Factors Influencing Change in Frailty Status in Retirement Village Residents

OBJECTIVES: Older people residing in retirement villages (RVs) (elsewhere called continuing care retirement communities) are thought to live in a relatively age-friendly environment. Many RVs have facilities and resources for health care and home-based supports and opportunities for physical activity and social engagement. Living within such environments may influence changes in frailty. DESIGN: Longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 578 residents from 33 RVs. METHODS: Resident international Resident Assessment Instrument data, used to develop the frailty index, and village-level data (by survey) were collected at baseline. Participants were reassessed with the international Resident Assessment Instrument 2.5 years later. Analysis of factors associated with worsening frailty or death was performed with multivariable logistic regression. RESULTS: At follow-up, 47 participants had died, and a further frailty index was calculated in 478 participants. Within the entire cohort, 289 (55.0%) stayed within the same frailty category, 23 (4.4%) improved, and 166 (31.6%) worsened in frailty status during a mean of 2.5 years. Aged >90 years at baseline [odds ratio (OR), 3.34; 95% CI, 1.61-6.93; P = .001], poor/fair quality of life (OR, 2.94; 95% CI, 1.35-6.40; P = .007), participation in social activities of long-standing interest in the last 30 days (comparator within 3 days: OR, 1.99; 95% CI, 1.06-3.71; P = .03), and villages owned by not-for-profit organizations (OR, 1.71; 95% CI, 1.06-2.77; P = .03) were associated with higher odds of worsening frailty status or death. There was a borderline significant association with not visiting a dentist in the past 12 months (OR, 1.43; 95% CI, 0.98-2.08; P = .07), with significance found on sensitivity analysis (OR, 1.57; 95% CI, 1.08-2.26; P = .02). CONCLUSIONS AND IMPLICATIONS: In older adults residing in presumed age-friendly communities, individual and RV-level factors were associated with worsening frailty or death, some of which are modifiable. Further research addressing differences between RV ownership models and how this influences frailty is needed. Understanding how the wider social and physical environment influences frailty is essential for designing frailty prevention strategies at the neighborhood level and in the creation of frailty-friendly and preventative environments.