BackgroundFrailty represents a public health priority and an increasingly prevalent condition in the ageing population. It is seen as reflecting an interaction among individual factors and a range of environmental elements. This study aims to examine the association between frailty and individual factors, physical and social environments among Chinese older people.MethodsThe data were from the Shanghai Healthy City Survey in 2017, which sampled 2559 older people aged ≥60 years from 67 neighbourhoods. The FRAIL scale was used to assess frailty, and social and physical environments were assessed using validated and psychometrically tested instruments. Individual factors included age, gender, education, employment, marital status, smoking, drinking, physical exercise, organization participation, self-rated health and psychological well-being. A multilevel analysis was conducted to examine whether physical and social environments were associated with frailty.ResultsThe prevalence of pre-frailty and frailty were 39.5 and 16.9%, respectively. The prevalence of frailty increased with age from 14.6% (60–64 years) to 26.5% (≥75 years). After adjusting for age and/or gender, older age, women, and those with low education, alcohol dependence, physical inactivity, poor self-rated health, or psychological disorders had a higher prevalence of frailty. The multilevel analysis indicated that after controlling for individual covariates, compared to the 1st quartile of aesthetic quality, the odds ratio (OR) of frailty for the 4th quartile was 0.65 (0.47–0.89); compared to the 1st quartile of walking environment, the OR of frailty for the 4th quartile was 0.43 (0.19–0.95); compared to the 1st quartile of social cohesion, the OR of frailty for the 4th quartile was 0.73 (0.54–0.99); compared to the 1st quartile of social participation, the ORs of frailty for the 2nd, 3rd and 4th quartiles were 0.76 (0.59–0.97), 0.59 (0.45–0.77) and 0.59 (0.45–0.77), respectively.ConclusionsFrailty is a highly prevalent health condition among the aged population in China. Healthcare should focus on frail elderly who are older age, women, those with low education, and those with mental health problems. It may decrease frailty among Chinese older people to encourage social participation and healthy behaviours and to build aesthetic, walkable and cohesive neighbourhoods.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0982-1) contains supplementary material, which is available to authorized users.

Background: Understanding the characteristics related to frailty transitions will allow for better future health practice and healthcare strategies. We evaluated the changes in frailty among community-dwelling older adults and to examine the predictors of the changes in frailty.Methods: A total of 4050 community residents aged ≥ 60 years were recruited in 2015 with follow-up after 2 years. At baseline, a multiple deficits approach was used to construct the Frailty Index (FI) according to the methodology of FI construction, and sociodemographic characteristics and lifestyles were also collected. The transitions in frailty between baseline and 2-year follow-up were evaluated. Multinomial logistic regressions were used to examine associations between predictors and the changes of frailty, adjusting for all of the covariates.Results: Of all of the 3988 participants at baseline, those with frailty status of robust, prefrail, and frail were 79.5%, 16.4%, and 4.1%, and these changed to 68.2%, 23.0%, and 8.8% after 2 years with 127 deceased and 23 dropped out. Twelve kinds of transitions from baseline of the three frailty statuses to four outcomes at follow-up (including death) significantly differed within each of gender and age group, as well between genders and age groups. Among these, 7.8% of prefrail or frail elders improved, 70.0% retained their frailty status, and 22.2% of robust or prefrail elders worsened in frailty status. In multivariable models, age was significantly associated with changes in frailty except for in the frail group; higher educational level and working predicted a lower risk of robust worsening. Of the lifestyle predictors, no shower facilities at home predicted a higher risk of robust worsening; more frequent physical exercise predicted a lower risk of robust worsening and a higher chance of frailty improvement; more frequent neighbor interaction predicted a lower risk of robust worsening and prefrail worsening; and more frequent social participation predicted a higher chance of prefrail improvement.Conclusions: The status of frailty was reversible among community-dwelling elderly, and sociodemographic and lifestyle factors were related to changes in frailty. These findings help health practitioners to recognize susceptible individuals in a community and provide health promotional planning to target aged populations.

Background: Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This study aims to develop a comprehensive and acculturative frailty screening scale to determine healthy aging among older Chinese adults. Setting and participants: A cross-sectional and a cohort study both based on community-dwelling older adults aged 65 and older. Methods: This study mainly consisted of two parts. First, the selection and revision of 20 items related to frailty based on a literature review, expert consultation, and stakeholder analysis; second, a cross-sectional study was conducted to simplify the scale and test the reliability and validity of the new frailty screening tool. The fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale, the Tilburg frailty indictor (TFI), and a 49-item Frailty Index (FI) were investigated as criteria. Additionally, a cohort study in Shanghai was conducted to verify the predictive validity of the new screening scale. The disability measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and all-cause mortality were documented as outcomes. Results: A 10-item Chinese frailty screening scale (CFSS-10) was successfully developed and validated. It presented a Cronbach’s α of 0.63 and an intraclass correlation coefficient of 0.73, which indicated good reliability. Taking the other frailty tools as criteria, Kappa values of 0.54–0.58 and an area under the curve of 0.87–0.91 showed good validity. The results of the log-binomial and Poisson models showed a high score, which predicted a higher risk of disability and all-cause mortality. An optimal cut-off point of 5 gave an excellent prediction of one-year disability. Conclusions: The CFSS-10 has good validity and reliability as a quick and acculturative frailty screening scale for community-dwelling older adults in Shanghai. It may also supplement existing frailty screening tools.

Background: Understanding the characteristics related to frailty transitions will allow for better future health practice and healthcare strategies. We evaluated the changes in frailty among communitydwelling older adults and to examine the predictors of the changes in frailty. Methods: A total of 4050 community residents aged ≥ 60 years were recruited in 2015 with follow-up after 2 years. At baseline, a multiple deficits approach was used to construct the Frailty Index (FI) according to the methodology of FI construction, and sociodemographic characteristics and lifestyles were also collected. The transitions in frailty between baseline and 2-year follow-up were evaluated. Multinomial logistic regressions were used to examine associations between predictors and the changes of frailty, adjusting for all of the covariates. Results: Of all of the 3988 participants at baseline, those with frailty status of robust, prefrail, and frail were 79.5%, 16.4%, and 4.1%, and these changed to 68.2%, 23.0%, and 8.8% after 2 years with 127 deceased and 23 dropped out. Twelve kinds of transitions from baseline of the three frailty statuses to four outcomes at follow-up (including death) significantly differed within each of gender and age group, as well between genders and age groups. Among these, 7.8% of prefrail or frail elders improved, 70.0% retained their frailty status, and 22.2% of robust or prefrail elders worsened in frailty status. In multivariable models, age was significantly associated with changes in frailty except for in the frail group; higher educational level and working predicted a lower risk of robust worsening. Of the lifestyle predictors, no shower facilities at home predicted a higher risk of robust worsening; more frequent physical exercise predicted a lower risk of robust worsening and a higher chance of frailty improvement; more frequent neighbor interaction predicted a lower risk of robust worsening and prefrail worsening; and more frequent social participation predicted a higher chance of prefrail improvement. Conclusions: The status of frailty was reversible among community-dwelling elderly, and sociodemographic and lifestyle factors were related to changes in frailty. These findings help health practitioners to recognize susceptible individuals in a community and provide health promotional planning to target aged populations. BackgroundFrailty is an unstable status with the age-related loss of physiological reserves and disorders in 4 homeostatic systems. [1,2] The presence of frailty is not only symptomatic in older individuals, but it also renders them more prone to downstream changes in long-term health outcomes, such as disability, hospitalization, institutionalization, and mortality. [1,[3][4][5][6] In the absence of a gold standard, the two approaches most widely used are frailty phenotype (FP)[1] and frailty index (FI).[7] FP is defined on the basis of weight loss, exhaustion, physical activity, walk time, and grip strength, while FI is defined as an individual's accumulated proportion of lis...