title: Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey.
abstract: BACKGROUND
  Despite having the third highest proportion of people aged 60 years and older in the world, Germany has been recently reported as having the lowest prevalence of frailty of 15 European countries. The objective of the study is to describe the prevalence of frailty in a large nationwide population-based sample and examine associations with sociodemographic, social support and health characteristics.
  
  
  METHODS
  We performed a cross-sectional analysis of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) conducted 2008-2011. Participants were 1843 community-dwelling people aged 65-79 years. Frailty and pre-frailty were defined, according to modified Fried criteria, as 3 and more or 1-2 respectively, of the following: exhaustion, low weight, low physical activity, low walking speed and low grip strength. The Oslo-3 item Social Support Scale (OSS-3) was used. Patient Health Questionnaire (PHQ-9) measured depressive symptoms and the Digit Symbol Substitution Test (DSST) measured cognition. Associations between participants' characteristics and frailty status were examined using unadjusted and adjusted multinomial logistic regression models estimating relative risk ratios (RRR) of frailty and pre-frailty.
  
  
  RESULTS
  The prevalence of frailty among women was 2.8% (CI 1.8-4.3) and pre-frailty 40.4% (CI 36.3-44.7) and among men was 2.3% (CI 1.3-4.1) and 36.9% (CI 32.7-41.3) respectively. Independent determinants of frailty, from unadjusted models, included older age, low socioeconomic status, poor social support, lower cognitive function and a history of falls. In adjusted models current depressive symptoms (RRR 12.86, CI 4.47-37.03), polypharmacy (RRR 7.78, CI 2.92-20.72) and poor hearing (RRR 5.38, CI 2.17-13.35) were statistically significantly associated with frailty.
  
  
  CONCLUSIONS
  Frailty prevalence is relatively low among community-dwelling older adults in Germany. Modifiable characteristics like low physical activity provide relevant targets for individual and population-level frailty detection and intervention strategies.
authors: Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64, Berlin, 12101, Germany. amanda.buttery@kclalumni.net.
authors: Amanda K
authors: AK
authors: Buttery
authors: Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64, Berlin, 12101, Germany. BuschM@rki.de.
authors: Markus A
authors: MA
authors: Busch
authors: Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64, Berlin, 12101, Germany. GaertnerB@rki.de.
authors: Beate
authors: B
authors: Gaertner
authors: Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64, Berlin, 12101, Germany. Scheidt-NaveC@rki.de.
authors: Christa
authors: C
authors: Scheidt-Nave
authors: Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64, Berlin, 12101, Germany. FuchsJ@rki.de.
authors: Judith
authors: J
authors: Fuchs
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly / Q000523:psychology / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011795:Surveys and Questionnaires