Predictors for transition to frailty status among older adults in Hong Kong: a 5-year longitudinal study

Background: Frailty is a significant predictor of hospitalisations, fall, and negative psychological consequences, all of which result in increasing demands for healthcare services and lower quality of life. In Hong Kong, studies measuring changes in frailty status within a short period, especially in psychosocial aspect, are limited. This study aimed to examine the psychosocial factors that predict the transition of frailty status and determine the patterns and probabilities of frailty status worsening and improvement over time. Methods: This is a secondary data analysis based on the longitudinal dataset from the Centre for Gerontological Nursing of the Hong Kong Polytechnic University from 2013 to 2017. Older adults aged >60 years with no significant cognitive problem were invited from community centres, hostels, and nursing homes to participate. Self-reported questionnaires and assessment tools were used. The dependent variables were changes of frailty status based on the Fried Frailty Index (eg, no change vs improvement). Frailty status of baseline and second attempt within 1 to 2 years were assessed. 107 independent variables of demographic, clinical, functional and psychosocial aspects were measured. Age and gender were confounding variables. Multiple stepwise logistic regression was used to determine significant factors associated with changes in frailty status. Results: A total of 926 participants attended the first data collection; 306 (33%) of them with the second attempt were analysed. At baseline, 80 (26.1%) participants were robust, 141 (46.1%) were prefrail, and 85 (27.8%) were frail. Compared with baseline status, 91 (29.7%)participants worsened, 156 (51%) remained unchanged, and 59 (19.3%) improved in frailty status at the second measurement. Improving or less worsening of frailty status was associated with more social engagement with friends and family (odds ratio [OR]=1.075, 95% confidence interval [CI]=1.007-1.148) and better self-reported psychological well-being. However, anxiety (OR=0.817, 95% CI=0.690-0.928) was associated with less improvement. Conclusions: This is the first longitudinal study of frailty status transition in terms of psychological well being, anxiety, and social engagement in a Chinese population. Higher psychological well-being and frequent social activities increase the likelihood of elderly people to perform daily physical activities, and are associated with slower rate of motor functioning decline and reduced ri