Factors Associated with Frailty Transitions among the Old-Old in Community: A Prospective Cohort Study

Abstract

Background: The identification of older adults with different frailty transitions, especially the old-old, is beneficial for stratified management. However, the factors associated with frailty transition in the elderly have not been fully elucidated. This study aimed to explore frailty transitions and associated factors among older adults. Methods: The participants were all from a prospective cohort study of older adults aged ≥75 years in a continuing care retirement community in Beijing, China. Frailty states were assessed using FRAIL at baseline and 1-year follow-up. The association between factors, including comprehensive geriatric assessment and laboratory indicators such as serum albumin and highsensitivity C-reactive protein (hsCRP), and frailty transitions were explored by binary logistic regression. The predicted value of the factors associated with frailty transitions was analyzed using the receiver operating characteristic curve (ROC), and the area under the ROC curve (AUC) was calculated. Results: A total of 183 older adults (mean age: 83.9±4.4 years; females, 59%) completed the frailty state assessment at baseline and 1-year followup. After adjusting for age and sex, walking speed(odds ratio [OR], 0.01; 95%confidence interval [CI]: 0.002-0.12),timed up-and-go (TUG) test(OR:1.08, 95% CI: 1.02-1.15), short physical performance battery(OR:0.79, 95% CI :0.68-0.92), serum albumin (OR:0.78, 95% CI:0.64-0.94), and serum hsCRP (OR:1.21, 95% CI:1.00-1.47) were associated with worsening of the frailty state. Cognitive function (OR:6.73, 95% CI:1.15-39.19) was associated with improving the frailty state. ROC analysis showed that low walking speed (AUC:0.81), long TUG test time(AUC:0.77), low Short Physical Performance Battery (SPPB)score (AUC:0.75), low serum albumin (AUC:0.68), and high serum hsCRP(AUC:0.80) could predict the decline in frailty state. Good cognitive function (AUC: 0.69) predicted an improvement in the frailty state. Conclusions: Frailty is dynamic. The frailty state of the old-old with poor physical function, low serum albumin, and high serum hsCRP was more likely to decline, but it was more likely to improve with good cognitive function. Walking speed, TUG test, SPPB, serum albumin, serum hsCRP, and cognitive function may predict frailty transitions among the old-old.