title: Transitions in frailty states among community-living older adults and their associated factors.
abstract: BACKGROUND
  Frailty renders older individuals more prone to adverse health outcomes. Little has been reported about the transitions between the different frailty states. We attempted to examine the rate of these transitions and their associated factors.
  
  
  METHODS
  We recruited 3018 Chinese community-living adults 65 years or older. Frailty status was classified according to the Fried criteria in 2 visits 2 years apart. Demographic data, medical conditions, hospitalizations, and cognition were recorded. Rates of transitions and associated factors were studied.
  
  
  RESULTS
  At baseline, 850 (48.7%) men and 884 (52.6%) women were prefrail. Among these, 23.4% men and 26.6% women improved after 2 years; 11.1% of men and 6.6% of women worsened. More men than women (P < .001) deteriorated into frailty. Hospitalizations, older age, previous stroke, lower cognition, and osteoarthritis were risk factors for decline among prefrail participants. Having diabetes was associated with 50% lower chance of improvement in women. Among the robust, older age and previous cancer, hospitalizations, chronic lung diseases, and stroke were risk factors for worsening. Higher socioeconomic status was protective. Previous stroke reduced the chance of improvement by 78% in frail men. Only younger age was associated with improvement in frail women.
  
  
  CONCLUSIONS
  Women were less likely to decline in frailty status than men. Hospitalizations, older age, previous stroke, lower cognitive function, diabetes, and osteoarthritis were associated with worsening or less improvement. Older age, previous cancer, hospitalizations, lung diseases, and stroke were risk factors for worsening in the robust and higher socioeconomic status was protective.
authors.affiliation: Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, Hong Kong SAR, China; The S.H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China. Electronic address: jennylee@cuhk.edu.hk.
authors.forename: Jenny S W
authors.initials: JS
authors.lastname: Lee
authors.affiliation: The S.H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Tung-Wai
authors.initials: TW
authors.lastname: Auyeung
authors.affiliation: The Jockey Club Centre of Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Jason
authors.initials: J
authors.lastname: Leung
authors.affiliation: Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; The S.H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kwok
authors.affiliation: Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; The S.H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002681:China; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012111:Residence Characteristics; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Frailty; elderly; fluctuation; older adults; transition