Unraveling the dynamics: Characteristics of prefrailty transition across different directions

Frailty progression is a complex and reversible process characterized by diverse trajectories. This study aimed to identify factors and stage-specific patterns associated with prefrailty transition directions, specifically progression to frailty versus reversion to robustness, to enhance understanding of the heterogeneous and dynamic nature of frailty transitions.

Participants were selected from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal survey of older U.S. adults. Frailty was assessed using the Fried Frailty Phenotype. Life course determinants, physical, psycho-cognitive, social characteristics and frailty dimensions were compared between prefrail-frail and prefrail-robust groups at the first and last visits during the prefrailty stage. Partitioning Around Medoids clustering analysis based on Gower distance was used to identify risk patterns, and logistic regression was used to assess their associations with prefrailty progression.

A total of 2155 participants were included. The prefrail-frail group exhibited significantly greater impairments across multiple measures during the prefrail stage. Five clusters were identified at each visit. Logistic regressions demonstrated that Cluster 4 (sleep-psychological vulnerability group [OR = 3.725, 95% CI = 2.342-5.925, P < .001]) in the first visit and Cluster 2 (multidomain impairment group [OR = 7.730, 95% CI = 3.754-15.917, P < .001]) in the last visit demonstrated the strongest association with prefrail-frail transition.

This study identified distinct stage-specific vulnerability profiles associated with prefrailty progression, provided novel insights into the dynamic and heterogeneous pathways of frailty progression, and may inform early risk stratification and stage-specific prevention strategies.