Frailty Assessment in Older Adults: A Twenty-Four Month Cohort Across Three Frailty Strata: Phenotype Distribution, Outcomes, and Intervention Response in Three Hundred and Eighty-Two Adults Aged Sixty-Five and Older

Abstract

Frailty defined by the Fried phenotype as the presence of three or more of weight loss, exhaustion, weakness, slow gait, and low physical activity is a clinically distinctive state of increased vulnerability to adverse outcomes in older adults. Pre-frailty (one or two criteria) represents an intermediate stage with elevated risk and substantial intervention responsiveness. We undertook a 24-month prospective cohort study of 382 community-dwelling adults aged 65 and older. Frailty distribution showed 30.9% robust, 44.0% pre-frail, and 25.1% frail. All-cause mortality differed substantially by frailty class: 24-month mortality was 5% in robust, 12% in pre-frail, and 30% in frail patients (HR for frail vs robust 5.18). Similar gradients applied for hospitalisation (4.4-fold), recurrent falls (4.8-fold), ADL functional decline (6.4-fold), and institutionalisation (4.2-fold). Multicomponent intervention including resistance exercise, protein supplementation, vitamin D, polypharmacy review, and psychosocial support produced measurable benefits with approximately 30% of pre-frail patients reverting to robust status and 22% of frail patients improving to pre-frail. The findings support routine frailty assessment in primary care and integrated multicomponent intervention for pre-frail and frail older adults.

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