Frailty index–predicted mortality is moderated by health-related behaviors: a 4-year community-based longitudinal-cohort study

Abstract To explore the separate and joint associations between frailty and long-term, all-cause mortality with health-related behaviors in older adults. We enrolled a total of 4050 community residents age ≥60 years from Songjiang District, Shanghai, China, and followed up with them every year from 2015 to 2018.Based on the standard procedure for creating an FI, we developed one containing 28 measured variables. Survival analyses were used to examine the risk ratios (RRs) between frailty and 4-year mortality; hazard ratios (HRs) were obtained and adjusted for gender and age. Over an average follow-up time of 1107.56 ± 144.43 days, 216 (5.4%) participants died. Of all participants, 71.7% were non-frail (FI = 0–0.1), 23.2% were pre-frail (FI = 0.1–0.2), and 5.1% were frail (FI ³0.2). Multivariate HRs (with 95% confidence intervals [CIs]) for all-cause mortality were 1.58 (1.06–2.34) and 2.63 (1.52 –4.55) for moderate (FI 0.1–0.2) and severe (FI >0.2) frailty, respectively, compared with mild frailty (<0.1). Risk of death for severely frail participants who were physically inactive (HR = 3.40; 95% CI, 1.78–6.50; P < 0.001) was 105%, much higher than for severely frail participants who performed physical exercise (HR = 2.34; 95% CI, 1.35–4.09; P < 0.01). Similarly, among severely frail participants, those who were socially inactive (HR = 5.77; 95% CI, 2.69–12.38; P < 0.01) were 344% more likely to die than those who regularly participated in social activities (HR = 2.33; 95% CI, 1.42–3.86; P < 0.01).