Frailty in older adults: a nationally representative profile in the United States
Open accessAbstract
BACKGROUND: Frailty assessment provides a means of identifying older adults most vulnerable to adverse outcomes. Attention to frailty in clinical practice is more likely with better understanding of its prevalence and associations with patient characteristics. We sought to provide national estimates of frailty in older people. METHODS: A popular, validated frailty phenotype proposed by Fried and colleagues was applied to 7,439 participants in the 2011 baseline of the National Health and Aging Trends Study, a national longitudinal study of persons aged 65 and older. All measures drew on a 2-hour in-person interview. Weighted estimates of frailty prevalence were obtained. RESULTS: Fifteen percent (95% CI: 14%, 16%) of the older non-nursing home population is frail, and 45% is prefrail (95% CI: 44%, 47%). Frailty is more prevalent at older ages, among women, racial and ethnic minorities, those in supportive residential settings, and persons of lower income. Independently of these characteristics, frailty prevalence varies substantially across geographic regions. Chronic disease and disability prevalence increase steeply with frailty. Among the frail, 42% were hospitalized in the previous year, compared to 22% of the prefrail and 11% of persons considered robust. Hip, back, and heart surgery in the last year were associated with frailty. Over half of frail persons had a fall in the previous year. CONCLUSIONS: Our findings support the importance of frailty in late-life health etiology and potential value of frailty as a marker of risk for adverse health outcomes and as a means of identifying opportunities for intervention in clinical practice and public health policy.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty.
“Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty (48,49).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [48]
The Results and Table 2 show that diabetes occurs among frail older adults, and the Results report multimorbidity, probable dementia, and functional limitations in the older population studied. The paper does not establish those latter findings specifically for adults with diabetes or identify diabetes-related comorbidity. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSome older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty.
“Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty (58,59).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [58]
The Results report diabetes among frail older adults and describe multimorbidity, probable dementia, and difficulty with functional tasks by frailty status. They support the point that some older adults with diabetes are frail, but do not establish diabetes-related comorbidity or cognitive and physical limitations specifically among participants with diabetes. The cited passages have no page numbers in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907 · see citing works
Self-citationGuralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., Scherr, P. A., & Wallace, R. B. (1994) · Journal of Gerontology · doi:10.1093/geronj/49.2.m85 · Cited by 9,792 · see citing works
Operationalizing a frailty index from a standardized comprehensive geriatric assessment
Jones, D. M., Song, X., & Rockwood, K. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52521.x · Cited by 605 · see citing works
Grip Strength Cutpoints for the Identification of Clinically Relevant Weakness
Alley, D. E., Shardell, M. D., Peters, K. W., McLean, R. R., Dam, T.-T. L., Kenny, A. M., Fragala, M. S., Harris, T. B., Kiel, D. P., Guralnik, J. M., et al. (2014) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/glu011 · Cited by 535 · cited 1× · see citing works
“Our scoring method may characterize some individuals as “frail” who could have performed highly if tested, and the use of percentile-based cutpoints bears further consideration: Research to optimize or tailor cutpoints for clinical relevance (35) is needed.”
Method
Flagged first, then by citations
Research works printed but not linked: 25
- Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: A call to action. J Am Med Dir Assoc. 2013;14(6):392-397. doi:10.1016/j.jamda.2013.03.022 · DOI
- Saliba D, Elliott M, Rubenstein LZ, et al. The Vulnerable Elders Survey: A tool for identifying vulnerable older people in the community. J Am Geri- atr Soc. 2001;49(12):1691-1699. doi:10.1046/j.1532-5415.2001.49281.x · DOI
- Strawbridge WJ, Shema SJ, Balfour JL, Higby HR, Kaplan GA. Anteced- ents of frailty over three decades in an older cohort. J Gerontol B Psychol Sci Soc Sci. 1998;53(1):S9-16. doi:10.1093/geronb/53B.1.S9 · DOI
- Rockwood K, Mitnitski A. Frailty in relation to the accumulation of defi- cits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722-727.
- Binder EF, Schechtman KB, Ehsani AA, et al. Effects of exercise train- ing on frailty in community-dwelling older adults: Results of a rand- omized, controlled trial. J Am Geriatr Soc. 2002;50(12):1921-1928. doi: 10.1046/j.1532-5415.2002.50601.x · DOI · Paper page
- Brown M, Sinacore DR, Binder EF, Kohrt WM. Physical and performance measures for the identification of mild to moderate frailty. J Gerontol A Biol Sci Med Sci. 2000;55(6):M350-M355. doi:10.1093/gerona/55.6.M350 · DOI
- Ensrud KE, Ewing SK, Taylor BC, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med. 2008;168(4):382-389. doi:10.1001/archinternmed.2007.113 · DOI · Paper page
- Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A pro- gram to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med. 2002;347(13):1068-1074. doi:10.1056/NEJ- Moa020423 · DOI
- Speechley M, Tinetti M. Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc. 1991;39(1):46-52. doi:10.1111/j.1532-5415.1991.tb05905.x · DOI
- Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominguez F Jr, Val- lone R. Screening for frailty: Criteria and predictors of outcomes. J Am Geri- atr Soc. 1991;39(8):778-784. doi:10.1111/j.1532-5415.1991.tb02700.x · DOI
- Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: Charac- terization in the women's health and aging studies. J Gerontol A Biol Sci Med Sci. 2006;61(3):262-266.
- Xue QL, Walston JD, Fried LP, Beamer BA. Prediction of risk of falling, physical disability, and frailty by rate of decline in grip strength: The wom- en's health and aging study. Arch Intern Med. 2011;171(12):1119-1121. doi:10.1001/archinternmed.2011.252 · DOI
- Ensrud KE, Ewing SK, Taylor BC, et al.; Study of Osteoporotic Fractures Research Group. Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744-751.
- Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of sur- gical outcomes in older patients. J Am Coll Surg. 2010;210(6):901-908. doi:10.1016/j.jamcollsurg.2010.01.028 · DOI · Paper page
- McAdams-DeMarco MA, Suresh S, Law A, et al. Frailty and falls among adult patients undergoing chronic hemodialysis: A prospective cohort study. BMC Nephrol. 2013;14:224. doi:10.1186/1471-2369-14-224 · DOI
- Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc. 2012;60(8):1487-1492. doi:10.1111/j.1532-5415.2012.04054.x · DOI · Paper page
- Cawthon PM, Marshall LM, Michael Y, et al.; Osteoporotic Fractures in Men Research Group. Frailty in older men: Prevalence, progression, and relationship with mortality. J Am Geriatr Soc. 2007;55(8):1216-1223. doi:10.1111/j.1532-5415.2007.01259.x · DOI
- Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 coun- tries. J Gerontol A Biol Sci Med Sci. 2009;64(6):675-681. doi:10.1093/ gerona/glp012 · DOI · Paper page
- Miller DR, Rogers WH, Kazis LE, Spiro A 3rd, Ren XS, Haffer SC. Patients' self-report of diseases in the Medicare Health Outcomes Survey based on comparisons with linked survey and medical data from the Veter- ans Health Administration. J Ambul Care Manage. 2008;31(2):161-177. doi:10.1097/01.JAC.0000314707.88160.9c · DOI
- Galvin JE, Roe CM, Xiong C, Morris JC. Validity and reliability of the AD8 informant interview in dementia. Neurology. 2006;67(11):1942- 1948. doi:10.1212/01.wnl.0000247042.15547.eb · DOI
- Raghunathan T E, Lepkowski JM, Van Hoewyk J, Solenberger P. A multi- variate technique for multiply imputing missing values using a sequence of regression models. Surv Methodol. 2001;27:85-95.
- McAdams-DeMarco MA, Law A, Salter ML, et al. Frailty and early hospital readmission after kidney transplantation. Am J Transplant. 2013;13(8):2091-2095. doi:10.1111/ajt.12300 · DOI
- Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorkston K, Chan L. Falls in the Medicare population: Incidence, associated factors, and impact on health care. Phys Ther. 2009;89(4):324-332. doi:10.2522/ ptj.20070107 · DOI
- Olshansky SJ, Antonucci T, Berkman L, et al. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff (Millwood). 2012;31(8):1803-1813. doi:10.1377/ hlthaff.2011.0746 · DOI · Paper page
- Institute of Medicine (U.S.). Committee on Geographic Variation in Health Care and Promotion of High-Value Care. Washington, DC: The National Academies Press; 2013.
Cited by
Sorted by citations
Jaul, E., & Barron, J. (2017) · Frontiers in Public Health · doi:10.3389/fpubh.2017.00335 · Cited by 946 · see citing works
13. Older Adults: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s013 · Cited by 381 · see citing works
13. Older Adults: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s013 · Cited by 209 · see citing works
Guerard, E. J., Deal, A. M., Chang, Y., Williams, G. R., Nyrop, K. A., Pergolotti, M., Muss, H. B., Sanoff, H. K., & Lund, J. L. (2017) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2017.0122 · Cited by 168 · see citing works
13. Older Adults: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s013 · Cited by 161 · see citing works
Kadambi, S., Loh, K. P., Dunne, R., Magnuson, A., Maggiore, R., Zittel, J., Flannery, M., Inglis, J., Gilmore, N., Mohamed, M., et al. (2020) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-020-0421-z · Cited by 149 · see citing works
13. Older Adults: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s013 · Cited by 87 · see citing works
Wu, C., Geldhof, G. J., Xue, Q.-L., Kim, D. H., Newman, A. B., & Odden, M. C. (2018) · American Journal of Epidemiology · doi:10.1093/aje/kwy041 · Cited by 45 · see citing works
Self-citationEspinoza, S. E., Woods, R. L., Ekram, A. R. M. S., Ernst, M. E., Polekhina, G., Wolfe, R., Shah, R. C., Ward, S. A., Storey, E., Nelson, M. R., et al. (2022) · The Journals of Gerontology: Series A · doi:10.1093/gerona/glab340 · Cited by 39 · see citing works
- Authors
- Bandeen-Roche, K., Seplaki, C. L., Huang, J., Buta, B., Kalyani, R. R., Varadhan, R., Xue, Q.-L., Walston, J. D., & Kasper, J. D.
- Affiliations
- University of Rochester Medicine (US)
- Johns Hopkins University (US)
- ORCID
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-08-21
- Volume
- 70
- Issue
- 11
- Pages
- 1427-1434
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC4723664
- OpenAlex
- W2177078719
- Cited by
- 800
- References
- 4
- Citations by year
- 2026: 52 · 2025: 93 · 2024: 101 · 2023: 90 · 2022: 92 · 2021: 88 · 2020: 82 · 2019: 69 · 2018: 54 · 2017: 46 · 2016: 32 · 2015: 1
- FWCI
- 22.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001079)
- National Institute on Aging (K01AG031332, U01AG032947, P30AG021334)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079637, K23DK093583)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- frailty, pre-frailty, older adults, frailty prevalence, Fried frailty phenotype, National Health and Aging Trends Study, racial and ethnic minorities, socioeconomic status, chronic disease, disability, hospitalization, falls, surgical procedures, sex differences
- MeSH terms
- Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic Disease, Female, Health Status, Hospitalization, Humans, Longitudinal Studies, Male, Residence Characteristics, Sex Factors, Socioeconomic Factors, United States, Geriatric Assessment, Prevalence, Frail Elderly, Mobility Limitation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
