Two-year evolution of frailty status and predictive factors in Chinese older adults: a national longitudinal study

With the global aging population, frailty in older adults has emerged as a critical focus in health and aging research. As a dynamic and multifactorial process, the transition to frailty is shaped by not only biological factors but also a range of social, psychological, and environmental influences. Identifying the key factors that drive the progression of frailty is essential for developing preventive interventions for at-risk individuals and for implementing more effective health practices and healthcare strategies for older adults.

Data for this study were drawn from the Fourth Sample Survey of the Aged Population in Urban and Rural China, organized by the China National Committee on Ageing. The baseline data were collected from older individuals who participated in the 2017 survey, and the follow-up data were from the 2019 survey. Frailty in older adults was assessed using the Frailty Index (FI) model, which was used to examine the current frailty status among older adults in China and to prospectively analyze the developmental trajectory of frailty. Logistic regression was used to identify the factors influencing the progression of frailty.

A total of 9,093 older adults were included in the analysis. FI values increased with age and were consistently higher in women than in men, indicating that older women had higher levels of frailty. During the two-year follow-up period, frailty status remained stable in most older adults (56.2%, 5,111/9,093), while 1,292 (14.2%, 1,292/9,093) experienced an improvement and 2,690 (29.6%, 2,690/9,093) experienced a worsening of frailty. Transitions to a more frail state were more common than transitions to an improved state. Additionally, transitions between adjacent frailty statuses were much more frequent than transitions across multiple frailty categories (3,669 (40.3%) versus 313 (3.4%)). Logistic regression analysis identified several factors influencing the progression of frailty status in older adults, including demographic factors (age, sex, residence, education, and marital status); family and economic status (living alone, employment, pension receipt, home ownership, financial status); health and medical factors (exercise, recent illness, annual medical checkups, hospitalizations); caregiver support; and social participation (public welfare participation, involvement in senior associations, helping seniors in need, recreational participation, and regular internet access).

The worsening of frailty with age is more common in older adults than the improvement of frailty. Among robust and pre-frail individuals, older women are more likely to experience a deterioration in frailty status. The factors influencing frailty transitions are multifaceted and complex. Therefore, when intervening in the progression of frailty among older adults, it is essential to comprehensively assess frailty risks and influencing factors based on the diverse characteristics and current status of individuals. Individualized, comprehensive, and targeted interventions and management strategies, tailored to different frailty stages and transition pathways, can help improve frailty in older adults.