Two-Year Evolution of Frailty Status and Predictive Factors in Chinese Older Adults: A National Longitudinal Study
Authors: Shi Jing , Zhang Luyao , Tao Yongkang , Gao Chao , Cen Yan , Li Sainan , Li Ying , Sang Botao , Liu Xiangfei , Ma Qinan , Zeng Xuezai , Zhang Yan , Liu Deping 
Published: September 2024

Background
With the global aging population, frailty in older adults has become a frontier and hotspot in health and aging research. As a dynamic process, the transition to frailty is
influenced not only by biological factors but also by various social, psychological, and environmental factors. Identifying the factors that influence the progression of frailty is key to achieving preventive interventions for at-risk individuals and implementing better health practices and healthcare strategies for older adults.
Methods
The data used in this study were obtained from the Fourth Sample Survey of the Aged
Population in Urban and Rural China database, organized by the ChinaNational Committee on Ageing. The baseline data used in this study was from elderly individuals who participated in the survey in 2017, and the follow-up data were from the 2019 survey. Frailty in older adults was assessed using the frailty index (FI) model to analyze the current frailty status among older adults in China and to prospectively analyze the developmental trajectory of frailty. Multivariate logistic regression was used to identify the factors that influence the progression of frailty.
Results
A total of 9,093 older adults were included in the analysis. FI values increased with age and were higher in women than in men at any age, suggesting that older women had higher levels of frailty than men. During the 2-year follow-up, most of the older adults' frailty remained stable (56.2%, 5,111/9,093), 1,292 (14.2%, 1,292/9,093) older adults' frailty improved, and 2,690 (29.6%, 2,690/9,093) older adults' frailty worsened. Transitions to a more frail status (i.e., worsening) were more common among older adults than transitions to an improved frailty status. Additionally, transitions between adjacent frailty statuses were more frequent than transitions across several frailty statuses (3,669 (40.3%) versus 313 (3.4%)). The results of multivariate logistic regression analyses revealed that age, sex, place of residence (general status), living alone, medical health status (co-morbidities among older adults, number of hospitalizations, frequency of exercise, activity of daily living function), care in case of illness, economic status (still working in an income-generating job, ownership of old-age pension or property rights, financial situation), and social participation status (participation in public service activities, participation in gerontological associations, regular access to the Internet) as factors that influence the progression of frailty status in older adults.
Conclusion
The worsening of frailty with age is more common in older adults than the transition to improved frailty. Among robust and pre-frail older adults, women are more likely to experience a worsening of their frailty status. Factors that influence the transition to frailty encompass multiple and complex elements. Therefore, when intervening in the progression of frailty in older adults, it is necessary to comprehensively assess the risk of frailty and the factors that influence it based on the multifaceted characteristics and current status of specific individuals. Individualized, comprehensive, and targeted interventions and management strategies tailored to different stages of frailty and transition pathways can improve frailty in older adults.