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Identifying Risk Factors for All-Cause Mortality in Older Adults: Rest-Activity Rhythm, Frailty, and Metabolic
Jisu Kim1, Jonathan Kenyon1, Lana Sargent2
1Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, USA (JK, JK, DLK, YK).
American Journal of Lifestyle Medicine
|November 7, 2025
Summary
Frailty and disrupted rest-activity rhythms (RAR) predict mortality in older adults, especially those with metabolic syndrome (MetS). Combined MetS, frailty, and low RAR significantly amplify mortality risk.
Area of Science:
- Gerontology
- Public Health
- Chronobiology
Background:
- Frailty, metabolic syndrome (MetS), and circadian rest-activity rhythms (RAR) are significant health concerns in older adults.
- Understanding their combined impact on mortality is crucial for public health interventions.
Purpose of the Study:
- To investigate the associations of frailty, MetS, and RAR with all-cause mortality in U.S. older adults.
- To determine if MetS modifies the relationship between frailty, RAR, and mortality.
Main Methods:
- Retrospective cohort study using NHANES 2011-2014 linked to the National Death Index through 2019.
- Included 1010 adults aged ≥ 60 years.
- Assessed frailty, MetS, and rest-activity rhythms (RAR) using validated criteria and actigraphy; analyzed mortality risk with Cox proportional-hazards models.
Main Results:
- Frailty (HR: 1.71; 1.11-2.62) and low rhythmic strength (RA) (HR: 1.46; 1.14-1.87) significantly predicted mortality.
- These associations were significant only in individuals with MetS.
- Frailty (HR: 1.89; 1.17-3.03) and low RA (HR: 1.49; 1.14-1.61) were associated with mortality in the MetS subgroup.
Conclusions:
- Frailty and disrupted RAR are independent predictors of mortality in older adults.
- Metabolic syndrome exacerbates the mortality risk associated with frailty and disrupted RAR.
- Combined MetS, frailty, and low RAR identify older adults at amplified mortality risk.
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