{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T23:18:56Z","timestamp":1793661536074,"version":"4.5.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2020YFC2003000 and 2020YFC2003001"],"award-info":[{"award-number":["2020YFC2003000 and 2020YFC2003001"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National High Level Hospital Clinical Research Funding","award":["BJ-2023-018"],"award-info":[{"award-number":["BJ-2023-018"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>With the global aging population, frailty in older adults has emerged as a critical focus in health and aging research. As a dynamic and multifactorial process, the transition to frailty is shaped by not only biological factors but also a range of social, psychological, and environmental influences. Identifying the key factors that drive the progression of frailty is essential for developing preventive interventions for at-risk individuals and for implementing more effective health practices and healthcare strategies for older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data for this study were drawn from the Fourth Sample Survey of the Aged Population in Urban and Rural China, organized by the China National Committee on Ageing. The baseline data were collected from older individuals who participated in the 2017 survey, and the follow-up data were from the 2019 survey. Frailty in older adults was assessed using the Frailty Index (FI) model, which was used to examine the current frailty status among older adults in China and to prospectively analyze the developmental trajectory of frailty. Logistic regression was used to identify the factors influencing the progression of frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 9,093 older adults were included in the analysis. FI values increased with age and were consistently higher in women than in men, indicating that older women had higher levels of frailty. During the two-year follow-up period, frailty status remained stable in most older adults (56.2%, 5,111\/9,093), while 1,292 (14.2%, 1,292\/9,093) experienced an improvement and 2,690 (29.6%, 2,690\/9,093) experienced a worsening of frailty. Transitions to a more frail state were more common than transitions to an improved state. Additionally, transitions between adjacent frailty statuses were much more frequent than transitions across multiple frailty categories (3,669 (40.3%) versus 313 (3.4%)). Logistic regression analysis identified several factors influencing the progression of frailty status in older adults, including demographic factors (age, sex, residence, education, and marital status); family and economic status (living alone, employment, pension receipt, home ownership, financial status); health and medical factors (exercise, recent illness, annual medical checkups, hospitalizations); caregiver support; and social participation (public welfare participation, involvement in senior associations, helping seniors in need, recreational participation, and regular internet access).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The worsening of frailty with age is more common in older adults than the improvement of frailty. Among robust and pre-frail individuals, older women are more likely to experience a deterioration in frailty status. The factors influencing frailty transitions are multifaceted and complex. Therefore, when intervening in the progression of frailty among older adults, it is essential to comprehensively assess frailty risks and influencing factors based on the diverse characteristics and current status of individuals. Individualized, comprehensive, and targeted interventions and management strategies, tailored to different frailty stages and transition pathways, can help improve frailty in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-025-06541-0","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T17:28:33Z","timestamp":1763400513000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Two-year evolution of frailty status and predictive factors in Chinese older adults: a national longitudinal study"],"prefix":"10.1186","volume":"25","author":[{"given":"Jing","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongkang","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Cen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sainan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Botao","family":"Sang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangfei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuezai","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deping","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"issue":"8","key":"6541_CR1","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1111\/j.1532-5415.2012.04054.x","volume":"60","author":"RM Collard","year":"2012","unstructured":"Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487\u201392.","journal-title":"J Am Geriatr Soc"},{"issue":"10","key":"6541_CR2","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1007\/s12603-012-0368-6","volume":"16","author":"X Fang","year":"2012","unstructured":"Fang X, Shi J, Song X, Mitnitski A, Tang Z, Wang C, et al. Frailty in relation to the risk of falls, fractures, and mortality in older Chinese adults: results from the Beijing longitudinal study of aging. J Nutr Health Aging. 2012;16(10):903\u20137.","journal-title":"J Nutr Health Aging"},{"issue":"1","key":"6541_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-04793-w","volume":"24","author":"J Shi","year":"2024","unstructured":"Shi J, Tao Y, Chen S, Zhou Z, Meng L, Duan C, et al. Interaction between hypertension and frailty and their impact on death risk in older adults: a follow-up study. BMC Geriatr. 2024;24(1):187.","journal-title":"BMC Geriatr"},{"issue":"10206","key":"6541_CR4","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1016\/S0140-6736(19)31786-6","volume":"394","author":"EO Hoogendijk","year":"2019","unstructured":"Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365\u201375.","journal-title":"Lancet"},{"issue":"3","key":"6541_CR5","first-page":"246","volume":"54","author":"R O\u2019Caoimh","year":"2018","unstructured":"O\u2019Caoimh R, Galluzzo L, Van der Rodr\u00edguez-Laso \u00c1, Ranhoff AH, Carcaillon-Bentata L, et al. Transitions and trajectories in frailty States over time: a systematic review of the European joint action ADVANTAGE. Ann Ist Super Sanita. 2018;54(3):246\u201352.","journal-title":"Ann Ist Super Sanita"},{"issue":"2","key":"6541_CR6","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/j.gerinurse.2020.10.005","volume":"42","author":"LYW Ho","year":"2021","unstructured":"Ho LYW, Cheung DSK, Kwan RYC, Wong ASW, Lai CKY. Factors associated with frailty transition at different follow-up intervals: a scoping review. Geriatr Nurs. 2021;42(2):555\u201365.","journal-title":"Geriatr Nurs"},{"issue":"6","key":"6541_CR7","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1111\/ggi.14579","volume":"23","author":"J Li","year":"2023","unstructured":"Li J, Zhu M, Zhao S, Liu X. Factors associated with frailty transitions among the old-old in a community. Geriatr Gerontol Int. 2023;23(6):405\u201310.","journal-title":"Geriatr Gerontol Int"},{"issue":"1","key":"6541_CR8","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-11358-7","volume":"12","author":"N Mielke","year":"2022","unstructured":"Mielke N, Schneider A, Huscher D, Ebert N, Schaeffner E. Gender differences in frailty transition and its prediction in community-dwelling old adults. Sci Rep. 2022;12(1):7341.","journal-title":"Sci Rep"},{"issue":"4","key":"6541_CR9","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/s00127-017-1339-3","volume":"52","author":"J Dom\u00e8nech-Abella","year":"2017","unstructured":"Dom\u00e8nech-Abella J, Lara E, Rubio-Valera M, Olaya B, Moneta MV, Rico-Uribe LA, et al. Loneliness and depression in the elderly: the role of social network. Soc Psychiatry Psychiatr Epidemiol. 2017;52(4):381\u201390.","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"6541_CR10","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1051445","volume":"10","author":"X Hu","year":"2022","unstructured":"Hu X, Meng L, Wei Z, Xu H, Li J, Li Y, et al. Prevalence and potential risk factors of self-reported diabetes among elderly people in China: a national cross-sectional study of 224,142 adults. Front Public Health. 2022;10:1051445.","journal-title":"Front Public Health"},{"key":"6541_CR11","volume-title":"Survey report on the living conditions of china\u2019s urban and rural older persons","author":"JW Dang","year":"2018","unstructured":"Dang JW, Wei YY, Liu NN. Survey report on the living conditions of china\u2019s urban and rural older persons. Beijing: Social Science Academic; 2018."},{"key":"6541_CR12","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-8-24","volume":"8","author":"SD Searle","year":"2008","unstructured":"Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24.","journal-title":"BMC Geriatr"},{"issue":"11","key":"6541_CR13","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1111\/ggi.13522","volume":"18","author":"MQ Thompson","year":"2018","unstructured":"Thompson MQ, Theou O, Adams RJ, Tucker GR, Visvanathan R. Frailty state transitions and associated factors in South Australian older adults. Geriatr Gerontol Int. 2018;18(11):1549\u201355.","journal-title":"Geriatr Gerontol Int"},{"issue":"9","key":"6541_CR14","first-page":"10","volume":"24","author":"M Hoover","year":"2013","unstructured":"Hoover M, Rotermann M, Sanmartin C, Bernier J. Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Health Rep. 2013;24(9):10\u20137.","journal-title":"Health Rep"},{"issue":"46","key":"6541_CR15","first-page":"3675","volume":"99","author":"XL Liu","year":"2019","unstructured":"Liu XL, Wang XX, Li N, Zeng L, Tao LY, Zhang H, et al. Application of multiple filling method in public health investigation. Natl Med J China. 2019;99(46):3675\u201377.","journal-title":"Natl Med J China"},{"issue":"4","key":"6541_CR16","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.11124\/JBISRIR-2016-003018","volume":"15","author":"J Ap\u00f3stolo","year":"2017","unstructured":"Ap\u00f3stolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, et al. Predicting risk and outcomes for frail older adults: an umbrella review of frailty screening tools. JBI Database System Rev Implement Rep. 2017;15(4):1154\u2013208.","journal-title":"JBI Database System Rev Implement Rep"},{"issue":"7","key":"6541_CR17","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1093\/gerona\/62.7.722","volume":"62","author":"K Rockwood","year":"2007","unstructured":"Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722\u20137.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"6541_CR18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-11-17","volume":"11","author":"J Shi","year":"2011","unstructured":"Shi J, Song X, Yu P, Tang Z, Mitnitski A, Fang X, et al. Analysis of frailty and survival from late middle age in the Beijing longitudinal study of aging. BMC Geriatr. 2011;11:17.","journal-title":"BMC Geriatr"},{"key":"6541_CR19","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.715659","volume":"8","author":"J Shi","year":"2021","unstructured":"Shi J, Tao Y, Meng L, Zhou B, Duan C, Xi H, et al. Frailty status among the elderly of different genders and the death risk: a follow-up study. Front Med Lausanne. 2021;8:715659.","journal-title":"Front Med Lausanne"},{"issue":"8","key":"6541_CR20","doi-asserted-by":"publisher","first-page":"2397","DOI":"10.1111\/jan.15168","volume":"78","author":"W Baek","year":"2022","unstructured":"Baek W, Min A. Frailty index and gender-specific mortality in Korean adults: findings from the Korean longitudinal study of aging (2006\u20132018). J Adv Nurs. 2022;78(8):2397\u2013407.","journal-title":"J Adv Nurs"},{"key":"6541_CR21","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.16262","volume":"11","author":"YY Chou","year":"2023","unstructured":"Chou YY, Lee YS, Lin CS, Chen JP, Kuo FH, Lin CF, et al. Gender-specific linkages: frailty, polypharmacy, anti-cholinergic burden, and 5-year mortality risk-a real-world analysis. PeerJ. 2023;11:e16262.","journal-title":"PeerJ"},{"issue":"10","key":"6541_CR22","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1097\/GME.0000000000001612","volume":"27","author":"H Ruan","year":"2020","unstructured":"Ruan H, Hu J, Zhao J, Tao H, Chi J, Niu X, et al. Menopause and frailty: a scoping review. Menopause. 2020;27(10):1185\u201395.","journal-title":"Menopause"},{"issue":"2","key":"6541_CR23","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1210\/jc.2017-01172","volume":"103","author":"A Swiecicka","year":"2018","unstructured":"Swiecicka A, Eendebak RJAH, Lunt M, O\u2019Neill TW, Bartfai G, Casanueva FF, et al. Reproductive hormone levels predict changes in frailty status in community-dwelling older men: European male ageing study prospective data. J Clin Endocrinol Metab. 2018;103(2):701\u20139.","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"6541_CR24","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1136\/jech-2011-200027","volume":"66","author":"A Etman","year":"2012","unstructured":"Etman A, Van der Burdorf A, Mackenbach JP, Van Lenthe FJ. Socio-demographic determinants of worsening in frailty among community-dwelling older people in 11 European countries[J]. J Epidemiol Community Health. 2012;66(12):1116\u201321.","journal-title":"J Epidemiol Community Health"},{"issue":"4","key":"6541_CR25","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1001\/archinte.166.4.418","volume":"166","author":"TM Gill","year":"2006","unstructured":"Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty States among community-living older persons [J]. Arch Intern Med. 2006;166(4):418\u201323.","journal-title":"Arch Intern Med"},{"key":"6541_CR26","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.maturitas.2018.11.006","volume":"119","author":"L Lorenzo-L\u00f3pez","year":"2019","unstructured":"Lorenzo-L\u00f3pez L, L\u00f3pez-L\u00f3pez R, Maseda A, Buj\u00e1n A, Rodr\u00edguez-Villamil JL, Mill\u00e1n-Calenti JC. Changes in frailty status in a community-dwelling cohort of older adults: the VERISA\u00daDE study. Maturitas. 2019;119:54\u201360.","journal-title":"Maturitas"},{"issue":"1","key":"6541_CR27","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-020-01530-x","volume":"20","author":"B Ye","year":"2020","unstructured":"Ye B, Chen H, Huang L, Ruan Y, Qi S, Guo Y, et al. Changes in frailty among community-dwelling Chinese older adults and its predictors: evidence from a two-year longitudinal study. BMC Geriatr. 2020;20(1):130.","journal-title":"BMC Geriatr"},{"issue":"1","key":"6541_CR28","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.archger.2011.04.020","volume":"54","author":"P Yu","year":"2012","unstructured":"Yu P, Song X, Shi J, Mitnitski A, Tang Z, Fang X, et al. Frailty and survival of older Chinese adults in urban and rural areas: results from the Beijing longitudinal study of aging. Arch Gerontol Geriatr. 2012;54(1):3\u20138.","journal-title":"Arch Gerontol Geriatr"},{"issue":"1","key":"6541_CR29","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/s12603-017-0916-1","volume":"22","author":"T Doi","year":"2018","unstructured":"Doi T, Makizako H, Tsutsumimoto K, Hotta R, Nakakubo S, Makino K, et al. Association between Insulin-like growth factor-1 and frailty among older adults. J Nutr Health Aging. 2018;22(1):68\u201372.","journal-title":"J Nutr Health Aging"},{"key":"6541_CR30","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.maturitas.2020.05.010","volume":"139","author":"Z Majid","year":"2020","unstructured":"Majid Z, Welch C, Davies J, Jackson T. Global frailty: the role of ethnicity, migration and socioeconomic factors. Maturitas. 2020;139:33\u201341.","journal-title":"Maturitas"},{"issue":"34","key":"6541_CR31","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000030169","volume":"101","author":"X Wang","year":"2022","unstructured":"Wang X, Hu J, Wu D. Risk factors for frailty in older adults. Medicine (Baltimore). 2022;101(34):e30169.","journal-title":"Medicine (Baltimore)"},{"issue":"5","key":"6541_CR32","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1111\/jnu.12588","volume":"52","author":"DSK Cheung","year":"2020","unstructured":"Cheung DSK, Kwan RYC, Wong ASW, Ho LYW, Chin KC, Liu JYW, et al. Factors associated with improving or worsening the state of frailty: a secondary data analysis of a 5-year longitudinal study. J Nurs Scholarsh. 2020;52(5):515\u201326.","journal-title":"J Nurs Scholarsh"},{"key":"6541_CR33","unstructured":"Quach LT, Primack J, Bozzay M, Madrigal C, Erqou S, Rudolph JL. The intersection of physical and social frailty in older adults. R I, Med J (2013). 2021;104(4):16\u20139."},{"issue":"1","key":"6541_CR34","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-023-06407-x","volume":"16","author":"Y Shimizu","year":"2023","unstructured":"Shimizu Y, Suzuki M, Hata Y, Sakaki T. The relationship between frailty and social participation: focus on subjective health. BMC Res Notes. 2023;16(1):123.","journal-title":"BMC Res Notes"}],"container-title":["BMC Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-025-06541-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12877-025-06541-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-025-06541-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T17:28:37Z","timestamp":1763400517000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgeriatr.biomedcentral.com\/articles\/10.1186\/s12877-025-06541-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6541"],"URL":"https:\/\/doi.org\/10.1186\/s12877-025-06541-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4820545\/v1","asserted-by":"object"}]},"ISSN":["1471-2318"],"issn-type":[{"value":"1471-2318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]},"assertion":[{"value":"29 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"In this study, all methods were carried out in accordance with relevant guidelines and regulations or declaration of Helsinki. This study was approved by the Ethics Review Committee of Beijing Hospital (2021BJYYEC-294-01). The participants provided their written informed consent to participate in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"911"}}