Impact of biopsychosocial frailty trends on survival and quality of life of older adults: a secondary analysis of data from a community-based active monitoring program

BACKGROUND: Advancing age frequently brings about a complex condition known as biopsychosocial frailty, which significantly impacts an older adult's survival and quality of life. This research investigates how changes in frailty levels affect mortality, hospitalization, and institutionalization, utilizing data from the "Long Live the Elderly!" program, a community-based initiative focused on proactive monitoring. METHODS: A secondary analysis was conducted on data from 6,802 older adults participating in the LLE program across six Italian cities. Frailty was assessed using the Short Functional Geriatric Evaluation, which encompasses physical, psychological, and socio-economic dimensions. Trends in frailty were analyzed over an average follow-up period of 4.6 years, with survival outcomes evaluated using Cox proportional hazard models. RESULTS: At baseline, 40.0% of participants were robust, 25.9% pre-frail, 27.4% frail, and 6.7% very frail. Frailty levels deteriorated in 36.9% of participants, while 11.2% experienced improvement. Higher frailty levels were significantly associated with increased mortality, hospitalization, and institutionalization. However, individuals whose frailty remained stable or improved showed significantly lower mortality rates compared to those whose frailty declined. Socio-economic enhancements were linked to better frailty outcomes, while psychophysical deterioration was the primary driver of declines. CONCLUSION: Frailty is a dynamic condition that may improve or worsen over time. Stabilizing or improving frailty trajectories was associated with reduced mortality, hospitalization, and institutionalization, supporting the relevance of multidimensional frailty monitoring in community settings These findings can support the importance of proactive multidimensional frailty monitoring in aging populations.