline.

METHODS

Data from 6722 participants in the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Baseline TyG index, METS-IR, eGDR, along with the frailty index (FI) over nine years, were calculated. FI trajectories were assessed using group-based trajectory model (GBTM). Logistic regression models were used to analyze the associations between IR indicators with FI trajectory and frailty risk. Restricted cubic splines (RCS) models were utilized to detect potential dose-response associations. Linear mixed-effects model was used to evaluate associations with FI development speed. Age, gender, educational level, marital status, smoking status, drinking status, life satisfaction, social activity and sleep duration were adjusted. Additionally, a two-sample Mendelian randomization (MR) was performed to assess the causality of observed associations.

RESULTS

Three FI trajectories including low-stable frailty, moderate-increasing frailty, and accelerated rising frailty were identified. Regarding the frail risk, each SD increment in TyG index was associated with a 16.1% increase in the risk of frailty (OR = 1.161; 95%CI: 1.092, 1.235). An inverse association was observed for eGDR with the OR (95%CI) being 0.741 (0.696, 0.788). A linear relationship was observed between baseline TyG index and frailty risk (P nonlinear = 0.696), but nonlinear association patterns for eGDR (P nonlinearity < 0.010) and METS-IR (P nonlinearity < 0.010). Each SD increment of TyG index was associated with greater FI increase (β = 0.005 SD/y; 95%CI = 0.002, 0.008 SD/y; P < 0.001). A similar association pattern was observed for METS-IR, and participants in the highest quartile of METS-IR showed significantly greater FI progression, with β value of 0.013 (95% CI = 0.004, 0.022). Each SD increment of eGDR was associated with a slower increase in FI (β=-0.006 SD/y, 95% CI=-0.009, -0.003 SD/y; P < 0.001). Participants in the highest quartile of eGDR presented a lower annual change in FI compared with participants in quartile 1 group during follow-up (β=-0.013 SD/y, 95% CI=-0.022, -0.005 SD/y; P for trend = 0.001). Similar findings were observed for physical function decline. Findings from MR analysis showed a causal relationship between higher TyG index and increased risk of frailty (β = 0.214, 95% CI = 0.079, 0.349; P = 0.002).

CONCLUSIONS

The non-insulin-based IR indicators, including TyG index, METS-IR and eGDR, were independently associated with the frailty progression and physical function decline. Monitoring and managing abnormal glucose metabolism should be recommended as a part of comprehensive strategies to prevent or delay the progression of frailty.

Associations Between Frailty and Risk of All-Cause and Cardiovascular Mortality in Patients with Prediabetes: A Population-Based Study

Objective

Diabetes is a well-known risk factor for frailty that has been associated with adverse prognosis. However, the association of frailty with all-cause and cardiovascular disease (CVD) mortality in patients with prediabetes has not been thoroughly explored.

Methods

Participants with prediabetes were derived from the 1999-2018 National Health and Nutrition Examination Survey and followed up for all-cause and CVD mortality until December 31, 2019. A frailty index calculated using a 49-item deficit accumulation model > 0.21 was used to indicate the presence of frailty. Kaplan-Meier curves and weighted Cox proportional hazards regression were used to assess the association between frailty and mortality.

Results

The weighted prevalence of frailty was 28.21% in this cohort of 7845 prediabetic participants with a mean age of 62.89 years. During a median follow-up time of 90 months, a total of 1983 all-cause (636 CVD-related) deaths occurred. Each 0.01 score increase in the frailty index was associated with a 5% and 6% increased risk of all-cause and CVD-related mortality, respectively. The hazard ratio and 95% confidence interval for all-cause and CVD mortality in the frailty group were 2.28 (1.89-2.76) and 2.84 (2.01-4.02), respectively, compared with those without frailty. Restricted cubic spline analysis showed a linear association between frailty index and all-cause or CVD mortality. Similar results were observed in the sensitivity analyses.

Conclusion

The frailty index was positively associated with all-cause and CVD mortality in participants with prediabetes, highlighting that appropriate screening and management of frailty may help reduce mortality in patients with prediabetes.

Indication of frailty transitions on 2-year adverse health outcomes among older Chinese inpatients: Insight from a multicenter prospective cohort study

INTRODUCTION

Frailty is thought to be associated with an increased risk of adverse health outcomes such as death and falls, but comparatively little is known about the impact of frailty transitions on the adverse health outcomes. Moreover, owing to insufficient sample size or a single-center study design, previous studies have not been sufficiently representative of elderly inpatients in China. This study aimed to provide estimates at the population level of the association between frailty transitions and adverse outcomes among elderly inpatients following discharge.

METHODS

This was a large-scale multicenter cohort study conducted from October 2018 to February 2021. The FRAIL scale was used to estimate frailty status. Frailty transitions were derived by considering frailty status at baseline and the 3-month follow-up, which encompassed five patterns: persistent non-frailty, persistent pre-frailty, persistent frailty, improvement in frailty, and worsening of frailty. The outcome variables included mortality, falls, hospital readmissions, and Health-Related Quality of Life (HRQoL). Cox proportional hazard regression, generalized linear models and linear regression was used to examine the association between frailty transitions and adverse health outcomes.

RESULTS

A total of 8,256 patients were included in the study, 40.70% of study participants were non-frail, 43.04% were pre-frail, and 16.27% were frail. Compared with patients who persistently non-frail patients, those who frailty improvement, persistent pre-frailty, worsening frailty, and persistent frailty showcased escalated risks of mortality within 2 years after enrollment [HR (95% CI): 1.32 (1.06-1.64)], 1.71 (1.37-2.13), 2.43 (1.95-3.02), and 2.44 (1.81-3.29), respectively. These groups also faced elevated hazards of 2-year falls [OR(95% CI): 1.586(1.13-2.23), 2.21(1.55-3.15), 1.94(1.33-2.82), 2.71(1.59-4.62)] and re-hospitalization risk within 2 years[OR(95% CI): 1.33(1.13-1.56), 1.56(1.32-1.86), 1.53(1.28-1.83), 2.29(1.74-3.01). The number of falls increased by 0.76 over 2 years in frailty-worsened patients and 0.81 in persistently pre-frail patients. The total days of rehospitalization increased by 0.35 over 2 years in frailty-improved patients, by 0.61 in frailty-worsened patients, by 0.66 in elderly in persistently pre-frail patients and by 0.80 in persistently frail patients. Moreover, patients exhibiting frailty-improved [-1.23 (95% CI: -2.12 to -0.35)], persistently pre-frail[-4.95 (95% CI: -5.96 to -3.94)], frailty-worsened [-3.67 (95% CI: -4.71 to -2.62)], and persistently frail [-9.76 (95% CI: -11.60 to -7.93)] displayed inverse correlations with the regression coefficients of HRQoL.

DISCUSSION

Frailty-improved, worsened, persistently pre-frail, and frail inpatients face higher risks of mortality, falls, rehospitalization, reduced HRQoL than consistently non-frail inpatients. Screening for frailty among elderly inpatients can identify individuals at increased risk of adverse health outcomes.

Associations of neutrophil/high-density lipoprotein cholesterol ratio with frailty and its mortality

Background

Frailty is an increasingly important determinant in the field of health, and its identification has important clinical significance in the field of critical care medicine. However, there are still a large number of challenges in quick and accurate identification of frailty. This study aims to evaluate the value of the neutrophil/high-density lipoprotein cholesterol ratio (NHR) in frailty and its long-term survival.

Methods

Adult participants from seven study cycles of the National Health and Nutrition Examination Survey (NHANES) database were included. Frailty was assessed with a 49-item Frailty Index (FI). Weighted logistic regression, restricted cubic spline (RCS), and Cox regression were used to analyze the association of NHR with frailty and its long-term survival. In addition, subgroup and interaction analyses were also performed.

Results

A total of 34,382 adult participants aged 47.6 on average were included, and 16,950 (48.8%) of them were males. After the adjustment of potential confounding variables, an increase of one standard deviation (SD) in NHR resulted in the increase of the incidence of frailty by 11% (OR: 1.11, 95% CI: 1.04-1.18, P = 0.002). RCS showed a J-shaped association between NHR and frailty, which was robust in all subgroups according to the subgroup analysis. In addition, the survival analysis revealed that NHR was significantly positively associated with all-cause (HR: 1.12, 95% CI: 1.07-1.17, P < 0.0001), cardiocerebrovascular disease (CCD)-specific (HR: 1.21, 95% CI: 1.11-1.33, P < 0.0001), and cancer-specific mortality risks (HR: 1.13, 95% CI: 1.07-1.19, P < 0.0001) in frail individuals.

Conclusion

In the American adult population, NHR maintains a J-shaped relationship with frailty. In addition, NHR can help predict long-term mortality in frail individuals. This study demonstrates that NHR may become an effective predictor of frailty and its mortality.

Development and validation of a nomogram to predict frailty risk in Chinese older adults combined with physical fitness test indicators

This study aimed to develop and validate a nomogram combined with the indicators of the physical fitness test to predict frailty risk in Chinese older adults. We recruited 344 participants from a community in Hebei Province, China. Data were collected on 57 candidate factor variables from sociodemographic factors, lifestyle factors, clinical factors, body composition test, and physical fitness test. Ultimately 6 factor variables were included in this predictive model: age, nutritional risk, hypertension, multimorbidity, depression and 2-Minute step test. The area under the curve (AUC) value in the training set and validation set is 0.866 and 0.854, which indicates that the model has a good ability to discriminate. The results of the H-L test indicate that the model is well calibrated. The calibration curves also indicate a good model fit. The model provides older adults with risk indicators to identify and prevent the onset of frailty as early as possible.

Association between complementary anthropometric measures and all-cause mortality risk in adults: NHANES 2011-2016

BACKGROUND

Previous studies using a single obesity indicator cannot fully assess the association between body shape and mortality. We aimed to investigate the association between complementary anthropometric measures and all-cause mortality risk.

METHODS

We combined National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016 with mortality data up to December 31, 2019. After excluding individuals with cancer at baseline, 13,728 participants were included. Cox regression models and restricted cubic spline (RCS) analyses were used to explore the association between general obesity, central obesity, and peripheral fat indicators and all-cause mortality risk.

RESULTS

A total of 743 deaths occurred over a median follow-up of 5.83 years. In multivariable-adjusted Cox models, each 10-cm increase in waist circumference (WC), each 0.1-unit increase in waist-to-height ratio (WHtR), and each 0.01-unit increase in A Body Shape Index (ABSI) were associated with 20% (HR = 1.20; 95% CI: 1.02-1.41), 119% (2.19; 1.70-2.83), and 5% (1.05; 1.03-1.08) increased all-cause mortality risk, respectively. Conversely, each 1-cm increment in mid-arm circumference (MAC) was associated with 13% (HR = 0.87; 95% CI: 0.83-0.92) decreased mortality risk. Compared with normal group (body mass index (BMI): 18.5- <25.0), underweight (HR = 1.97; 95% CI: 1.12-3.45) and grade 3 obesity (1.37; 1.04-1.81) were at higher mortality risk. However, after further adjustment for WC, the effect of grade 3 obesity disappeared, and the RCS analyses for BMI changed from a J-shaped (P < 0.05 for non-linearity test) to a negative association (P < 0.01).

CONCLUSIONS

Underweight, grade 3 obesity, and central obesity were associated with an increased mortality risk, while peripheral fat was inversely associated with mortality.

The association between PM2.5 and frailty: evidence from 122 cities in China and 7 countries in Europe

BACKGROUND

The accelerated aging process worldwide is placing a heavy burden on countries. PM2.5 particulate matter exposure is a significant factor affecting human health and is crucial in the aging process.

METHODS

We utilized data from China Health and Retirement Longitudinal Study (CHARLS) and the Survey of Health, Aging, and Retirement in Europe (SHARE) to study the relationship between PM2.5 exposure and the frailty index. Acquire PM2.5 exposure data for China and Europe, match them according to geographic location within the database. Our study used frailty index to evaluate frailty, which comprises 29 items. We examined the association between PM2.5 and frailty index using fixed-effects regression models and Mendelian randomization (MR) analysis.

RESULTS

We first examined the association between PM2.5 and frailty index using fixed-effects regression models, revealing a notable positive link across populations in China (coefficient = 0.0003, P = 0.0380) and Europe (Coefficient = 0.0019, P < 0.0001). This suggests that PM2.5 exposure is a significant risk factor for frailty, leading to accelerated frailty. Moreover, our MR analysis uncovered a possible causal association (OR = 1.2933, 95%CI: 1.2045-1.3820, P < 0.0001) between PM2.5 exposure and the frailty index.

CONCLUSIONS

Our findings indicate that long-term exposure to PM2.5 in the environment is a risk factor for physical frailty and may have a potential causal relationship. Given the rapid global aging trend, public health measures are needed to reduce PM2.5 concentrations and prevent frailty.

The effect of frailty on postoperative recovery in patients with cardiovascular surgery

This study aimed to examine the impact of frailty on postoperative morbidity and mortality in patients undergoing cardiovascular surgery, questioning the adequacy of the preoperative American Society of Anesthesiologists (ASA) as the sole assessment tool. In a cohort of 76 patients undergoing cardiovascular interventions, we analyzed demographic data, Edmonton Frail Scale (EFS), ASA scores, Charlson Comorbidity Index values, surgery and hospitalization durations, intraoperative blood pressures, inotropic needs, erythrocyte transfusions, and pre/postoperative hemoglobin levels. Pearson chi-squared and Spearman tests were performed. Correlation of postoperative intensive care unit (ICU) stay, extubation time, ward stay, discharge status, morbidity rates, and ASA and EuroSCORE II results with EFS scores. The demographic profile indicated a mean age of 59.67 ± 13.02 years, with a majority of male patients (59.2%). Frailty status varied, with 48.7% non-frail, 26.3% vulnerable, 18.4% mildly frail, and 6.6% moderately frail. Surgical data revealed an average duration of 300.93 minutes and a mean ICU stay of 54.48 ± 101.16 hours. Statistical analysis showed significant differences in frailty levels based on initial morbidity (χ2 = 10.612, P = .014) but not in ASA score distribution by morbidity status (χ2 = 1.634, P = .442). A negative correlation was observed between EFS scores and hemoglobin levels, along with a positive correlation between the EuroSCORE II score and the duration of intubation, extubation, and ICU stay. Frailty significantly contributes to increased morbidity and necessitates evaluation alongside preoperative ASA scores to inform the need for prehabilitation. The ultimate goal extends beyond patient survival, aiming to ensure recovery while maintaining the quality of life and functional independence.

Scale-based screening and assessment of age-related frailty

As the population ages, the prevalence of age-related frailty increases sharply, which increases the risk of poor health status of older adults, such as disability, falls, hospitalization, and death. Across the globe, frailty is moving toward the forefront of health and medical research. Currently, frailty is believed to be preventable and reversible, so the early identification of frailty is critical. However, there are neither precise biomarkers of frailty nor definitive laboratory tests and corresponding clinical testing techniques and equipment in clinical practice. As a result, the clinical identification of frailty is mainly achieved through the widely used frailty scale, which is an objective, simple, time-saving, effective, economical, and feasible measurement tool. In this narrative review, we summarized and analyzed the various existing frailty scales from different perspectives of screening and evaluation, aiming to provide a reference for clinical researchers and practitioners to judge and manage frail older people accurately.

Exploring the mediating roles of depression and cognitive function in the association between sarcopenia and frailty: A Cox survival analysis approach

BACKGROUND

Despite earlier research indicating a potential link between the development of sarcopenia and an elevated risk of frailty, the lack of comprehensive prospective data on the correlation between sarcopenia and frailty incidence leaves open the question of whether depression and cognitive function mediate this association.

OBJECTIVE

The principal aim of the current investigation was to evaluate the intricate interplay among sarcopenia, depression, and cognitive function collectively influence the risk of developing frailty.

METHODS

The participants included in this study were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS), which collectively encompassed a total of 3,108 participants. To examine the interrelationships among sarcopenia, depression, cognitive function, and the incidence of frailty, we employed Cox regression models along with structural equation modelling, while making necessary adjustments for baseline demographic characteristics and various lifestyle factors.

RESULTS

During a 4-year follow-up, we documented 753 frailty events. Compared to those with nonsarcopenia, those with possible sarcopenia and sarcopenia presented risk ratios for frailty events of 1.354 (95 % CI: 1.156, 1.586) and 1.514 (95 % CI: 1.203, 1.907), respectively. Stratified analyses by different statuses of sarcopenia further revealed that the significant effect of depression on frailty was present across all groups (nonsarcopenia, possible sarcopenia and sarcopenia), whereas the effect of cognitive function on frailty was limited to the non-sarcopenia and possible sarcopenia groups. Mediation analysis showed that sarcopenia was correlated not only with frailty through depression and cognitive function separately but also through a chain-mediated effect of depression and cognitive function together.

CONCLUSIONS

Sarcopenia is associated with frailty, depression and cognitive function playing partial, mediating roles. Frailty's susceptibility to depression and cognitive function differs based on sarcopenia status. Therefore, comprehensive interventions that include sarcopenia screening, interventions, improvements in depression, the promotion of mental health, and delays in cognitive decline will be more effective in preventing and delaying frailty. This effectiveness is particularly relevant for middle-aged and older adults who reside in China.

Application of laboratory frailty index in predicting delirium in elderly patients with community-acquired pneumonia

Background

With the global aging population, community-acquired pneumonia and delirium are increasingly critical health issues among the elderly. The Laboratory Frailty Index provides an objective measure of frailty. This study explores its capacity in predicting delirium and examines the interplay between frailty and nutritional status in elderly patients with community-acquired pneumonia.

Methods and materials

This retrospective study included 481 elderly patients aged 75 and above diagnosed with community-acquired pneumonia. The Laboratory Frailty Index was calculated by dividing the sum of abnormal indicator scores by the total number of test indicators, resulting in a score ranging from 0 to 1, with higher values indicating greater frailty.

Results

Higher Laboratory Frailty Index scores were associated with an increased risk of delirium. The index's predictive accuracy improved when combined with nutritional assessments. Patients experiencing malnutrition alongside higher frailty scores exhibited a higher risk of adverse outcomes. Nutritional status mediated the relationship between frailty and delirium, underlining the significance of addressing both variables.

Conclusion

The Laboratory Frailty Index is a robust predictor of delirium in elderly patients with community-acquired pneumonia. These findings provide valuable insights for the early identification and intervention of delirium in clinical settings.