Frailty transitions and their association with mortality in older adults

Frailty is a dynamic condition in older adults, and transitions between frailty states may occur over time. However, predictors and clinical implications of changes in frailty status, particularly frailty improvement, remain insufficiently understood.

Predictors and clinical implications of changes in frailty status over time have not been studied in detail. This study aimed to evaluate these aspects.

In this retrospective cohort study, 2573 patients were screened. After applying exclusion criteria and including only those with longitudinal follow-up, 399 patients were included in the final analysis. Frailty was assessed by the Fried frailty phenotype. Participants were categorised as robust (0), pre-frail (1-2) and frail (3-5). Changes in frailty status from baseline and associations with overall survival were analysed.

We included 399 outpatients from a geriatric clinic. The mean age was 83 ± 7 years, and 291 (73%) were women. At baseline, 9.3% (n = 37) were robust, 34.3% (n = 137) were pre-frail, and 56.4% (n = 225) were frail. Over a median follow-up of 14 months (interquartile range 12-23 months and range 6-71 months), 17.8% of participants improved, 16.0% deteriorated and 66.2% remained stable. Compared to baseline, weight loss and handgrip strength improved while walking speed worsened. Younger age (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.88-0.97, P = 0.003) was independently associated with improvement of frailty status. In the adjusted model, higher glomerular filtration rate was not statistically significant but demonstrated a trend towards association with improvement in overall frailty status (OR 1.02, 95% CI 1.00-1.04, P = 0.057). Overall, frailty transitions were not significantly associated with survival; however, in pre-frail individuals, progression to frailty was associated with shorter survival (41 vs 65 months, P = 0.010). Among pre-frail participants, older age (OR 1.08, 95% CI 1.00-1.16, P = 0.049), higher number of medications (OR 1.25, 95% CI 1.07-1.45, P = 0.005) and higher vitamin D levels (OR 1.06, 95% CI 1.01-1.10, P = 0.011) independently predicted transition to frailty.

Frailty is potentially reversible, particularly in the pre-frail stage. Improvements in weight loss and muscle strength contribute to enhanced frailty status. Early identification and targeted interventions in pre-frail individuals may prevent progression and reduce adverse outcomes.