Medical Sciences · Oct 22, 2026
Understanding the Prevalence, Factors, and Patient-Centered and Economic Outcomes of Prefrailty and Frailty in Community-Dwelling Older Singaporean Adults
By Man REK, Gupta P, Wong CMJ et al.
Introduction: The objective of this study was to determine the prevalence, factors associated with, and patient-centered and economic outcomes of prefrailty and frailty in a multi-ethnic population of community-dwelling older Singaporean adults aged ≥60 years. Methods: We included 2110 participants (mean age ± SD: 72.4 ± 8.1 years; 52.6% female) from the cross-sectional Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study (2017 to 2022). A modified Fried frailty cross-sectional phenotype classification was used to categorize participants as prefrail or frail, based on them having 1–2 or ≥3 of the following characteristics: underweight (body mass index < 18.5 kg/m2), slowness (sex-specific lowest quintile of time taken to complete a 4 m gait speed test), weakness (sex-specific lowest quintile of grip strength), self-reported exhaustion (score < 10 in the Vitality domain of the 12-item short-form survey), and low physical activity duration (sex-specific lowest quintile of those individuals a non-zero duration). Sociodemographic, clinical and lifestyle factors, patient-centered (health-related quality of life, functional disability, life-space mobility, depressive symptoms, falls and perceived economic hardship) and economic (healthcare expenditure, work productivity loss) outcomes were assessed via standardized clinical testing and/or validated questionnaires. Ordinal logistic regression models with dominance analysis, linear, negative binomial and two-part regression models were utilized to explore the associated factors and patient-centered and economic outcomes of prefrailty and frailty, respectively. Results: The census-adjusted prevalence of prefrailty and frailty were 64.6% and 11.0%, respectively. Age, minority ethnicity, and cognitive impairment contributed ≥70% of the total model effect, with the remaining contributors being female sex, diabetes, and polypharmacy. The frailty severity spectrum (none, prefrailty and frailty) were also associated with 1.74% to 164.49% significantly poorer outcomes across the majority of patient-centered outcomes assessed. No significant overall differences in annual healthcare expenditure and productivity loss were observed. Conclusions: Over half and one in ten of community-dwelling older Singaporeans were prefrail and frail, respectively, with both groups experiencing substantially poorer patient-centered outcomes. Older age, female sex and cognitive impairment were associated with greater odds of presenting along the frailty severity spectrum and warrants further verification through longitudinal investigations.