Frailty transitions and their association with mortality in older adults

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2026-09-06 Epub Date: 2026-07-15 DOI:10.1111/imj.70502

Evrim Ataca, Mert Can Ataca, Cihan Heybeli, Lee Smith, Nicola Veronese, Irem Tanriverdi, Pinar Soysal

{"title":"Frailty transitions and their association with mortality in older adults","authors":"Evrim Ataca, Mert Can Ataca, Cihan Heybeli, Lee Smith, Nicola Veronese, Irem Tanriverdi, Pinar Soysal","doi":"10.1111/imj.70502","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Aims</h3>\n \n <p>Predictors and clinical implications of changes in frailty status over time have not been studied in detail. This study aimed to evaluate these aspects.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We included 399 outpatients from a geriatric clinic. The mean age was 83 ± 7 years, and 291 (73%) were women. At baseline, 9.3% (<i>n</i> = 37) were robust, 34.3% (<i>n</i> = 137) were pre-frail, and 56.4% (<i>n</i> = 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, <i>P</i> = 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, <i>P</i> = 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, <i>P</i> = 0.010). Among pre-frail participants, older age (OR 1.08, 95% CI 1.00–1.16, <i>P</i> = 0.049), higher number of medications (OR 1.25, 95% CI 1.07–1.45, <i>P</i> = 0.005) and higher vitamin D levels (OR 1.06, 95% CI 1.01–1.10, <i>P</i> = 0.011) independently predicted transition to frailty.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"56 9","pages":"1565-1574"},"PeriodicalIF":1.8000,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.70502","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal Medicine Journal","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.70502","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/7/15 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

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.

Aims

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

Methods

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.

Results

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.

Conclusions

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.

查看原文本刊更多论文

老年人的衰弱转变及其与死亡率的关系。

背景：衰弱是老年人的动态状态，衰弱状态之间的转换可能随着时间的推移而发生。然而，虚弱状态变化的预测因素和临床意义，特别是虚弱改善，仍然没有得到充分的了解。目的：衰弱状态随时间变化的预测因素和临床意义尚未得到详细研究。本研究旨在评价这些方面。方法：回顾性队列研究共筛选2573例患者。在应用排除标准并仅纳入纵向随访的患者后，399例患者被纳入最终分析。脆弱性通过Fried脆弱性表型进行评估。参与者被分类为健壮(0)，体弱（1-2）和体弱（3-5）。从基线开始分析虚弱状态的变化及其与总生存期的关系。结果：我们纳入了一家老年诊所的399名门诊患者。平均年龄83±7岁，女性291例（73%）。基线时，9.3% （n = 37）体质强健，34.3% （n = 137）体弱，56.4% （n = 225）体弱。在中位随访14个月（四分位数间隔12-23个月和6-71个月）中，17.8%的参与者改善，16.0%恶化，66.2%保持稳定。与基线相比，体重减轻和握力有所改善，而步行速度则恶化。年龄越小（优势比（OR） 0.93, 95%可信区间（CI） 0.88-0.97, P = 0.003）与虚弱状态的改善独立相关。在调整后的模型中，较高的肾小球滤过率无统计学意义，但有与整体虚弱状态改善相关的趋势（OR 1.02, 95% CI 1.00-1.04, P = 0.057）。总体而言，衰弱转变与生存率无显著相关性；然而，在虚弱前个体中，进展到虚弱与较短的生存期相关（41个月vs 65个月，P = 0.010）。在虚弱前的参与者中，年龄较大（OR 1.08, 95% CI 1.00-1.16, P = 0.049）、较多的药物剂量（OR 1.25, 95% CI 1.07-1.45, P = 0.005）和较高的维生素D水平（OR 1.06, 95% CI 1.01-1.10, P = 0.011）独立预测了向虚弱的过渡。结论：虚弱是潜在可逆的，特别是在虚弱前期。体重减轻和肌肉力量的改善有助于增强虚弱状态。对体弱前期个体的早期识别和有针对性的干预可以防止病情恶化并减少不良后果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.