Frailty reversal and its main determinants: a population-based observational and longitudinal study

Clinical guidelines recommend frailty screening for the aged population, given that frailty is frequently reversible. However, little is known about frailty and prefrailty reversal rates in the general population if no specific interventions have been implemented.

To assess real-world frailty and prefrailty reversal rates in the general population aged ≥65 years, the main contributing clinical conditions and the main risk factors for reversing frailty and prefrailty.

Observational longitudinal 12-month study (2019) of all 1·5 million persons aged ≥65 years in Catalonia. Data were retrospectively collected from various health databases through the Catalan Public Data Analysis for Health Research and Innovation (PADRIS) V.2022 programme. Frailty status according to the electronic Screening Index for Frailty (e-SIF) was determined for 31 December 2018 and for 31 December 2019.

The study included 1 465 312 Catalan inhabitants (mean age 75.8 years, 57.0% women). The annual frailty and pre-frailty reversal rates were 7.1% and 4.6%, respectively. Both rates were higher in men and decreased with age. The e-SIF components with the greatest impact on frailty reversal were non-planned hospitalisations, polypharmacy, orthostatic hypotension or syncope, anaemia and visual impairment. Female sex, age, dependency, ≥2 comorbidities and polypharmacy had an independent protective effect on 12-month frailty and pre-frailty reversals.

Prefrailty and frailty are reversible, but reversal is unlikely in cases of multimorbidity, polypharmacy and functional dependency in older and severely frail individuals. Interventions that mainly target the avoidance of non-planned hospitalisations, polypharmacy and falls would have the greatest impact on reversing frailty and pre-frailty.