Prevalence and Correlates of Frailty Among Community-Dwelling Chinese Older Adults: The China Health and Retirement Longitudinal Study

Abstract

Background: Frailty is an age-related clinical syndrome of decreased resilience to stressors and is associated with numerous adverse outcomes. Although there is preponderance of literature on frailty in developed countries, limited investigations have been conducted in less developed regions including China-a country that has the world's largest aging population. We examined frailty prevalence in China by sociodemographics and geographic region, and investigated correlates of frailty.

Methods: Participants were 5,301 adults aged ≥60 years from the China Health and Retirement Longitudinal Study. Frailty was identified by the validated physical frailty phenotype (PFP) scale. We estimated frailty prevalence in the overall sample and by sociodemographics. We identified age-adjusted frailty prevalence by geographical region. Bivariate associations of frailty with health and function measures were evaluated by chi-squared test and analysis of variance.

Results: We found 7.0% of adults aged 60 years or older were frail. Frailty is more prevalent at advanced ages, among women, and persons with low education. Age-adjusted frailty prevalence ranged from 3.3% in the Southeast and the Northeast to 9.1% in the Northwest, and was more than 1.5 times higher in rural versus urban areas. Frail versus nonfrail persons had higher prevalence of comorbidities, falls, disability, and functional limitation.

Conclusions: We demonstrated the utility of the PFP scale in identifying frail Chinese elders, and found substantial sociodemographic and regional disparities in frailty prevalence. The PFP scale may be incorporated into clinical practice in China to identify the most vulnerable elders to reduce morbidity, prevent disability, and enable more efficient use of health care resources.

Keywords: Aging; China; Disparities; Frailty.

Figure 1.

Age-adjusted prevalence of frailty among adults aged ≥60 years by districts, China Health and Retirement Longitudinal Study, 2011. Weighted prevalence was estimated at the weighted mean age in each district.

Figure 2.

Venn diagram showing extent of overlap of frailty with activity of daily living (ADL) disability and comorbidity (≥2 chronic conditions). A total of 2,802 adults aged ≥60 years had frailty and/or ADL disability and/or comorbidity. Of these, 347 were frail, 2,290 had ADL disability, and 1,043 had comorbidity. Ten self-reported physician diagnosed chronic conditions were considered: hypertension, diabetes, cancer or militant tumor (excluding minor skin cancer), lung disease, liver disease, kidney disease, stomach or other digestive disease, cardiac disease (including myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), stroke, and arthritis or rheumatism.