Journal of Frailty & Aging最新文献

{"title":"Psoas muscle density predicts elective colorectal surgical outcomes more accurately than psoas muscle area or indexed area.","authors":"Louis Scarrold, Douglas Stupart, David Watters","doi":"10.1016/j.tjfa.2025.100037","DOIUrl":"https://doi.org/10.1016/j.tjfa.2025.100037","url":null,"abstract":"<p><strong>Background: </strong>CT measurements of psoas muscle density (PMD) and area (PMA) (with or without indexing to height-squared or body-surface-area) are used interchangeably as sarcopenia measures - it is unknown which best correlates with surgical risk.</p><p><strong>Objectives: </strong>1.Determine the correlation between psoas muscle density, area, and indexed area; 2.Identify which psoas measures most strongly associated with surgical outcomes DESIGN: The University Hospital Geelong Colorectal database included all patients who underwent elective colorectal surgery from 2007 to 2014 (minimum five-years follow-up). Pre-operative CT scans were reviewed, psoas measures correlated with each other and with outcomes.</p><p><strong>Setting: </strong>University Hospital Geelong is a regional referral hospital in Victoria, Australia.</p><p><strong>Participants: </strong>This database listed 552 patients, 120 were excluded as pre-operative CT-films were not accessible, leaving 432 patients included.</p><p><strong>Exposure: </strong>Psoas muscle density, area, and area indexed by height-squared and body-surface-area.</p><p><strong>Measurements: </strong>Pearson correlations investigated correlations between psoas muscle measures. Logistic regression and ROC-analysis investigated each psoas measures association with peri‑operative morbidity. Kaplan-Meier survival-analysis investigated the association of each psoas measure with long-term survival.</p><p><strong>Results: </strong>Mean age was 70.4 years, 41 % were female. Psoas muscle density correlated poorly with area (R²=0.15). Unindexed psoas muscle area correlated well with area indexed by height-squared (R²=0.950) and body-surface-area (R²=0.938). Long-term survival was associated with psoas muscle density (HR1.515(95 %CI 1.062-2.161)) and area (HR1.886(95 %CI 1.322-2.692)). Increasing psoas muscle density (reduced sarcopenia) was associated with decreased major-complications (OR0.963(95 %CI 0.938-0.989)) and peri‑operative mortality (OR0.903(95 %CI 0.847-0.962)), with ROC-curve AUC=0.829 indicating an accurate test. There was no association between psoas muscle area and major-complications (OR1.000(95 %CI 1.000-1.000)), nor peri‑operative mortality (OR1.000(95 %CI 0.999-1.001)), with ROC-curves AUC=0.507-0.521. Indexed area measures were not associated with outcomes.</p><p><strong>Conclusions: </strong>Psoas muscle density and area did not correlate. Both were associated with long-term survival, but only density was associated major-complications and mortality. Indexing removed the correlation of area with long-term survival.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 3","pages":"100037"},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate admission to the surgery hospital significantly optimises quality indicators in older patients with hip fractures: A before-and-after study.","authors":"José Luis Dinamarca-Montecinos, Alejandra Leiva Vásquez, Carmelinda Ruggiero, Yasna Barrera Fernández, Rayén Delgado Gac, Ada Carrillo, Gedeón Lazcano Améstica, Daniel Ulloa Vásquez, Fernando Aranda, Andrés Canales Pizarro, Graciela Mardones, Constanza Morales Gherardelli, Victoria Assael Novik, Osvaldo Sepúlveda, Jossie Acuña, Carola Arancibia Aravena, Julio Ibarra, Jack Bell, Emma Sutton","doi":"10.1016/j.tjfa.2025.100014","DOIUrl":"https://doi.org/10.1016/j.tjfa.2025.100014","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures generate high biomedical, social, functional, organisational, and economic costs. There are various quality indicators to guide its management. One of them is surgery within 48-72 h. In Chilean public health system, this indicator has out-of-standard results. This situation could have organizational causes: after hip fracture diagnosis, many older patients are first referred to general hospitals, whilst waiting an orthopedic surgical bed.</p><p><strong>Objective: </strong>To evaluate the effects of a protocol of immediate-admission to the surgery hospital on organisational and economic indicators of hip-fractured older patients.</p><p><strong>Design: </strong>Before-and-after study, between 01/01/2017-09/30/2019; 12 months before and 21 months after implementation.</p><p><strong>Setting: </strong>Regional surgical hospital responsible for 87 % of the older population in its assigned territory, in the more aged region of Chile.</p><p><strong>Participants: </strong>Anonymised data of 902 hip-fractured older adults (≥ 60 years).</p><p><strong>Intervention: </strong>Implementation of a protocol that requires immediate admission to the surgical hospital of all older hip-fractured patients at the time of diagnosis.</p><p><strong>Measurements: </strong>Number of hip-fractured patients with no immediate admission, time to surgery, total in-hospital time, and economic costs. Normality tests (Kolmogorov-Smirnov), non-parametric tests (Chi-squared), Mann-Whitney and Kruskal-Wallis tests were performed. Measures of central tendency (medians and percentiles) were used.</p><p><strong>Results: </strong>After protocol there was a significant reduction in the proportion of patients referred to general hospitals in both, first and second year (pre=37,8 %; post 1 = 27,3 %; post 2 = 23,3 %, p = 0,000). Time to surgery was also significantly reduced (medians bed days pre=15, post 1 = 11, post 2 = 10, p = 0,000). Total in-hospital time decreased 21 % (3395 bed days), and there was also a significant decrease in costs from USD130,000 to USD35,000 (p = 0,000).</p><p><strong>Conclusion: </strong>Immediate admission to orthopedic surgical hospital of older adults with hip fractures significantly decreases inter-hospital transfers, time to surgery, total in-hospital time, and direct hospital costs.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 3","pages":"100014"},"PeriodicalIF":3.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide insights into frailty: Systematic review and meta-analysis of community-based prevalence studies from India.","authors":"Sunanda Gupta, Aninda Debnath, Ankit Yadav, Anubhav Mondal, Shweta Charag, Jugal Kishore","doi":"10.1016/j.tjfa.2025.100032","DOIUrl":"https://doi.org/10.1016/j.tjfa.2025.100032","url":null,"abstract":"<p><p>Frailty, a biologic syndrome of decreased reserve and resistance to stressors, affects 5 % to 17 % of older adults and is linked to factors like low BMI, female sex, and low exercise levels. With India's older population expected to double by 2050, frailty presents major public health and economic challenges. This study summarizes the prevalence of frailty among community-dwelling Indians. This systematic review and meta-analysis followed PRISMA guidelines to determine the prevalence of frailty among adults in India. We conducted a comprehensive search across multiple databases, including PubMed, Scopus, EMBASE, and Web of Science, up to January 16, 2024, excluding hospital-based studies and reviews. Data were analyzed using STATA software with a random-effects model, and quality was assessed using the JBI Critical Appraisal Checklist. The meta-analysis revealed a pooled frailty prevalence of 36 % (95 % CI: 29 % to 44 %) among 330,007 community-dwelling adults in India, with significant heterogeneity across studies (I² = 99.95 %). Frailty prevalence varied by assessment method, with 48 % using the frailty index and 31 % using the Fried phenotype. Subgroup analyses indicated significant variability in frailty prevalence by gender, data source, and assessment tool, with no significant publication bias detected. This meta-analysis found a pooled frailty prevalence of 36 % and pre-frailty prevalence of 48 % among adults in India, with higher frailty in women (45 %) than men (35 %) and variation across assessment tools. Future research should focus on longitudinal studies and developing tailored frailty assessment tools.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100032"},"PeriodicalIF":3.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-based physical activity and nutrition interventions in low-income and/or rural older adults: A scoping review.","authors":"Elizabeth Bernard, Nash Brewer, Jeanette C Prorok, Perry Kim, John Muscedere","doi":"10.1016/j.tjfa.2025.100034","DOIUrl":"https://doi.org/10.1016/j.tjfa.2025.100034","url":null,"abstract":"<p><p>The objective of this review was to identify evidence-based, community-based physical activity (PA) and nutrition-based programs aimed at facilitating health behaviour change among low-income older adults and/or those living in rural/remote areas. This review followed the scoping review methodology proposed by Arksey & O'Malley. The Michie behaviour change wheel was used to categorize intervention types. Of the 2954 retrieved citations, 25 articles met the inclusion criteria. All study interventions demonstrated positive outcomes, including improvements in fruit and vegetable consumption, PA levels, physical function and nutrition knowledge. Study findings highlight that PA and nutrition-based interventions can be effective to facilitate behavior change in low-income and/or rural older adults. Limited research exists looking specifically at older adults living in rural communities, with only two of the 25 included articles including rural study populations.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100034"},"PeriodicalIF":3.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitating oral and dental care in older people in low- and middle-income countries: The role of teledentistry.","authors":"Sedighe Sadat Hashemikamangar, Behnaz Behniafar","doi":"10.1016/j.tjfa.2025.100035","DOIUrl":"https://doi.org/10.1016/j.tjfa.2025.100035","url":null,"abstract":"","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100035"},"PeriodicalIF":3.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of objective and subjective socioeconomic status with intrinsic capacity deficits among community-dwelling middle-aged and older adults in China: A cross-sectional study.","authors":"Fangqin Tan, Xiaoxia Wei, Ji Zhang, Yihao Zhao, Yue Zhang, Haiying Gong, Jean-Pierre Michel, Enying Gong, Ruitai Shao","doi":"10.1016/j.tjfa.2025.100036","DOIUrl":"https://doi.org/10.1016/j.tjfa.2025.100036","url":null,"abstract":"<p><strong>Background: </strong>Intrinsic capacity (IC), representing an individual's full range of physical and mental abilities, is influenced by objective socioeconomic status (SES); however, the impact of subjective SES remains unclear.</p><p><strong>Objectives: </strong>This study aims to assess IC and investigate the relationship between SES and IC deficits, with a particular focus on the role of subjective SES.</p><p><strong>Design: </strong>Cross-sectional study SETTING: 45 communities in two provinces in China PARTICIPANTS: Community-dwelling middle-aged and older adults aged 50 and above MEASUREMENTS: IC was assessed following the Integrated Care for Older People guideline. SES was measured through objective SES (education and occupation) and subjective SES (measured by MacArthur Scale). Ordinal logistic regression models were performed to estimate the association between SES and IC.</p><p><strong>Results: </strong>Among 3,058 participants (61.3 ± 8.05 years, 54.8 % women), 2,333 (76.3 %) showed deficits in at least one IC subdomain, particularly sensory (63.5 %), vitality (25.8 %) and cognition (18.4 %). A dose-response association was observed between SES and IC deficits. Individuals with high subjective SES (OR: 0.72, 0.60-0.87), high education (OR: 0.54, 0.38-0.75), and high occupation (OR: 0.64 0.50-0.81) exhibited lower IC deficits risk compared with counterparts. Individuals with high education and middle subjective SES or high occupation and middle subjective SES had 67 % (OR: 0.33, 0.18-0.60) and 49 % (OR: 0.51, 0.35-0.74) lower risk than those with low SES.</p><p><strong>Conclusions: </strong>These findings suggest that individuals with low SES may be more vulnerable to IC deficits. Addressing social inequalities in the early assessment of IC is crucial for reducing health disparities and promoting healthy ageing.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100036"},"PeriodicalIF":3.3,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of assessment tools for cognitive frailty: Use, psychometric properties, and clinical utility.","authors":"Kate Dobie, Christopher J Barr, Stacey George, Nicky Baker, Morgan Pankhurst, Maayken Elizabeth Louise van den Berg","doi":"10.1016/j.tjfa.2025.100033","DOIUrl":"https://doi.org/10.1016/j.tjfa.2025.100033","url":null,"abstract":"<p><strong>Background: </strong>The concept of 'cognitive frailty' (CF) was first developed by an international consensus group in 2013 and defined as evidence of both physical frailty and cognitive impairment without a clinical diagnosis of AD or another dementia. CF has been associated with adverse health outcomes and early identification is vital. Difficulty in the assessment of CF however is the lack of a diagnostic gold standard.</p><p><strong>Objectives: </strong>This review aimed to identify assessment tools used to diagnose cognitive impairment in the diagnosis of cognitive frailty, their psychometric qualities and clinical utility.</p><p><strong>Research design and methods: </strong>Six databases were searched between 2013-2024. Studies were eligible if they reported a method of defining cognitive frailty, named the assessment tools, and stated cutoff values used to define cognitive impairment.</p><p><strong>Results: </strong>In the 116 included studies, large heterogeneity was found in the tools utilised, and cutoff scores applied, to diagnose cognitive impairment in the diagnosis of cognitive frailty. This review has demonstrated that diagnosis of CF relies predominantly on the use of three cognitive assessment tools (Mini Mental State Examination, Montreal Cognitive Assessment, Clinical Dementia Rating) from a total of 22 different tools identified in the literature. For assessment of physical frailty, 11 different tools were identified, with the Fried Frailty Index and FRAIL Scale predominantly utilised.</p><p><strong>Discussion and implications: </strong>The variation in the tools used to identify the diagnosis of CF means there is inconsistency in reporting, potentially impacting both the understanding of the prevalence, and the appropriate direction of intervention strategies.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100033"},"PeriodicalIF":3.3,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of frailty trajectories in world trade center general responders and the association with World Trade Center Exposure.","authors":"Hannah M Thompson, Katherine A Ornstein, Elena Colicino, Nicolo Foppa Pedretti, Ghalib Bello, Ahmad Sabra, Erin Thanik, Roberto G Lucchini, Michael Crane, Susan L Teitelbaum, William W Hung, Fred Ko","doi":"10.1016/j.tjfa.2025.100027","DOIUrl":"10.1016/j.tjfa.2025.100027","url":null,"abstract":"<p><strong>Background: </strong>As the World Trade Center (WTC) General Responder Cohort ages, it is imperative to study their aging process and identify factors that can be targeted for interventions.</p><p><strong>Objectives: </strong>Our goal was to utilize a previously developed WTC Clinical Frailty Index (CFI) to identify distinct frailty trajectories and associated factors in this cohort.</p><p><strong>Design: </strong>A latent class mixed model evaluated frailty trajectories using WTC CFIs. Multinomial regression models were used to assess associations between frailty trajectory and sociodemographic and WTC characteristics.</p><p><strong>Setting: </strong>We utilized data collected during routine WTC monitoring visits from 2004 until 2021.</p><p><strong>Participants: </strong>The participants were WTC general responders.</p><p><strong>Measurements: </strong>Relative risk ratios (RRR) assessed associations with a 95 % confidence interval (CI).</p><p><strong>Results: </strong>Three distinct linear frailty trajectories were identified: high CFI (indicating higher frailty), low CFI, and progressively increasing CFI. Compared with the low CFI group, females were more likely to be in the high CFI and progressively increasing CFI groups (RRR 1.66, 95 %CI 1.46, 1.90; RRR 1.32, 95 %CI 1.15, 1.53, respectively). Education beyond high school and elevated income were protective against high CFI and progressively increasing CFI groups. Individuals that self-identified as Hispanic had an elevated RRR for the high CFI group (RRR 1.17, 95 %CI 1.04, 1.31). Occupation on 9/11, such as construction and maintenance and repair, as well as high/very high WTC exposure were significantly associated with both the high CFI and progressively increasing CFI groups.</p><p><strong>Conclusions: </strong>Several sociodemographic and WTC variables were associated with more hazardous frailty trajectories in WTC general responders. This work is beneficial to informing and directing future interventions for those at higher-risk for more hazardous frailty progression.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100027"},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing an Electronic Frailty Index (eFI) and a biological age trajectory with a cohort of over one million older adults in Hong Kong.","authors":"Tung Wai Auyeung, Carolyn Poey Lyn Kng, Tak Yeung Chan, Elsie Hui, Chi Shing Leung, James Ka Hay Luk, Kwok Yiu Sha, Teresa Kim Kum Yu","doi":"10.1016/j.tjfa.2025.100021","DOIUrl":"10.1016/j.tjfa.2025.100021","url":null,"abstract":"<p><strong>Background: </strong>Electronic health record (EHR) has been in place in many parts of the world. This fits in very well to the frailty index calculation proposed by Rockwood and thus a frailty index can potentially be generated automatically from an EHR database. Therefore, the Hong Kong Hospital Authority (HA) attempted to develop an electronic frailty index (HK eFI), by employing thirty-eight health variables from her own EHR database.</p><p><strong>Methods: </strong>Five cohorts of patients aged 60 years or above ever attended any services provided by the Hong Kong HA in the year 2015, 2016, 2017, 2018 and 2019, were included. The HK eFI trajectory with ageing, generated by the five cohorts, were compared to the one described by Rockwood's group. Following the UK eFI method, 4 levels of frailty were categorized, and they were examined whether they were related to mortality, readmission rate and hospitalization patient days.</p><p><strong>Results: </strong>Each successive cohort consisted of increasing number of patients aged 60 years or above. (2015, 1.14 million; 2016, 1.19 million; 2017,1.25 million; 2018, 1.31 million; 2019, 1.38 million). The gradients of the five trajectories ranged from 0.035 to 0.037, representing an increase in FI approximately 3.6 % annually. The intercept of the curves converged at 0.1, representing the FI at age 60 years was 0.1. Compared to the fit group, the adjusted hazard ratios of mortality of the mild, moderate and severe frail group were 1.77, 3.31 and 6.65 respectively and they were all statistically higher than the fit group. (p < 0.005) Likewise, there was a stepwise increase in readmission rate and hospital patient days utilization with increasing frailty levels.</p><p><strong>Conclusion: </strong>It is feasible to develop an eFI and a biological age trajectory from a large EHR database with local adaptation.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100021"},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the risk of frailty based on care receipt, unmet care needs and socio-economic inequalities: A longitudinal analysis of the English Longitudinal Study of Ageing.","authors":"David R Sinclair, Asri Maharani, Andrew Clegg, Barbara Hanratty, Gindo Tampubolon, Chris Todd, Raphael Wittenberg, Terence W O'Neill, Fiona E Matthews","doi":"10.1016/j.tjfa.2025.100012","DOIUrl":"10.1016/j.tjfa.2025.100012","url":null,"abstract":"<p><strong>Background: </strong>The older population is increasingly reliant on social care, especially those who are frail. However, an estimated 1.5 million people over 65 in England have unmet care needs. The relationship between receiving care, or receiving insufficient care, and changes in frailty status remains unclear.</p><p><strong>Objectives: </strong>To investigate the associations between care receipt (paid or unpaid), unmet care needs, frailty status, and mortality.</p><p><strong>Design: </strong>We used multistate models to estimate the risk of increasing or decreasing levels of frailty, using English Longitudinal Study of Ageing (ELSA) data. Covariates included age, gender, wealth, area deprivation, education, and marital status. Care status was assessed through received care and self-reported unmet care needs, while frailty status was determined using a frailty index.</p><p><strong>Participants: </strong>15,003 individuals aged 50+, using data collected over 18 years (2002-2019).</p><p><strong>Results: </strong>Individuals who receive care are more susceptible to frailty and are less likely to recover from frailty to a less frail state. The hazard ratio of males receiving care transitioning from prefrailty to frailty was 2.1 [95 % CI: 1.7-2.6] and for females 1.8 [1.5-2.0]. Wealth is an equally influential predictor of changes in frailty status: individuals in the lowest wealth quintile who do not receive care are as likely to become frail as those in the highest wealth quintile who do receive care. As individuals receiving care (including unpaid care) are likely to be in poorer health than those who do not receive care, this highlights stark inequalities in the risk of frailty between the richest and poorest individuals. Unmet care needs were associated with transitioning from prefrailty to frailty for males (hazard ratio: 1.7 [1.2-2.4]) but not for females.</p><p><strong>Conclusions: </strong>Individuals starting to receive care (paid or unpaid) and people in the poorest wealth quintile are target groups for interventions aimed at delaying the onset of frailty.</p>","PeriodicalId":51629,"journal":{"name":"Journal of Frailty & Aging","volume":"14 2","pages":"100012"},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}