Association of Frailty With Recovery From Disability Among Community-Dwelling Older Adults: Results From Two Large U.S. Cohorts

Abstract

Background: Disability in activities of daily living (ADLs) is a dynamic process and transitions among different disability states are common. However, little is known about factors affecting recovery from disability. We examined the association between frailty and recovery from disability among nondisabled community-dwelling elders.

Methods: We studied 1,023 adults from the Cardiovascular Health Study (CHS) and 685 adults from the Health and Retirement Study (HRS), who were ≥65 years and had incident disability, defined as having difficulty in ≥1 ADL (dressing, eating, toileting, bathing, transferring, walking across a room). Disability recovery was defined as having no difficulty in any ADLs. Frailty was assessed by slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as "nonfrail" (0 criteria), "prefrail" (1-2 criteria), or "frail" (3-5 criteria).

Results: In total, 539 (52.7%) CHS participants recovered from disability within 1 year. Almost two-thirds of nonfrail persons recovered, while less than two-fifths of the frail recovered. In the HRS, 234 (34.2%) participants recovered from disability within 2 years. Approximately half of the nonfrail recovered, while less than one-fifth of the frail recovered. After adjustment, prefrail and frail CHS participants were 16% and 36% less likely to recover than the nonfrail, respectively. In the HRS, frail persons had a 41% lower likelihood of recovery than the nonfrail.

Conclusions: Frailty is an independent predictor of poor recovery from disability among nondisabled older adults. These findings validate frailty as a marker of decreased resilience and may offer opportunities for individualized interventions and geriatric care based on frailty assessment.

Keywords: Disablement process; Frailty; Recovery; Resilience.

Figure 1.

Proportions of recovery from disability by frailty status. Notes: Participants who died in the following visit after the onset of incident disability were included and considered not to recover. Participants who were alive but not interviewed in the following visit after the onset of incident disability were excluded. Recovery from disability was defined as no difficulty in any of six activities of daily living (dressing, eating, toileting, bathing, transferring, and walking across a room) within 1 year in the Cardiovascular Health Study and within 2 years in the Health and Retirement Study after the onset of disability.

Figure 2.

Association of frailty and components of frailty with recovery from disability. Notes: Points estimates (unadjusted) are accompanied by 95% confidence intervals. Prefrailty and frailty were modeled simultaneously with nonfrail persons being the reference. Each of five binary frailty components (slowness, weakness, exhaustion, inactivity, and shrinking) were estimated separately. Two study cohorts were analyzed independently.