Gender Differences in Frailty Progression and Recovery in Older Adults in Long-Term Care.

Objectives: To examine gender differences in frailty transitions in relation to predictive factors and outcomes.

Design: Retrospective analysis of long-term care data.

Setting and participants: Older adults (men = 10,683; women = 18,976; ≥65 years of age) were assessed annually over 3 years.

Methods: A deficit accumulation frailty index was constructed using 43 health measures. Trajectories among the 4 frailty states and mortality were evaluated by comparing women and men. Probabilities of frailty transitions and odds of death were evaluated using Poisson and logistic regression. Covariates included baseline frailty, age, admission year, education, and marital status.

Results: The 3-year mortality rate was 29% in women and 37% in men; each additional health deficit at baseline increased the odds of mortality by 13% in both genders. Among survivors, frailty trajectories were dominated by stabilization (46%), whereas 16% showed an improvement and 38% showed a decline. An increase in deficits at baseline was associated with a 58% increase in deficits after 3 years for women (67%, 57%, and 47% in 1, 2, and 3 years, respectively), with similar trends observed for men. Age advancement increased deficit counts by 3% in women and 4% in men, and the odds of death increased by 4% in women and 6% in men. Residents with high school or more education showed a greater risk of health decline in 1 year (23% in women, 35% in men). Being married increased the risk of health decline for 73% in women and 72% in men.

Conclusions and implications: Frailty affected health changes and mortality; those who were less frail were more likely to maintain/improve. Education and marriage had gender-specific effects on health changes. These findings enlighten management strategies targeting frailty and demographic profiles.