Factors Associated With Improving or Worsening the State of Frailty: A Secondary Data Analysis of a 5‐Year Longitudinal Study

Abstract

Purpose This study aims to examine the frailty transition patterns of older adults recruited from both community and residential care settings within a 5‐year period, and to identify the physical and psychosocial factors associated with the transitions. Design This study is a secondary data analysis of a longitudinal study for tracking the change of health status of older adults 60 years of age or older. Participants who had undergone at least two assessments during 2013–2017 were selected for analysis. Guided by the Gobben’s Frailty Model, biopsychosocial predictors were comprehensively identified from the literature, and their relationship to frailty state transition was explored. Methods We compared the baseline characteristics of participants at the frail, pre‐frail, and robust states (categorized using the Fried Frailty Index). A generalized estimating equation was used to identify factors associated with an improvement or a deterioration in frailty. The probability of transitions between frailty states was calculated. Findings Among the 306 participants, 19% (n = 59) improved and 30% (n = 92) declined in frailty within the project period. Sleep difficulties (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.07–2.90; p = .027), better cognitive status (OR = 0.80–0.84; 95% CI: 0.66–0.98 and 0.73–2.73; p = .031 and .018), good nutritional status (OR = 0.74; 95% CI: 0.59–0.91; p = .005), slow mobility (OR = 1.03–1.13; 95% CI: 1.00–1.05 and 1.03–1.25; p = .047 and .014), hearing impairment (OR = 2.83; 95% CI: 1.00–8.01; p = .05), better quality of health—physical domain (OR = 0.95; 95% CI: 0.92–0.99; p = .006), and better functional ability (OR = 0.85–0.97; 95% CI: 0.79–0.92 and 0.96–0.99; p < .001 and p = .003) were significant associated factors in the worsening group. More physical activity (OR = 1.01; 95% CI: 1.00–1.01 and 1.01–1.02; p = .026 and p < .001), hearing impairment (OR = 0.26; 95% CI: 0.08–0.86; p = .028), and slow mobility (OR = 0.93; 95% CI: 0.87–1.00; p = .037) were significant associated factors in the improvement group. Conclusions Frailty is a crucial global public health issue. This study provides evidence for nurses to holistically consider the associated factors and to design effective interventions to combat frailty in our ageing society. Clinical Relevance Frailty is a transient state that can be reversed. Professional nurses working in both community and residential care settings should be able to identify older adults at risk and improve their health conditions appropriately.

Association between hearing loss and frailty: a systematic review and meta-analysis

“…Figure 1 summarises the results of the systematic search of the literature. Five thousand and thirty (5030) articles were screened for eligibility, but only 16 fulfilled criteria for inclusion and these resulted in 13 cross-sectional and 5 longitudinal datasets (two studies reported both cross-sectional and longitudinal data [ 27 , 28 ]). Among these, two studies [ 29 , 30 ], and the longitudinal component of one study [ 27 ] did not include sufficient data for meta-analysis.…”

“…Five thousand and thirty (5030) articles were screened for eligibility, but only 16 fulfilled criteria for inclusion and these resulted in 13 cross-sectional and 5 longitudinal datasets (two studies reported both cross-sectional and longitudinal data [ 27 , 28 ]). Among these, two studies [ 29 , 30 ], and the longitudinal component of one study [ 27 ] did not include sufficient data for meta-analysis. Fourteen studies were included in the quantitative analysis with 12 sets of cross-sectional data (including 12,313 participants) and three sets of longitudinal data (including 3042 participants).No case-control studies met our inclusion criteria.…”

Social factors predicting improvement of frailty in community‐dwelling older adults: Korean Frailty and Aging Cohort Study

“…In previous longitudinal studies, greater physical activity decreased frailty over time. 26,27 Physical activity can reduce the effect of aging by increasing physical capacity and help recover from acute disease and thus positively help prevent frailty. 28 The present study also showed that low depressive symptoms were a protective factor in pre-frail improvement.…”

Examining patterns of frailty and associated factors in older adults

“…The research team conducted secondary analysis of health status data obtained from community and nursing home dwelling adults (N=306) aged 60 years or older living in Hong Kong. 4 Using a complex correlational design, data from two annual assessments were analysed to describe participants' frailty characteristics and compare the changes between assessments. Demographic, physical and psychological factors were used to categorise participants as frail, pre-frail and robust.…”

“…The retrospective health status data 4 accessed was a convenient source of frailty factors; however the findings may not represent the wider Hong Kong ageing population or be transferrable to other ageing populations. The importance of utilising existing health data sets is evident.…”