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Transitions Between Frailty States Among Community-Living Older Persons
Open accessAbstract
BACKGROUND: Little is known about the natural course of frailty. We performed a prospective study to determine the transition rates between frailty states and to evaluate the effect of the preceding frailty state on subsequent frailty transitions. METHODS: We studied 754 community-living persons, aged 70 years or older, who were nondisabled in 4 essential activities of daily living. Frailty, assessed every 18 months for 54 months, was defined on the basis of weight loss, exhaustion, low physical activity, muscle weakness, and slow walking speed. Participants were classified as frail if they met 3 or more of these criteria, as prefrail if they met 1 or 2 of the criteria, and as nonfrail if they met none of the criteria. RESULTS: Of the 754 participants, 434 (57.6%) had at least 1 transition between any 2 of the 3 frailty states during 54 months. The rates were 36.8%, 21.5%, and 9.2% for 1, 2, and 3 transitions, respectively. During the 18-month intervals, transitions to states of greater frailty were more common (rates up to 43.3%) than transitions to states of lesser frailty (rates up to 23.0%), and the probability of transitioning from being frail to nonfrail was very low (rates, 0%-0.9%), even during an extended period. The likelihood of transitioning between frailty states was highly dependent on one's preceding frailty state. CONCLUSIONS: Frailty among older persons is a dynamic process, characterized by frequent transitions between frailty states over time. Our findings suggest ample opportunity for the prevention and remediation of frailty.
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“and moderate/severe frailty (RR 2.60, 95% CI 1.36-4.96) (95).”
From Frailty in elderly people (2013) · cites this paper as [95]
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“Risk of admission to long-term care is also increased in those with mild frailty (adjusted risk ratio (RR) 2.54, 95% CI 1.67-3.86)”
From Frailty in elderly people (2013) · cites this paper as [95]
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“The Yale Precipitating Events Project (PEP) is a cohort study based in New Haven CT that enrolled individuals aged 70 years or older.”
From A standard procedure for creating a frailty index (2008) · cites this paper as [15]
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Fougère, B., Sirois, M., Carmichael, P., Batomen, B., Chicoulaa, B., Escourrou, E., Nourhashémi, F., Oustric, S., Vellas, B. J., Ané, S., et al. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.11.008 · Cited by 16
Zingmark, M., & Norström, F. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02283-x · Cited by 15
“While recovery towards better health/less disability occur, the overall pattern in these studies indicates that over time, the large proportion of participants decline towards poorer health/more disability [8, 17].”
BackgroundResultTakayanagi, N., Sudo, M., Yamashiro, Y., Chiba, I., Lee, S., Niki, Y., & Shimada, H. (2021) · Scientific Reports · doi:10.1038/s41598-021-98286-0 · Cited by 15
van Maldegem, S. J. M. V. C. –., Hoedjes, M., Seidell, J. C., van de Poll-Franse, L. V., Buffart, L. M., Mols, F., & Beijer, S. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.16299 · Cited by 18
Natural History Trajectories of Frailty in Community-Dwelling Older Japanese Adults
Tange, C., Nishita, Y., Tomida, M., Otsuka, R., Ando, F., Shimokata, H., & Arai, H. (2022) · The Journals of Gerontology Series A · doi:10.1093/gerona/glac130 · Cited by 15
“Frailty reversibility has been observed in previous studies (4,7,8,41).”
BackgroundThe Effectiveness of a Hybrid Exercise Program on the Physical Fitness of Frail Elderly
Wang, Z., Meng, D., He, S., Guo, H., Tian, Z., Wei, M., Yang, G., & Yang, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191711063 · Cited by 15
Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index
Beier, F., Löffler, M., Nees, F., Hausner, L., Frölich, L., & Flor, H. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03416-6 · Cited by 15
“Given that frailty is a potentially reversible state [42], the identification of characteristic correlates and knowledge about the underlying deficits is necessary for offering timely and appropriate interventions.”
BackgroundPatient-Reported Frailty and Functional Status in Heart Failure With Preserved Ejection Fraction
Kaul, P., Rathwell, S., Lam, C. S. P., Westerhout, C. M., Spertus, J. A., Anstrom, K. J., Blaustein, R. O., Ezekowitz, J. A., Pieske, B. M., Roessig, L., et al. (2023) · JACC Heart Failure · doi:10.1016/j.jchf.2022.11.015 · Cited by 15
Achour, J., Abulizi, X., Makinson, A., Arvieux, C., Bonnet, F., Goujard, C., Lambert, O., Slama, L., Blain, H., Meyer, L., et al. (2024) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofae229 · Cited by 15
“A longer follow-up of elderly PWH will likely reveal a higher frequency of progression to frailty [18, 19].”
BackgroundEstablishing a clinically applicable frailty phenotype screening tool for aging dogs
Russell, K. J., Mondino, A., Fefer, G., Griffith, E. H., Saker, K. E., Gruen, M. E., & Olby, N. J. (2024) · Frontiers in Veterinary Science · doi:10.3389/fvets.2024.1335463 · Cited by 16
Laosa, O., Topinková, E., Bourdel‐Marchasson, I., Vellas, B. J., Izquierdo, M., Paolisso, G., Hardman, T. C., Zeyfang, A., Pedraza, L., Carnicero, J. A. C., et al. (2025) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2025.100512 · Cited by 15
Wong, C. Y., Green, P., & Williams, M. R. (2013) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.13.45 · Cited by 15
Development of Home-Based Frailty Detection Device Using Wireless Sensor Networks
Lin, C., Chen, C.-C., Lin, P.-S., Lee, R.-G., Huang, J.-S., Tsai, T.-H., & Chang, Y.-C. (2016) · Journal of Medical and Biological Engineering · doi:10.1007/s40846-016-0127-y · Cited by 15
“Frailty can be controlled and eased [2, 3].”
Li, C., Snih, S. A., Chou, L., Karmarkar, A. M., Kuo, Y., Markides, K. S., & Ottenbacher, K. J. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01583-y · Cited by 15
Exploring Frailty: Community Physical and Occupational Therapists’ Perspectives
Roland, K. P., Theou, O., Jakobi, J. M., Swan, L., & Jones, G. R. (2011) · Physical & Occupational Therapy In Geriatrics · doi:10.3109/02703181.2011.616986 · Cited by 15
“, hip fracture) rendering them frail (Gill et al., 2006).”
BackgroundSoto‐Gordoa, M., Arrospide, A., Hernández, M. M., Mora, J., Fullaondo, A., Larrañaga, I., de Manuel, E., & Mar, J. (2016) · Value in Health · doi:10.1016/j.jval.2016.08.002 · Cited by 15
“When patients decompensated and required additional attention, they were referred to secondary care [21].”
BackgroundAlhasan, H. S., Wheeler, P. C., & Fong, D. T.-P. (2021) · Cyborg and Bionic Systems · doi:10.34133/2021/9841342 · Cited by 14
“[9], frailty is a reversible phenomenon that can be prevented or postponed if it is managed properly by valid and specifically designed interventions.”
BackgroundHospital-Based Health Professionals’ Perceptions of Frailty in Older People
Manuel, K., Crotty, M., Kurrle, S. E., Cameron, I. D., Lane, R., Lockwood, K. A., Block, H., Sherrington, C., Pond, D. C., Nguyen, T. A., et al. (2024) · The Gerontologist · doi:10.1093/geront/gnae041 · Cited by 14
“…explore and identify communication techniques that help health professionals to reframe the topic of frailty from the personal (e.g., personal inadequacy) to the clinical while emphasizing frailty as a dynamic state (Archibald et al., 2021; Gill et al., 2006) when discussing frailty with patients.”
BackgroundÓ’Caoimh, R., Molloy, D. W., Fitzgerald, C., van Velsen, L., Cabrita, M., Nassabi, M. H., de Vette, F., Weering, M. D.-V., Jansen-Kosterink, S. M., Kenter, W., et al. (2017) · International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE) · doi:10.5220/0006331800910103 · Cited by 14
Sha, S., Chan, S. H., Chen, L., Xu, Y., & Pan, Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095105 · Cited by 16
Takayanagi, N., Sudo, M., Yamashiro, Y., Chiba, I., Lee, S., Niki, Y., & Shimada, H. (2022) · Scientific Reports · doi:10.1038/s41598-022-14304-9 · Cited by 14
The Effect of Acculturation on Frailty Among Older Mexican Americans
Masel, M. C., Howrey, B. T., & Peek, M. K. (2010) · Journal of Aging and Health · doi:10.1177/0898264310391786 · Cited by 14
Reversible states of physical and/or cognitive dysfunction: A 9-year longitudinal study
Qualls, C., Waters, D. L., Vellas, B. J., Villareal, D. T., Garry, P. J., Gallini, A., & Andrieu, S. (2017) · The journal of nutrition health & aging · doi:10.1007/s12603-017-0878-3 · Cited by 14
“A person’s ability to transition out of an worsened health state, and back to an improved, or “normal” state is influenced not only by age (3, 5, 7-10), but also by the state of health when the transition occurs (3, 11, 12).”
Management of Locally Advanced and Metastatic Esophageal Cancer in the Older Population
Bracken-Clarke, D. M., Farooq, A. R., & Horgan, A. M. (2018) · Current Oncology Reports · doi:10.1007/s11912-018-0745-3 · Cited by 14
Vinjerui, K. H., Boeckxstaens, P., Douglas, K. A., & Sund, E. R. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-035070 · Cited by 14
Sugie, M., Harada, K., Takahashi, T., Nara, M., Fujimoto, H., Kyo, S., & Ito, H. (2020) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.14003 · Cited by 14
Frailty scales – their potential in interprofessional working with older people: a discussion paper
Poltawski, L., Goodman, C. M., Iliffe, S., Manthorpe, J., Gage, H., Shah, D., & Drennan, V. M. (2011) · Journal of Interprofessional Care · doi:10.3109/13561820.2011.562332 · Cited by 13
Fougère, B., Morley, J. E., Little, M. O., Barreto, P. D. S., Cesari, M., & Vellas, B. J. (2017) · The journal of nutrition health & aging · doi:10.1007/s12603-017-0987-z · Cited by 14
“Frailty has proven to be a dynamic and reversible process: frail individuals can experience either improvement or worsening in their frailty status along time (75).”
RetractedCai, S., Li, J., Fang, Y., Feng, Z., Liu, H., Chen, J., Yang, X., Lin, B., & Tian, Z. (2025) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2025.105782 · Cited by 17
Fustinoni, S., Santos‐Eggimann, B., & Henchoz, Y. (2021) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2021-216633 · Cited by 13
Metadata
- Authors
- Gill, T. M., Gahbauer, E. A., Allore, H. G., & Han, L.
- Affiliations
- Yale University (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2006-02-27
- Volume
- 166
- Issue
- 4
- Pages
- 418
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2022181538
- Cited by
- 1,141
- References
- 44
- Citations by year
- 2026: 76 · 2025: 67 · 2024: 84 · 2023: 56 · 2022: 91 · 2021: 85 · 2020: 82 · 2019: 82 · 2018: 81 · 2017: 73 · 2016: 66 · 2015: 53 · 2014: 43 · 2013: 39 · 2012: 37
- FWCI
- 10.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Patrick and Catherine Weldon Donaghue Medical Research Foundation
- Yale University (P30AG21342)
- National Institute on Aging (R01AG022993, R37AG017560, K24AG021507, R37AG17560, P30 AG21342, P30AG021342)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- frailty, pre-frailty, frailty transitions, community-dwelling older adults, frailty prevention, activities of daily living, weight loss, muscle weakness, physical activity, walking speed, exhaustion
- MeSH terms
- Aged, Aged, 80 and over, Female, Geriatrics, Humans, Male, Prospective Studies, Severity of Illness Index, Time Factors, Frail Elderly
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