Background Frailty in older adults is dynamic and shaped by clinical, functional, and social factors, yet longitudinal transitions in community populations are not well characterised. We examined one-year changes in frailty and identified factors associated with improvement and progression. Methods We performed a longitudinal analysis of community-dwelling adults aged ≥65 years from the population-based Queenstown Health District cohort. Baseline (Wave 1, 2023–2024) demographic, clinical, and lifestyle data were collected, with reassessment at one year (Wave 2). Frailty was measured using the Clinical Frailty Scale. Ordinal logistic regression modelled overall direction of frailty transition, while multinomial logistic regression identified factors associated with improvement or worsening relative to stability. Alluvial plots illustrated transitions across frailty states over time. Results Among 1,153 participants (mean age 74.5 ± 6.6 years; 55.8% female), frailty remained stable in 627 (54.4%), improved in 211 (18.3%), and worsened in 315 (27.3%) over one year. Visualisation demonstrated predominant stability with bidirectional movement between frailty categories. In ordinal analyses, diabetes (OR 1.39, 95% CI 1.06–1.83), smoking (OR 1.89, 95% CI 1.19–3.03), and iADL impairment (OR 1.56, 95% CI 1.01–2.41) were associated with worsening, while higher physical activity was protective (OR 0.70, 95% CI 0.51–0.98). Multinomial models showed stroke history associated with improvement (OR 4.23, 95% CI 1.46–12.25), whereas iADL impairment reduced the likelihood of improvement (OR 0.48, 95% CI 0.28–0.82). Conclusion Frailty was largely stable but exhibited meaningful bidirectional transitions. Functional impairment and modifiable behaviours were key predictors, underscoring the importance of repeated assessment and function-focused prevention to mitigate frailty progression.
Purpose Falls are the leading cause of injury and injury-related mortality among older adults in the U.S. and a major contributor to fracture risk. Muscle function (strength and power) has been associated with risk of recurrent and injurious falls, yet studies vary by measurement methods and anatomical locations. This review synthesizes evidence on associations between muscle function and fall outcomes, identifies methodological limitations, and suggests directions for future research. Methods PubMed and Embase were searched for peer-reviewed articles published between 2000 and September 16, 2026 examining associations of muscle function with recurrent or injurious falls among adults aged ≥50 years. Performance-based measures of muscle function (e.g., chair stands) were excluded to focus on direct strength and power assessments. Two reviewers screened abstracts and full texts, one extracted study characteristics, and one performed a risk-of-bias assessment. Results Seventeen studies were included, with eight rated ‘good’ and nine rated ‘fair’ quality. Most found that higher grip strength was associated with lower odds of recurrent and injurious falls, though sex-specific associations remain underexplored. Leg strength was evaluated in only one study, and leg power in two studies. Both reported associations of higher leg power with lower odds of injurious falls that were similar in magnitude to grip strength associations, but only one was statistically significant. Conclusion Reduced upper-extremity strength may be a risk factor for recurrent and injurious falls, whereas evidence for lower-extremity power remains limited and inconsistent. Future research should incorporate multiple muscle function measures, standardize injury definitions, and examine sex-specific associations.
Background Intrinsic capacity (IC) is central to healthy aging, but its prognostic relevance among the oldest old remains unclear. Objectives To investigate the associations of IC with disability and mortality, and to determine whether an exploratory cardio-renal measure adds prognostic information. Design Prospective cohort study, with the two cohorts analyzed separately. Setting Community-dwelling older adults in Japan. Participants Adults aged 85–89 years from the Kawasaki Aging and Wellbeing Project (KAWP; n = 942) and the Tokyo Oldest-Old Survey on Total Health (TOOTH; n = 393). Measurements Five IC domains were individually rescaled to a 0–100 scale and averaged, with higher scores indicating better capacity. An exploratory cardio-renal measure comprising N-terminal pro-B-type natriuretic peptide and cystatin C was entered alongside the IC score. The outcomes were incident disability (long-term care insurance certification in KAWP; activities of daily living dependency in TOOTH) and all-cause mortality. Cox proportional hazards and Fine-Gray competing-risk models were adjusted for age, sex, education, smoking status, comorbidity burden, and body mass index. Results In KAWP, each 10-point increment in the IC score was associated with lower risks of care level 1 (adjusted hazard ratio [HR] 0.72, 95% CI 0.66–0.79) and mortality (HR 0.78, 0.68–0.90). In TOOTH, associations were comparable for mortality (HR 0.74, 0.60–0.91) and disability or death (HR 0.78, 0.67–0.91). The association with disability was no longer evident when death was treated as a competing event. The cardio-renal measure provided modest but consistent incremental information for mortality. Conclusions Higher IC was associated with lower risks of disability and mortality among octogenarians across two independent Japanese cohorts. These findings suggest that IC captures shared vulnerability to disability and death and may serve as a population-level marker of vulnerability rather than as a tool for individual-level risk stratification.
Introduction We investigated the prevalence and clinical risk factors associated with frailty, and frailty’s relationship with health-related quality of life (HRQoL) in urban and rural South Africa. Methods In a population-based cross-sectional study, using age- and sex-stratified random sampling of adults aged ≥40 years, researcher-administered questionnaires collected socio-demographic and clinical data. Physical assessments included body mass index (BMI), grip strength, short physical performance battery (SPPB), vision and hearing, and EuroQol 5-Dimensions 5-Levels measured HRQoL. A modified Fried’s Frailty Phenotype defined frailty. Multivariable logistic regression calculated the odds of frailty for associated risk factors, and logistic and quantile regression examined HRQoL by frailty status. Results Amongst 1,893 participants, median age 60 years [IQR 50-70], 54% female, the overall study prevalence of frailty was 16.4%. Frailty was more common in those ≥70 years than those 40–49-years old (32.5% vs. 7.5%; OR 6.0 [95%CI 3.7,8.4], p < 0.001), and in females compared to males (19.2% vs. 13.1%; OR 1.6 [1.2,2.0], p < 0.001). Older age (≥60 years), urban residence, low educational attainment, moderate to severe food insecurity, visual and hearing impairments, self-reported disability, BMI<18kg/m2, and impaired SPPB were all independently associated with frailty. Compared to being robust, frailty was associated with a lower HRQoL utility score (median 0.81(IQR 0.71-0.86) in frail vs. 0.86 (0.83-0.90) in robust/prefrail, β -0.05 ([95%CI -0.07,-0.03], p < 0.001). Conclusion Frailty is common and associated with poorer HRQoL. The identified clinical risk factors can be used to prioritise individuals for referral for clinical assessment of frailty in SA.
