BMC Geriatrics · Nov 6, 2026
Multidimensional frailty trajectories and associated factors in older adults with pulmonary tuberculosis: a prospective longitudinal study
By Lei D, Fu Z, Liu Q et al.
Background: Older adults with pulmonary tuberculosis (TB) are particularly vulnerable to multidimensional frailty. However, longitudinal evidence regarding patterns of frailty changes after antituberculosis treatment initiation and their associated factors remains limited. This study aimed to identify distinct trajectories of multidimensional frailty among older adults with pulmonary TB and to examine the associations of anxiety, depression, insomnia, and clinical characteristics with different frailty trajectories. Methods: A prospective longitudinal study was conducted among 251 older adults with pulmonary TB. Multidimensional frailty was assessed using the Tilburg Frailty Indicator (TFI) at 1, 3, 9, and 12 months after initiation of antituberculosis treatment. At baseline, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and insomnia was assessed using the Athens Insomnia Scale (AIS). Latent class growth analysis was used to identify distinct trajectories of multidimensional frailty. Least absolute shrinkage and selection operator (LASSO) regression was subsequently applied to select candidate variables, followed by multinomial logistic regression to examine factors associated with trajectory membership. Results: Three distinct trajectories of multidimensional frailty were identified: high-frailty decreasing (13.1%), moderate-frailty improving (17.9%), and low-frailty persistent (68.9%) trajectory. Multinomial LASSO regression selected 14 candidate variables potentially associated with frailty trajectory membership. Compared with the low-frailty persistence trajectory, a history of smoking (OR = 4.668, 95% CI 1.217–7.904, P = 0.025) was associated with greater odds of membership in the high-frailty decreasing trajectory. In contrast, higher albumin levels (OR = 0.892, 95% CI 0.798–0.996, P = 0.043), absence of anxiety symptoms (OR = 0.093, P = 0.001), absence of depressive symptoms (OR = 0.044, P < 0.001), and absence of insomnia (OR = 0.020, P < 0.001) were associated with lower odds of membership in the high-frailty decreasing trajectory. Compared with the low-frailty persistence trajectory, absence of anxiety symptoms, absence of insomnia, and absence of depressive symptoms were also associated with lower odds of membership in the moderate-frailty improvement trajectory. Conclusions: Multidimensional frailty exhibited substantial heterogeneity among older adults with pulmonary TB during antituberculosis treatment. Baseline anxiety, depressive symptoms, and insomnia, together with albumin level, were associated with distinct frailty trajectories. Early frailty screening during antituberculosis treatment, integrated with assessment of psychological and sleep status and routine laboratory indicators, may facilitate trajectory-based risk stratification and individualized management of frailty in older adults with pulmonary TB. Clinical trial number: Not applicable.