Differences in Clinical Characteristics, Muscle Mass, and Physical Performance Among Different Frailty Levels in Chinese Older Men
Frailty is a vulnerable state that increases the risk of adverse health outcomes in older adults and explains significant heterogeneity in health status. In China, the frailty phenotype scale and frailty index (FI) have been useful tools for identifying frail older individuals. However, the factors that discriminate frailty levels in Chinese older adults remain undetermined. Early detection of frailty-related factors and subsequent interventions are essential for maintaining functionality and preventing adverse health outcomes in this population. This study aimed to explore the differences in clinical characteristics, muscle mass, and physical performance among older Chinese men with varying levels of frailty.
The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethical Committee of Beijing Hospital. Informed written consent was obtained from all participants. Chinese men aged 60 years and older were recruited during regular health examinations at Beijing Hospital between October 2015 and October 2016. Data on general characteristics, medical history, and the burden of chronic diseases were collected. Polypharmacy was defined as the use of more than five medications. The number of comorbidities was calculated using the Charlson Comorbidity Score. A comprehensive assessment was performed using the Geriatric Depression Scale-5 (GDS-5), Mini-Mental State Examination (MMSE), Mini-Nutritional Assessment Short-Form (MNA-SF), Athens Insomnia Scale (AIS), Basic Activities of Daily Living (ADL), and Instrumental ADL (IADL).
Frailty was defined according to Fried phenotype criteria, which include exhaustion, weakness, slowness, physical inactivity, and weight loss. Participants were classified as frail if they met three or more criteria, prefrail if they met one or two criteria, and robust if they met none. A total of 64 potential deficits were evaluated and included in the FI. Physical function was assessed using objective measures: the Timed Up and Go Test (TUG), 5-Time Sit to Stand Test (5STS), standing balance, handgrip strength, and gait speed. Appendicular skeletal muscle mass (ASM) was determined using a bioelectrical impedance analysis (BIA) system. Relative ASM (RASM) was calculated as ASM divided by height squared (ASM/height², kg/m²). Sarcopenia was defined according to the Asian Working Group on Sarcopenia (AWGS) criteria.
The study included 101 male participants with a mean age of 79.4 years (range: 63–95 years). Among them, 25 (24.8%) were classified as robust, 63 (62.4%) as prefrail, and 13 (12.9%) as frail. The FI values were 0.15 in the robust group, 0.18 in the prefrail group, and 0.29 in the frail group, with significant differences among the groups. Sarcopenia was significantly more prevalent in the frail (61.5%) and prefrail groups (28.6%) compared to the robust group (4.0%).
Participants with higher frailty levels were significantly older, had lower BMI values, and lower physical activity levels. They also had a higher number of comorbid conditions, higher rates of diabetes mellitus, cancers, prostatic diseases, urinary incontinence, insomnia, and hearing loss. However, there were no significant differences in the prevalence of hypertension, coronary artery disease, kidney disease, stroke, osteoporosis, dementia, Parkinson’s disease, or immune diseases among the three groups. Smoking, alcohol intake, falls in the previous year, and the prevalence of bodily pain, impaired vision, memory decline, and depression were similar across frailty levels. Polypharmacy was more common in frailer older adults. Cognitive decline was highest in the frail group and lowest in the robust group, with significant differences among the groups. Nutritional status declined significantly, while disability increased stepwise with frailty severity.
Logistic regression analysis revealed that polypharmacy was independently associated with the risk of prefrailty, while cognitive decline was independently associated with frailty. Age, BMI, insomnia, comorbidity, undernutrition, hearing loss, lower physical activity, ADL, urinary incontinence, diabetes mellitus, prostatic disease, and malignant tumors were not significantly associated with prefrailty or frailty. When prefrail and frail participants were combined, polypharmacy remained related to frailty status.
Participants with higher frailty levels had lower ASM and RASM. Functional limitations were more pronounced in frailer individuals, with slower TUG times, impaired balance, poorer performance in the 5STS test, weaker grip strength, and slower walking speed. Logistic regression analysis showed that muscle mass and balance decline were significantly associated with prefrailty. The association between prefrailty and ASM remained significant even after adjusting for confounding factors. Poor balance was also associated with prefrailty, but this association was attenuated when adjusted for polypharmacy. RASM was not associated with frailty. The TUG and 5STS tests were not significantly associated with frailty status. The FI was inversely associated with ASM, handgrip strength, and walking speed, but not with RASM.
The study highlights the importance of early identification of prefrailty and frailty in older adults. Muscle mass and balance assessments could be valuable additions to routine health examinations for early screening of frailty. These findings may inform the development of interventions to enhance the effectiveness of regular health examinations and promote functionality among older people.
doi.org/10.1097/CM9.0000000000000035
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