This is a hospital based large-scale cross-sectional national survey to report the prevalence of frailty in China, the FRAIL scale was used in this study. Overall, our study reports the prevalence estimates of frailty and pre-frailty were 18.0% and 43.0%, which is similar to the previous results. B. He et al screened 81258 participants (14 studies) for meta-analysis, and reported that the pooled prevalence of frailty and prefrailty were 10% and 43% separately among Chinese community-dwelling adults aged 60 years or older . Lina Ma et al reported that the prevalence of frailty among Chinese hypertensive participants aged 60 years or older is 19.6% with a sample of 1111, using the 68‐item frailty index . Binru Han et al reported that among elderly patients undergoing thoracic and abdominal surgery, the prevalence of frailty was 26.12% with a sample of 245, using frailty phenotype . The reason for this phenomenon may be attributed to three aspects. Firstly, since our 9996 subjects come from various departments of the study hospitals, including internal medicine ward and surgery ward, the prevalence of frailty (18.02%) is the average result of each department. The reported prevalence of frailty among patients post thoracic and abdominal surgery and hypertensive patients is higher than 18%, also remind us that postoperative patients and hypertensive patients may be at high-risk for frailty. Secondly, the reported prevalence of frailty and pre-frailty among community-dwelling elderly is 10%, which is lower than our findings, and 43% of pre-frailty, which is similar our findings. This result has sounded the alarm for us. The community elderly and the patients share the same rate of pre-frailty prevalence rate. Public health interventions are urgently needed. Meanwhile, the high prevalence of frailty among patients also reminds us that we should pay attention to the continuing care for discharged patients, give them positive health guidance and help them return to health balance. Thirdly, we should keep in mind that the comparison results may be affected by the use of different screening tools.
The associated factors for frailty included physical dimension, psychological dimension and social dimension . There were several meaningful factors founded in our study. In general, frailty can be viewed either as a syndrome or as a state. We conducted the survey on the first or second day of hospital admission. Multivariate analysis showed that aged female patients with BMI<18.5, ethnic minorities, drinking history, emergency and referral admission, falls in the last year, cognitive impairment, vision dysfunction, sleeping dysfunction, urinary dysfunction and defecation dysfunction had a higher risk of frailty after controlling the confounding effect of department clustering.
Age as a contributing factor for frailty has been reported in lots of studies [20, 21], our research also confirmed that frailty is an age-associated syndrome. In our study, frailty was more prevalent in females, which consistent with other research findings [22, 23]. The frailty-sex differences have been explained by differences in co-morbidity, mood, cognition, and pathophysiological factors. . Ethnic minorities tend to have higher rates of frailty than Han nationality. The specific difference in favor of frailty susceptibility can be explained by relatively low level of education or income in ethnic minorities inpatients . The relationship between alcohol and risk of frailty is often complicated. In our study, frailty was more prevalent in patient with a history of alcohol intake. However, Gotaro Kojima et al found that non-drinkers seem more likely than those with low alcohol consumption to develop frailty with a sample of 2544 community-dwelling people . The link between frailty and alcohol may depend on the drinking patterns, drinking amounts each time and cumulative alcohol consumption .
Nutritional status is also an associated factor for frailty, the contribution of malnutrition to frailty was identified in this study. We found that patients with low weight (BMI＜18.5) were higher risk for frailty, whereas high weight population did not present frailty risk. These results differed from those of previous studies. It is reported that since overweight may directly cause slowness and poor exercise tolerance, people with higher weight and obesity are more likely to be frailty [28, 29]. The difference may be due to the two previous studies were all-female sample. Malnutrition significantly influences the development of frailty can be attributed to weight loss leads to weakness, exhaustion, slow walking speed and low physical activity . Thus, doctors and nurses should pay more attention to diet management and exercise education for elderly patients in order to improve patients’ weight management and keep healthy weight.
Patients admission through emergency present more risk for frailty. It is also reported that the prevalence of frailty among older emergency department patients is quit high, which varied from 43.7% to 45.3% with different screening scales . The condition of patients admitted from emergency department was critically ill, which may accompany by weakness, muscle loss and frailty. This study results reminds us that we not only need to pay attention to elderly patients admitted from emergency department, but also need focus on emergency care. Screening for frailty in older emergency department patients is needed, which can inform prognosis and target discharge planning including community services required .
Falls and frailty share many significant characteristics. Falls in older people is a well-recognized risk factor for frailty . On the other hand, the presence of frailty also confers a particularly poor prognosis of falling, prolonged bed rest and immobilization may accelerate the development of frailty . Furthermore, health was no longer just the absence of diseases, which was seen as a state of complete well-being on different domains . Our result showed that poor vision, sleeping dysfunction, urinary dysfunction and defecation dysfunction were all important affect factors for frailty. Therefore, we strongly appeal that every country could raise additional domestic funds for public health and committed to promoting a National Fitness Program. In these projects, specially trained nurses that encourage patients to take exercise and teach them how to exercise are urgently needed.
This study reveals another phenomenon worthy of attention. We were surprised to find that the prevalence of cognitive impairment is up to 20.57% among elderly inpatients, and 26.94% of frailty prevalence rate among the population. Geriatric cognitive disorders were significantly associated with an increased risk of frailty, which were consistent with other researches . Deirdre A. Robertson et al also concluded that frailty may be a marker for future cognitive impairment . Make a deep understanding of the combination of cognition and physical frailty may have important clinical implications in hospitals. Early interventions in frailty patients may alleviate the progression of cognitive impairment, and vice versa.