Trajectories, Transitions, and Trends in Frailty among Older Adults: A Review

Air Pollution Control Mitigates Frailty Progression: Evidence from Two Cohorts of Older Adults and DNA Methylation Insights

Frailty is an underappreciated but modifiable clinical syndrome, but little about how air quality improvements could influence frailty progression is known. Here, we utilized two Chinese cohorts with repeated follow-up visits to address this knowledge gap and explored the underlying DNA methylation mechanisms. We first conducted a multistate modeling analysis in the Chinese Longitudinal Healthy Longevity Study (CLHLS), a nationwide cohort with 21,654 older adults who had participated in at least two survey waves. An interquartile range reduction in PM2.5 exposure increased the likelihood of improvement for frail/prefrail individuals by more than 50% while lowering their risks of worsening frailty or mortality. A quasi-experimental study within a CLHLS subcohort of 1816 adults, leveraging the implementation of China's Clean Air Act, further validated these findings. Additionally, in the Guangxi Eco-Environmental Health and Aging Study─a regional prospective cohort based in Guilin, China─we included 235 older adults with follow-up data and identified three frailty-related CpG sites that were associated with PM2.5 exposure. The CpG site cg25453797 mapped to the PRKCE gene was robustly associated with the change in frailty. These findings demonstrate that air quality improvement benefits older adults by alleviating the frailty burden. DNA methylation may serve as a potential biomarker to capture the health benefits of environmental policy interventions.

A comparative analysis of binary and multi-class classification machine learning algorithms to detect current frailty status using the English longitudinal study of ageing (ELSA)

Background

Physical frailty is a pressing public health issue that significantly increases the risk of disability, hospitalization, and mortality. Early and accurate detection of frailty is essential for timely intervention, reducing its widespread impact on healthcare systems, social support networks, and economic stability.

Objective

This study aimed to classify frailty status into binary (frail vs. non-frail) and multi-class (frail vs. pre-frail vs. non-frail) categories. The goal was to detect and classify frailty status at a specific point in time. Model development and internal validation were conducted using data from wave 8 of the English Longitudinal Study of Ageing (ELSA), with external validation using wave 6 data to assess model generalizability.

Methods

Nine classification algorithms, including Logistic Regression, Random Forest, K-nearest Neighbor, Gradient Boosting, AdaBoost, XGBoost, LightGBM, CatBoost, and Multi-Layer Perceptron, were evaluated and their performance compared.

Results

CatBoost demonstrated the best overall performance in binary classification, achieving high recall (0.951), balanced accuracy (0.928), and the lowest Brier score (0.049) on the internal validation set, and maintaining strong performance externally with a recall of 0.950, balanced accuracy of 0.913, and F1-score of 0.951. Multi-class classification was more challenging, with Gradient Boosting emerging as the top model, achieving the highest recall (0.666) and precision (0.663) on the external validation set, with a strong F1-score (0.664) and reasonable calibration (Brier Score = 0.223).

Conclusion

Machine learning algorithms show promise for the detection of current frailty status, particularly in binary classification. However, distinguishing between frailty subcategories remains challenging, highlighting the need for improved models and feature selection strategies to enhance multi-class classification accuracy.

Preliminary results of a multidimensional approach to screen for frailty in community-dwelling older adults of eight Italian regions: the SUNFRAIL+ study

Background

Frailty syndrome in older adults is an age-related decline in many physiological systems, that results in a reduced response to minor stressors, and leading to an increased risk of falls, hospitalization, disability and death. Frailty can be prevented, reversed or mitigated by early screening for frailty risk in community-dwelling older adults, allowing for preventive interventions on clinical and social determinants.

Objectives

The present article reports the preliminary results of the SUNFRAIL+ study multidimensional cascade assessment in a group of community-dwelling older adults of 8 Italian regions aimed to stratify the population according to the needs of care at the first administration, integrated with the quality of life (QoL) assessment to evaluate the impact of early, integrated care.

Methods

The SUNFRAIL+ study performed a multidimensional assessment of community-dwelling older adults by linking elements of the SUNFRAIL frailty assessment tool with an in-depth assessment of biopsychosocial domains of frailty, through validated questionnaires and physical tests.

Results

The sample consisted of 743 participants (279 males and 464 females). The mean score of the multidimensional assessment with the SUNFRAIL tool was 2.31 (SD ± 0.7) with the cut-off point of frailty set at 3. The analysis revealed a significant difference in SUNFRAIL scores between the age groups. The results confirmed that individuals with higher frailty scores are significantly more likely to experience falls. Significant and conceptually valid correlations were found between physical and cognitive tests and QoL scores. Frailty is significantly associated with a lower physical and mental quality of life. The results indicated that older age and lower education levels are associated with higher frailty scores.

Conclusion

The study demonstrates important different correlation levels, firstly between the assessment of frailty by SUNFRAIL and the perceived QoL; secondarily among all SUNFRAIL spheres and their second test sets that more objectively evaluate each frailty domain. The study demonstrates that the SUNFRAIL+ approach accurately assesses frailty status owing to its strong correlation with the SF-12 quality of life assessment.

Frailty in motion: Amnestic mild cognitive impairment and Alzheimer's disease cohorts display heterogeneity in multimorbidity classification and longitudinal transitions

BackgroundData-driven examination of multiple morbidities and deficits are informative for clinical and research applications in aging and dementia. Resulting profiles may change longitudinally according to dynamic alterations in extent, duration, and pattern of risk accumulation. Do such frailty-related changes include not only progression but also stability and reversion?ObjectiveWith cognitively impaired and dementia cohorts, we employed data-driven analytics to (a) detect the extent of heterogeneity in frailty-related multimorbidity and deficit burden subgroups and (b) identify key person characteristics predicting differential transition patterns.MethodsWe assembled baseline and 2-year follow-up data from the National Alzheimer's Coordinating Center for amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) cohorts. We applied factor analyses to 43 multimorbidity and deficit indicators. Latent Transition Analysis (LTA) was applied to the resulting domains in order to detect subgroups differing in transition patterns for multimorbidity and deficit burden. We characterized heterogeneity in change patterns by evaluating key person characteristics as differential predictors.ResultsFactor analyses revealed five domains at two time points. LTA showed that two latent burden subgroups at Time 1 (Low, Moderate) differentiated into an additional two subgroups at Time 2 (adding Mild, Severe). Transition analyses detected heterogeneous changes, including progression, stability, and reversion. Baseline classifications and transitions varied according to clinical cohort, global cognition, sex, age, and education.ConclusionsHeterogeneous frailty-related subgroup transitions can be (a) detected in aging adults living with aMCI and AD, (b) characterized as not only progression but also stability and reversion, and (c) predicted by precision characteristics.

Association between objective physical activity and frailty transition in community-dwelling prefrail Japanese older adults

BACKGROUND

Frailty transition is common, and increased physical activity can prevent it. An objective assessment of physical activity could eliminate bias and provide more precise information on the association between frailty transitions and physical activity.

OBJECTIVES

This study aimed to examine the association between objective physical activity and frailty transition in community-dwelling prefrail Japanese older adults.

DESIGN

This is a retrospective cohort study based on the National Institute for Longevity Science-Longitudinal Study of Aging data.

PARTICIPANTS

A total of 387 community-dwelling older adults with prefrailty were enrolled (mean age 72.0 years).

MEASUREMENTS

Frailty was assessed using modified components of the Cardiovascular Health Study criteria, and frailty statuses were reassessed two years later. The frailty transitions were categorized into three groups: deterioration, persistence, and reversal. Participants wore a uniaxial accelerometer to assess the physical activities. Differences in baseline characteristics according to frailty transitions were assessed. To compare the baseline objective physical activities based on frailty transition, a general linear model and a logistic regression model were used.

RESULTS

Among the 387 participants, 40 (10.3%) deteriorated to frailty, 97 (25.0%) reversed to robust, and the majority (n = 250, 64.6%) remained prefrail after a 2-year follow-up. Using the general linear model, after adjusting for other factors, total energy expenditure (TEE) in the reversal group was significantly higher than that in the deterioration and persistence groups. No differences in TEE were observed between the persistence and deterioration groups. No significant differences existed in the numbers of daily steps, exercise energy expenditure (EEE) and physical activity with different intensity among these three groups. The logistic model also showed a significant association between TEE and the reversal of frailty.

CONCLUSION

Frailty transitions were common in the Japanese prefrail population. This study showed that a higher TEE was positively associated with frailty reversal in prefrail older adults. Promoting proactive programs for older adults to increase physical activity could help them stay healthy and prevent frailty deterioration.

The development of frailty trajectories in world trade center general responders and the association with World Trade Center Exposure

BACKGROUND

As the World Trade Center (WTC) General Responder Cohort ages, it is imperative to study their aging process and identify factors that can be targeted for interventions.

OBJECTIVES

Our goal was to utilize a previously developed WTC Clinical Frailty Index (CFI) to identify distinct frailty trajectories and associated factors in this cohort.

DESIGN

A latent class mixed model evaluated frailty trajectories using WTC CFIs. Multinomial regression models were used to assess associations between frailty trajectory and sociodemographic and WTC characteristics.

SETTING

We utilized data collected during routine WTC monitoring visits from 2004 until 2021.

PARTICIPANTS

The participants were WTC general responders.

MEASUREMENTS

Relative risk ratios (RRR) assessed associations with a 95 % confidence interval (CI).

RESULTS

Three distinct linear frailty trajectories were identified: high CFI (indicating higher frailty), low CFI, and progressively increasing CFI. Compared with the low CFI group, females were more likely to be in the high CFI and progressively increasing CFI groups (RRR 1.66, 95 %CI 1.46, 1.90; RRR 1.32, 95 %CI 1.15, 1.53, respectively). Education beyond high school and elevated income were protective against high CFI and progressively increasing CFI groups. Individuals that self-identified as Hispanic had an elevated RRR for the high CFI group (RRR 1.17, 95 %CI 1.04, 1.31). Occupation on 9/11, such as construction and maintenance and repair, as well as high/very high WTC exposure were significantly associated with both the high CFI and progressively increasing CFI groups.

CONCLUSIONS

Several sociodemographic and WTC variables were associated with more hazardous frailty trajectories in WTC general responders. This work is beneficial to informing and directing future interventions for those at higher-risk for more hazardous frailty progression.

Predictors of frailty trajectories among people with HIV

OBJECTIVE

This study aimed to estimate the latent frailty trajectories and identify corresponding predictors (sociodemographic, HIV-related, comorbidities, and behavioral) among a cohort of people with HIV (PWH).

DESIGN

Longitudinal observational study using latent class growth modeling.

METHODS

Nine hundred and seventy-six PWH aged 40 years and older with frailty measured from at least two visits within the ACTG HAILO cohort were included. Frailty components included weakness, physical activity, weight loss, exhaustion, and slowness. Latent class growth models were estimated to capture change in frailty over time; multinomial logistic regression was used to estimate associations between predictors and frailty trajectory class.

RESULTS

At baseline, participants were M  = 51.5 years old ( SD  = 7.5), 81% male ( n  = 783), 48% White non-Hispanic ( n  = 461), and 20% Hispanic ( n  = 195). Latent class growth models identified three frailty trajectories: sustained robustness ( n  = 811; 83%), worsening frailty ( n  = 79; 8%), and frailty improvement ( n  = 86; 9%). Older age, race, sex at birth, select comorbidities (cardiovascular disease, depression, type 2 diabetes), and behavioral characteristics (physical activity, smoking, and alcohol) were associated with fluctuations in frailty trajectories over time ( P  < 0.05).

CONCLUSION

Modifiable factors such as managing comorbidities and promoting physical activity present ideal opportunities for future interventions to prevent or slow the progression of frailty.

Association between physical activity and frailty transitions in middle-aged and older adults: a nationwide longitudinal study

BACKGROUND

Frailty has become an important health problem in the middle-aged and older people population. Physical activity (PA) is a key intervention for frailty prevention and management. However, studies of the association between COVID-19 pre-pandemic PA and the worsening or improvement of frailty during the pandemic remain unclear.

METHODS

This longitudinal cohort study used data from the English Longitudinal Study of Ageing (ELSA), including participants aged 50 and over. Three intensities of PA (vigorous, moderate, and mild) were categorized as less than once per week and at least once per week, respectively, based on participant self-report. The frailty index (FI) assessed the frailty status, defining frailty as FI ≥ 25. Logistic regression was applied to examine the association between PA and frailty, estimating odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

Of the 4379 non-frail participants at baseline (median age 67, 54.9% female), 8.1% developed frailty during a mean follow-up of 3.5 years. Among 564 frail participants at baseline (median age 71, 66.5% female), 17.9% regained health. Compared to those engaging in PA less than once per week, participants who engaged in vigorous (OR: 0.47 [95% CI: 0.35-0.62]), moderate (OR: 0.37 [95% CI: 0.29-0.48]), or mild (OR: 0.38 [95% CI: 0.26-0.56]) PA at least once a week had a lower risk of frailty worsening. Additionally, participants who engaged in moderate (OR: 2.04 [95% CI: 1.29-3.21]) or mild (OR: 2.93 [95% CI: 1.54-5.58]) PA at least once a week had a higher likelihood of frailty improvement. Sensitivity analyses based on comprehensive PA levels confirmed these findings. Participants who maintained at least one PA per week had lower frailty worsening (Vigorous, OR: 0.20 [95%CI: 0.12-0.33]; Moderate, OR: 0.13 [95%CI: 0.09-0.19]; Mild, OR: 0.20 [95%CI: 0.11-0.38]) and higher frailty improvement rates (Moderate, OR: 3.43 [95%CI: 1.93-6.11]; Mild, OR: 4.65 [95%CI: 1.90-11.42]). In addition, individuals (Vigorous, OR: 0.35 [95%CI: 0.20-0.60]; Moderate, OR: 0.36 [95%CI: 0.22-0.56]) who transitioned from inactive to active also exhibited a lower risk of frailty.

CONCLUSIONS

This study emphasized the critical role of PA in preventing and improving frailty in middle-aged and older people, especially during the COVID-19 pandemic. Our study also highlighted the importance of maintaining PA habits to reduce frailty risk and promote its improvement. Also, the study indicated that individuals who transitioned from inactive to active had a lower risk of frailty. These findings enriched the understanding of the association between PA and frailty and provided valuable insights for addressing the health impact of future pandemics on middle-aged and older people.

Long-term changes in frailty and incident atrial fibrillation, heart failure, coronary heart disease, and stroke: A prospective follow-up study

BACKGROUND

People with frailty have increased prevalence and incidence of atrial fibrillation (AF).

OBJECTIVE

The study aimed to further investigate the association of long-term changes in frailty with risk of new-onset AF. Its associations with heart failure (HF), coronary heart disease (CHD), and stroke were also evaluated as a secondary aim.

METHODS

More than 50,000 participants from UK Biobank cohort were included, with frailty index (FI) data and free of AF, HF, CHD, or stroke in baseline and follow-up assessments. Frailty status of the participants was categorized into nonfrail, prefrail, and frail based on their FI scores. FI in baseline and follow-ups are used to calculate the trajectories of frailty (ΔFI).

RESULTS

During a median of 5.1 years of follow-up from the final assessment, 1729 cases of AF were recorded. Frailty trajectory analysis showed that even a 0.01 point per year increase in ΔFI was associated with 14% (95% confidence interval [CI] 1.08-1.20) higher risk of AF, independent of baseline FI after adjusting for potential confounders. Compared with maintained nonfrail participants, those with sustained frail status had the highest risk of incident AF (hazard ratio [HR] 1.95, 1.61-2.36). The risk declined by 30% (95% CI 0.53-0.94) when frail participants regressed to nonfrail or prefrail status, compared with sustained frail participants. These associations were similar in HF and CHD however not significant in stroke.

CONCLUSION

In middle-aged and elderly individuals, frailty remission or nonfrailty maintenance was associated with lower risk of AF, HF, and CHD compared with persistent frailty, regardless of previous frailty status and established risk factors.

Longitudinal trajectories of frailty and cognitive decline among older Korean cancer survivors

This study aimed to identify frailty trajectories among older adults diagnosed with cancer, as well as the impacts of frailty trajectories on cognitive decline at an eight-year follow-up. We used longitudinal data from the Korean Longitudinal Study of Aging. A total of 173 older Korean cancer survivors were included in our analysis. Frailty and cognitive function were assessed using the multi-domain frailty index and the Korean version of the mini mental state examination, respectively. Latent class growth modeling and multivariate logistic regression were employed. Two distinct frailty trajectories were identified: "low and stable" (75.1%) and "moderate and increasing" (24.9%). Older cancer survivors in the "moderate and increasing" frailty group were 4.89 times more likely to experience cognitive decline at the eight-year follow-up than their counterparts in the "low and stable" frailty group. Periodic evaluation and timely management of frailty could contribute to preventing cognitive decline among older cancer survivors.

Influence of Frailty Status on the Efficacy of Epidural Steroid Injections in Elderly Patients With Degenerative Lumbar Spinal Disease

Background: The global increase in the elderly population has led to a higher prevalence of degenerative lumbar spinal diseases. Epidural steroid injection (ESI) is a widely used procedure for managing lower back pain. This study investigated the association of preprocedural frailty status with the efficacy of ESI in elderly patients diagnosed with degenerative lumbar spinal diseases. Methods: This retrospective observational study included patients aged 65 years and older who underwent lumbar ESI. Frailty status (robust, prefrail, and frail) assessed via the Frailty Phenotype Questionnaire was collected along with demographic and clinical parameters. Good analgesia was defined as a ≥ 50% reduction in pain score at 4-week follow-up evaluation. Multivariable logistic regression analyses were performed to identify factors associated with poor analgesia. Results: We included 289 patients in this study. Frailty status correlated with analgesic outcomes, with worsening frailty status correlating with increasingly poor analgesia after the injection (robust = 34.5%, prefrail = 40.8%, and frail = 60.0%, p=0.003), predominantly in female patients. After adjusting for demographic and clinical factors, frail patients demonstrated much higher odds of poor analgesia than robust individuals (adjusted odds ratio [aOR] = 2.673, 95% confidence interval [CI] = 1.338-5.342, p=0.005). Conversely, prefrail patients did not show a significant association with analgesic outcome (aOR = 1.293, 95% CI = 0.736-2.272, p=0.372). Conclusions: Frailty, but not prefrailty, appeared to be an independent factor associated with poor analgesic efficacy of ESI in elderly patients with symptomatic degenerative lumbar spinal disease receiving conservative care.

Frailty trajectories and determinants in Chinese older adults: A longitudinal study

OBJECTIVES

This study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese.

METHODS

2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors.

RESULTS

Four FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed.

CONCLUSIONS

Frailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.

Impact of activity limitations due to fear of falling on changes in frailty in Korean older adults: a longitudinal study

This study investigated the frailty change patterns among Korean older adults during 2006-2020 and the effect of activity limitations induced by the fear of falling (FOF) on these patterns. We employed a descriptive longitudinal design utilizing data from Waves 1 to 8 of the Korean Longitudinal Study of Aging. The exclusion criteria were a baseline age < 65 years, frailty index (FI) captured only at baseline, and death or unknown survival status. Multilevel modeling, combining regression equations at two levels, was used to examine the effect of activity limitations due to FOF on frailty, adjusting for other confounding factors. An increase in FI (1.97; p < .001) was demonstrated in participants who had experienced falls versus those who had not in the past 2 years. Notably, those facing activity limitations due to FOF exhibited a more significant increase in FI (4.62; p < .001) compared with those without; frailty progression intensified over time in the former (0.54, p < .001). Activity limitations due to FOF had a more pronounced impact on frailty than falls; moreover, these activity limitations accelerated the progression of frailty. Healthcare providers must prioritize addressing FOF by employing both physical and psychological interventions to mitigate activity limitations and ultimately decelerate frailty.

Complete dentures associated with frailty among edentulous older Japanese people: A prospective analysis

OBJECTIVE

This study aimed to explore the cross-sectional and prospective associations between self-reported functionality of complete dentures (FCD), satisfaction with complete dentures (SCD) and the ability to chew hard food (ACHF) on the one hand and the frailty index (FI) on the other hand among edentulous community-dwelling older Japanese people.

METHODS

The study examined 770 edentulous participants of the Nihon University Japanese Longitudinal Study of Aging. The self-reported FCD, SCD and ability to chew six groups of food (from hardest to softest) with complete dentures were the independent variables at the baseline. The FI was computed including 40 deficits as the dependent variable at the baseline and 4 years later. Cross-sectional and prospective generalized linear regression models were fitted controlling for age, gender, marital status, education, working status and area of residence.

RESULTS

The use of non-functional complete dentures and dissatisfaction with complete dentures were both associated with a higher FI cross-sectionally (3.9% [95% CI 2.2-5.6] and 3.2% [95% CI 1.5-4.9], respectively) and prospectively (3.9% [95% CI 2.0-6.0] and 3.3% [95% CI 1.3-5.3], respectively). Regarding the ability to chew, a higher FI at baseline was observed among those able to chew food of Group 2 (1.9%, [95% CI 0.1-3.7]) and Groups 4-6 (1.9%, [95% CI 0.1-3.7]), and a progressive increment in the FI, as the participants reported being able to chew softer groups of food at the follow-up (Group 2: 2.2% [95% CI 0.05-4.3]; Group 3: 3.6% [95% CI 1.2-6.0]; and Groups 4-6: 3.4 [95% CI 0.7-6.1]).

CONCLUSION

Self-reported use of non-functional complete dentures, dissatisfaction with dentures and a reduced ACHF with complete dentures were associated with a higher FI both cross-sectionally and prospectively.

One-Year Frailty Transitions Among Persons With HIV Aged 70 Years or Older on Antiretroviral Treatment

Background

People with HIV (PWH) are aging. Frailty is an age-related condition predictive of hospitalization and mortality. Here, we assessed the frequency and factors associated with frailty transitions at 1-year follow-up in elderly PWH.

Methods

Five hundred eight PWH aged 70 years or older who were on antiretroviral treatment were included in the French multicenter SEPTAVIH study in 2019-2020. Participants were classified as robust, prefrail, or frail according to Fried frailty phenotype at baseline and at 1 year. Logistic regression models were used to evaluate socioeconomic and medical factors associated with transition between frailty states. Models were adjusted for gender, age at baseline, education, and period of HIV diagnosis (before vs after 1996).

Results

Seventeen PWH died during the 1-year follow-up. Of the remaining 491 PWH (median age, 73 years), frailty status worsened for 18% of participants and improved for 14% at 1 year. Advanced age, baseline CD4+ T-cell count <350 cells/mm3, and type 2 diabetes were associated with transition from prefrailty to frailty (adjusted odds ratio [aOR], 1.10 per 1-year positive difference; 95% CI, 1.01-1.20; aOR, 3.05; 95% CI, 1.14-8.18; and aOR, 2.63; 95% CI, 1.05-6.57; respectively). Being female was associated with more frequent improvement from prefrailty to robustness (aOR, 2.50; 95% CI, 1.09-5.55).

Conclusions

Preventing frailty in elderly PWH is a long-term problem, beginning with the early diagnosis of HIV infection and the management of comorbidities.

Longitudinal trajectories of frailty are associated with short-term mortality in older people: a joint latent class models analysis using 2 UK primary care databases

OBJECTIVES

Frailty is a dynamic health state that changes over time. Our hypothesis was that there are identifiable subgroups of the older population that have specific patterns of deterioration. The objective of this study was to evaluate the application of joint latent class model in identifying trajectories of frailty progression over time and their group-specific risk of death in older people.

STUDY DESIGN AND SETTING

The primary care records of UK patients, aged over 65 as of January 1, 2010, included in the Clinical Practice Research Datalink: GOLD and AURUM databases, were analyzed and linked to mortality data. The electronic frailty index (eFI) scores were calculated at baseline and annually in subsequent years (2010-2013). Joint latent class model was used to divide the population into clusters with different trajectories and associated mortality hazard ratios. The model was built in GOLD and validated in AURUM.

RESULTS

Five trajectory clusters were identified and characterized based on baseline and speed of progression: low-slow, low-moderate, low-rapid, high-slow, and high-rapid. The high-rapid cluster had the highest average starting eFI score; 7.9, while the low-rapid cluster had the steepest rate of eFI progression; 1.7. Taking the low-slow cluster as reference, low-rapid and high-rapid had the highest hazard ratios: 3.73 (95% CI 3.71, 3.76) and 3.63 (3.57-3.69), respectively. Good validation was found in the AURUM population.

CONCLUSION

Our research found that there are vulnerable subgroups of the older population who are currently frail or have rapid frailty progression. Such groups may be targeted for greater healthcare monitoring.

[Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil]

Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.

Association of changes in frailty status with the risk of all-cause mortality and cardiovascular death in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BACKGROUND

Few studies have investigated the association between changes in frailty status and all-cause mortality, inconsistent results were reported. What's more, studies that evaluated the effect of changes of frailty on cardiovascular death in older population are scanty. Therefore, the present study aims to investigate the association of such changes with the risk of all-cause mortality and cardiovascular death in older people, using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

A total of 2805 older participants from two consecutive waves (i.e. 2011 and 2014) of the CLHLS were included for analysis. Based on the changes in frailty status from wave 2011 to wave 2014, participants were categorized into 4 subgroups, including sustained pre/frailty, robustness to pre/frailty, pre/frailty to robustness and sustained robustness. Study outcomes were all-cause mortality and cardiovascular death, and Cox regression analysis examined the association of changes in frailty status with outcomes.

RESULTS

From wave 2011 to wave 2014, 33.2% of the participants had frailty transitions. From wave 2014 to wave 2018, there were 952 all-cause mortalities and 170 cardiovascular deaths during a follow-up of 9530.1 person-years, and Kaplan-Meier analysis demonstrated that cumulative incidences of the two outcomes were significantly lower in more robust participants (all log-rank p < 0.001). Compared with the subgroup of sustained pre/frailty, the fully adjusted HRs of all-cause mortality were 0.61 (95% CI: 0.51-0.73, p < 0.001), 0.51 (95% CI: 0.42-0.63, p < 0.001) and 0.41 (0.34-0.49, p < 0.001) in the subgroup of robustness to pre/frailty, the subgroup of pre/frailty to robustness, and the subgroup of sustained robustness, respectively. The fully adjusted HRs of cardiovascular death were 0.79 (95% CI: 0.52-1.19, p = 0.256) in the subgroup of robustness to pre/frailty, 0.45 (95% CI: 0.26-0.76, p = 0.003) in the subgroup of pre/frailty to robustness and 0.51 (0.33-0.78, p = 0.002) in the subgroup of sustained robustness when comparing to the subgroup of sustained pre/frailty, respectively. Stratified analysis and extensive sensitivity analyses revealed similar results.

CONCLUSIONS

Frailty is a dynamic process, and improved frailty and remaining robust are significantly associated with lower risk of all-cause mortality and cardiovascular death in older people.

Effects of Physical Activity on Body Composition, Muscle Strength, and Physical Function in Old Age: Bibliometric and Meta-Analyses

OBJECTIVES

Accumulating evidence suggests that physical activity (PA) is an efficient intervention to maintain functional capabilities and mitigate physiological changes in the older population. However, an attempt has yet to be made to comprehensively investigate the published landscape on the subject.

METHODS

This study had two aims. The first aim was to perform a bibliometric analysis for two keywords, "aging" and "PA", to analyze the research trend. Since "frailty" was the most noticeable co-occurring keyword with the two keywords, the second aim was to investigate the effects of PA, particularly, resistance training (RT), on frailty using a meta-analysis to provide a summary of the current evidence base.

RESULTS

The bibliometric analysis revealed that the number of publications on this research topic has gradually increased, highlighting the importance of understanding the role of PA in aging. The meta-analysis found that RT had significant beneficial effects on physical frailty factors, including handgrip strength, lower limb strength, balance, gait speed, and stair-climbing ability.

CONCLUSION

These findings demonstrate that RT is an effective intervention for improving physical function in frail populations; thus, it has important implications for the development of PA programs for older adults with frailty. Future research is warranted to explore the optimal dose, frequency, and duration of RT programs for older adults, as well as the potential benefits of combining RT with other forms of PA, such as aerobic or balance exercises.

How to construct a frailty index from an existing dataset in 10 steps

BACKGROUND

The frailty index is commonly used in research and clinical practice to quantify health. Using a health deficit accumulation model, a frailty index can be calculated retrospectively from data collected via survey, interview, performance test, laboratory report, clinical or administrative medical record, or any combination of these. Here, we offer a detailed 10-step approach to frailty index creation, with a worked example.

METHODS

We identified 10 steps to guide the creation of a valid and reliable frailty index. We then used data from waves 5 to 12 of the Health and Retirement Study (HRS) to illustrate the steps.

RESULTS

The 10 steps are as follows: (1) select every variable that measures a health problem; (2) exclude variables with more than 5% missing values; (3) recode the responses to 0 (no deficit) through 1 (deficit); (4) exclude variables when coded deficits are too rare (< 1%) or too common (> 80%); (5) screen the variables for association with age; (6) screen the variables for correlation with each other; (7) count the variables retained; (8) calculate the frailty index scores; (9) test the characteristics of the frailty index; (10) use the frailty index in analyses. In our worked example, we created a 61-item frailty index following these 10 steps.

CONCLUSIONS

This 10-step procedure can be used as a template to create one continuous health variable. The resulting high-information variable is suitable for use as an exposure, predictor or control variable, or an outcome measure of overall health and ageing.

Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology

Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.

Trends in Frailty Prevalence Among Older Adults in Korea: A Nationwide Study From 2008 to 2020

BACKGROUND

We aimed to evaluate the nationwide trend of the prevalence of frailty in older adults in Korea from 2008 to 2020 to inform future geriatric healthcare policies.

METHODS

The study used data of individuals aged 65 years and older from the Korea National Health and Nutrition Examination Survey, a nationwide repeated cross-sectional survey. Frailty was defined using frailty index, classified as non-frail (frailty index ≤ 0.15), pre-frail (0.15 < frailty index ≤ 0.25), or frail (frailty index > 0.25).

RESULTS

The study included 17,784 individuals, with the mean age of 72.4 and mean frailty index of 0.2. The prevalence of frailty in older adults in South Korea decreased significantly from 2008 (41.1%) to 2020 (23.1%). The decrease in the frailty index was observed in all age groups (all P < 0.05). As components of frailty index, we found that certain comorbidities, such as dyslipidemia, diabetes mellitus, and cardiovascular disease, have increased over time, while factors such as chewing difficulty, activity limitation, and smoking, have decreased.

CONCLUSION

The prevalence of frailty in older adults in South Korea has decreased significantly during the study period. Historical improvements in healthcare access and preventive measures may have contributed to this trend.

Effects of social activity participation and trust in the community on the transition of frailty classification in late-stage older adults: a 4-year prospective cohort study

OBJECTIVES

In Japan, frailty is a major risk factor for requiring long-term care, especially among older adults aged 75 years or older (ie, late-stage older adults). Both physical and social factors (eg, social activities, social support and community trust) are protective factors against frailty. However, few longitudinal studies have examined reversible change or stage improvement in frailty. This study investigated social activity participation and trust in the community that may affect the transition of late-stage older adults' frailty status.

DESIGN

A mail-based survey was used to analyse the improvement or deterioration of frailty status (categorised as frailty, pre-frailty and robust) over a 4-year period. Binomial and multinomial logistic regression analyses were conducted; the transition in frailty classification was the dependent variable, while a change in social activity participation and the degree of trust in the community were the independent variables.

SETTING

Ikoma City, Nara Prefecture, Japan.

PARTICIPANTS

4249 community-dwelling older adults, aged ≥75 years, not requiring long-term care who completed a follow-up questionnaire from April to May 2016.

RESULTS

Adjusting for confounding factors, no significant social factors were detected regarding improvement in frailty. However, an increase in exercise-based social participation was an improvement factor in the pre-frailty group (OR 2.43 (95% CI 1.08 to 5.45)). Conversely, a decrease in community-based social activity was a risk factor in the deterioration from pre-frailty to frailty (OR 0.46 (95% CI 0.22 to 0.93)). In the robust group, increased community-based social activity (OR 1.38 (95% CI 1.00 to 1.90)) was a protective factor against frailty, whereas decreased community trust was a risk factor (OR 1.87 (95% CI 1.38 to 2.52)).

CONCLUSIONS

No social factors had a significant influence on the improvement of frailty in late-stage older adults. However, the promotion of exercise-based social participation was found to be important for improvement in the pre-frailty state.

TRIAL REGISTRATION NUMBER

UMIN000025621.