Associations between lifestyle, physical and social environments and frailty among Chinese older people: a multilevel analysis

Frailty represents a public health priority and an increasingly prevalent condition in the ageing population. It is seen as reflecting an interaction among individual factors and a range of environmental elements. This study aims to examine the association between frailty and individual factors, physical and social environments among Chinese older people.

The data were from the Shanghai Healthy City Survey in 2017, which sampled 2559 older people aged ≥60 years from 67 neighbourhoods. The FRAIL scale was used to assess frailty, and social and physical environments were assessed using validated and psychometrically tested instruments. Individual factors included age, gender, education, employment, marital status, smoking, drinking, physical exercise, organization participation, self-rated health and psychological well-being. A multilevel analysis was conducted to examine whether physical and social environments were associated with frailty.

The prevalence of pre-frailty and frailty were 39.5 and 16.9%, respectively. The prevalence of frailty increased with age from 14.6% (60–64 years) to 26.5% (≥75 years). After adjusting for age and/or gender, older age, women, and those with low education, alcohol dependence, physical inactivity, poor self-rated health, or psychological disorders had a higher prevalence of frailty. The multilevel analysis indicated that after controlling for individual covariates, compared to the 1st quartile of aesthetic quality, the odds ratio (OR) of frailty for the 4th quartile was 0.65 (0.47–0.89); compared to the 1st quartile of walking environment, the OR of frailty for the 4th quartile was 0.43 (0.19–0.95); compared to the 1st quartile of social cohesion, the OR of frailty for the 4th quartile was 0.73 (0.54–0.99); compared to the 1st quartile of social participation, the ORs of frailty for the 2nd, 3rd and 4th quartiles were 0.76 (0.59–0.97), 0.59 (0.45–0.77) and 0.59 (0.45–0.77), respectively.

Frailty is a highly prevalent health condition among the aged population in China. Healthcare should focus on frail elderly who are older age, women, those with low education, and those with mental health problems. It may decrease frailty among Chinese older people to encourage social participation and healthy behaviours and to build aesthetic, walkable and cohesive neighbourhoods.