{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T17:48:16Z","timestamp":1777139296983,"version":"3.51.4"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100005224","name":"National Center for Immunization and Respiratory Diseases","doi-asserted-by":"publisher","award":["U01IP001074"],"award-info":[{"award-number":["U01IP001074"]}],"id":[{"id":"10.13039\/100005224","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>We studied the relationship of frailty and acute lower respiratory infection (ALRI) among a multi-site cohort of community-dwelling older adults aged \u226560 years in India. During January 2019\u2012January 2020, participants completed the Edmonton Frail Scale (EFS) at baseline and every 3 months at four sites in India, with each participant completing a maximum of four surveys. Participants were categorized as non-frail (0\u20135 points), vulnerable (6\u20137 points), and frail (\u22658 points) based on EFS score. Project nurses made weekly home visits to identify ALRI episodes with onset during past 7 days. We estimated adjusted hazard ratios (aHR) for having an ALRI episode within 90 days after EFS by frailty category. We also assessed risk of deterioration of frailty during 7\u2013100 days after ALRI episode onset in terms of an increased EFS score by \u22651 point and change of frailty category. Among 5801 participants (median age 65 years, 41% males), 3568 (61\u00b75%) were non-frail, 1507 (26%) vulnerable, and 726 (12\u00b75%) frail at enrolment. Compared with non-frail participants, the hazard of an ALRI episode was higher among vulnerable (aHR: 1\u00b76, (95%CI 1\u00b73\u20132.0) and frail participants (aHR: 1\u00b77, 95%CI 1\u00b73\u20132\u00b72). Participants having ALRI within the past 7\u2013100 days were at increased risk of worsening frailty category (aOR: 1.9, 95%CI 1\u00b73\u20132.8) compared to participants without an ALRI episode during the same period. The association between ALRIs and worsened frailty suggests prevention of ALRIs through vaccination and other strategies may have broad reaching health benefits for older adults.<\/jats:p>","DOI":"10.1371\/journal.pgph.0003903","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T18:54:02Z","timestamp":1735671242000},"page":"e0003903","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["A vicious cycle of frailty and acute lower respiratory infection among community-dwelling adults (\u2265 60 years): Findings from a multi-site INSPIRE cohort study, India"],"prefix":"10.1371","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-267X","authenticated-orcid":true,"given":"Siddhartha","family":"Saha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritvik","family":"Amarchand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakesh","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aslesh","family":"O. Prabhakaran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prabu","family":"Rajkumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumit","family":"Dutt Bhardwaj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4441-4443","authenticated-orcid":true,"given":"Suman","family":"Kanungo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0702-5628","authenticated-orcid":true,"given":"Radhika","family":"Gharpure","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn E.","family":"Lafond","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Azziz-Baumgartner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9173-7811","authenticated-orcid":true,"given":"Anand","family":"Krishnan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,12,31]]},"reference":[{"issue":"10206","key":"pgph.0003903.ref001","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/S0140-6736(19)31785-4","article-title":"Management of frailty: opportunities, challenges, and future directions","volume":"394","author":"E Dent","year":"2019","journal-title":"Lancet"},{"issue":"10206","key":"pgph.0003903.ref002","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/S0140-6736(19)31786-6","article-title":"Frailty: implications for clinical practice and public health","volume":"394","author":"EO Hoogendijk","year":"2019","journal-title":"Lancet"},{"issue":"10132","key":"pgph.0003903.ref003","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1016\/S0140-6736(18)30668-8","article-title":"Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study","volume":"391","author":"T Gilbert","year":"2018","journal-title":"Lancet"},{"issue":"11","key":"pgph.0003903.ref004","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1017\/S0950268818001486","article-title":"Severe morbidity among hospitalised adults with acute influenza and other respiratory infections: 2014\u20132015 and 2015\u20132016","volume":"146","author":"HE Segaloff","year":"2018","journal-title":"Epidemiol Infect"},{"key":"pgph.0003903.ref005","doi-asserted-by":"crossref","first-page":"101896","DOI":"10.1016\/j.eclinm.2023.101896","article-title":"Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study.","volume":"57","author":"HJC McAuley","year":"2023","journal-title":"EClinicalMedicine."},{"issue":"12","key":"pgph.0003903.ref006","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1038\/s43587-021-00155-y","article-title":"Longitudinal Aging Study in India (LASI): new data resources for addressing aging in India.","volume":"1","author":"DE Bloom","year":"2021","journal-title":"Nat Aging."},{"issue":"1","key":"pgph.0003903.ref007","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1186\/s12889-022-13181-1","article-title":"Multimorbidity and its associated risk factors among older adults in India.","volume":"22","author":"MR Khan","year":"2022","journal-title":"BMC Public Health"},{"issue":"3","key":"pgph.0003903.ref008","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1093\/infdis\/jiaa092","article-title":"Frailty Hinders Recovery From Influenza and Acute Respiratory Illness in Older Adults","volume":"222","author":"C Lees","year":"2020","journal-title":"J Infect Dis"},{"issue":"1","key":"pgph.0003903.ref009","doi-asserted-by":"crossref","first-page":"7966","DOI":"10.1038\/s41598-021-86854-3","article-title":"Frailty is associated with susceptibility and severity of pneumonia in older adults (A JAGES multilevel cross-sectional study).","volume":"11","author":"K Iwai-Saito","year":"2021","journal-title":"Sci Rep."},{"issue":"1","key":"pgph.0003903.ref010","article-title":"Functional status recovery trajectories in hospitalised older adults with pneumonia","volume":"9","author":"CM Park","year":"2022","journal-title":"BMJ Open Respir Res"},{"issue":"10100","key":"pgph.0003903.ref011","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specific mortality for 264 causes of death, 1980\u20132016: a systematic analysis for the Global Burden of Disease Study 2016.","volume":"390","author":"Global Burden of Diseases Causes of Death Collaborators","year":"2017","journal-title":"Lancet"},{"issue":"9","key":"pgph.0003903.ref012","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1007\/s12603-022-1845-1","article-title":"Functional Decline in COVID-19 Older Survivors Compared to Other Pneumonia Patients, a Case Control Study","volume":"26","author":"S Le Gentil","year":"2022","journal-title":"J Nutr Health Aging"},{"issue":"3","key":"pgph.0003903.ref013","doi-asserted-by":"crossref","first-page":"e1001977","DOI":"10.1371\/journal.pmed.1001977","article-title":"Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982\u20132012: A Systematic Analysis.","volume":"13","author":"KE Lafond","year":"2016","journal-title":"PLoS Med."},{"issue":"10127","key":"pgph.0003903.ref014","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/S0140-6736(17)33293-2","article-title":"Estimates of global seasonal influenza-associated respiratory mortality: a modelling study","volume":"391","author":"AD Iuliano","year":"2018","journal-title":"Lancet"},{"key":"pgph.0003903.ref015","doi-asserted-by":"crossref","first-page":"04027","DOI":"10.7189\/jogh.11.04027","article-title":"Incidence, risk factors, and viral etiology of community-acquired acute lower respiratory tract infection among older adults in rural north India.","volume":"11","author":"R Kumar","year":"2021","journal-title":"J Glob Health"},{"issue":"1","key":"pgph.0003903.ref016","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12877-022-02891-1","article-title":"Socioeconomic vulnerability and frailty among community-dwelling older adults: cross-sectional findings from longitudinal aging study in India, 2017\u201318.","volume":"22","author":"S Srivastava","year":"2022","journal-title":"BMC Geriatr."},{"issue":"10","key":"pgph.0003903.ref017","doi-asserted-by":"crossref","first-page":"e052473","DOI":"10.1136\/bmjopen-2021-052473","article-title":"Cohort profile: Indian Network of Population-Based Surveillance Platforms for Influenza and Other Respiratory Viruses among the Elderly (INSPIRE).","volume":"11","author":"A Krishnan","year":"2021","journal-title":"BMJ Open"},{"key":"pgph.0003903.ref018","article-title":"Open Source Epidemiologic Statistics for Public Health, Version.","author":"OpenEpi","journal-title":"www.OpenEpi.com, [Internet]."},{"issue":"3","key":"pgph.0003903.ref019","doi-asserted-by":"crossref","first-page":"442","DOI":"10.4103\/ijcm.IJCM_616_20","article-title":"Frailty, Disability, and Mortality in a Rural Community-Dwelling Elderly Cohort from Northern India.","volume":"46","author":"RS Rath","year":"2021","journal-title":"Indian J Community Med"},{"issue":"5","key":"pgph.0003903.ref020","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1093\/ageing\/afl041","article-title":"Validity and reliability of the Edmonton Frail Scale.","volume":"35","author":"DB Rolfson","year":"2006","journal-title":"Age Ageing."},{"key":"pgph.0003903.ref021","author":"British Geriatrics Society","journal-title":"The Edmonton Frail Scale01-09-2018"},{"issue":"7","key":"pgph.0003903.ref022","doi-asserted-by":"crossref","first-page":"e0219083","DOI":"10.1371\/journal.pone.0219083","article-title":"Prevalence of frailty in a tertiary hospital: A point prevalence observational study.","volume":"14","author":"SJG Richards","year":"2019","journal-title":"PLoS One."},{"issue":"3","key":"pgph.0003903.ref023","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/0898264314551172","article-title":"Social relationships and hypertension in late life: evidence from a nationally representative longitudinal study of older adults","volume":"27","author":"YC Yang","year":"2015","journal-title":"J Aging Health"},{"issue":"11","key":"pgph.0003903.ref024","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1136\/thoraxjnl-2013-204282","article-title":"Risk factors for community-acquired pneumonia in adults in Europe: a literature review.","volume":"68","author":"A Torres","year":"2013","journal-title":"Thorax"},{"issue":"1","key":"pgph.0003903.ref025","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12879-024-09033-5","article-title":"Clinical features and outcomes of influenza and RSV coinfections: a report from Canadian immunization research network serious outcomes surveillance network.","volume":"24","author":"H Pott","year":"2024","journal-title":"BMC Infect Dis."},{"key":"pgph.0003903.ref026","author":"US Centers for Disease Control and Prevention","year":"2024","journal-title":"Adult BMI Categories"},{"issue":"2","key":"pgph.0003903.ref027","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.cegh.2019.01.013","article-title":"Survival analysis in longitudinal studies for recurrent events: Applications and challenges,.","volume":"7","author":"M Thenmozhi","year":"2019","journal-title":"Clinical Epidemiology and Global Health"},{"issue":"3","key":"pgph.0003903.ref028","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afad034","article-title":"Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002\u20132017).","volume":"52","author":"A Maharani","year":"2023","journal-title":"Age Ageing."},{"issue":"4","key":"pgph.0003903.ref029","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.jamda.2017.09.026","article-title":"The Prevalence and Correlates of Frailty in Urban and Rural Populations in Latin America, China, and India: A 10\/66 Population-Based Survey.","volume":"19","author":"JJ Llibre Rodriguez","year":"2018","journal-title":"J Am Med Dir Assoc."},{"issue":"3","key":"pgph.0003903.ref030","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1002\/agm2.12263","article-title":"The prevalence of frailty and its relationship with sociodemographic factors, regional healthcare disparities, and healthcare utilization in the aging population across India.","volume":"6","author":"S Singhal","year":"2023","journal-title":"Aging Med (Milton)."},{"issue":"3","key":"pgph.0003903.ref031","first-page":"364","article-title":"Prevalence and Determinants of Frailty in Older Adults in India","volume":"30","author":"Y Kashikar","year":"2016","journal-title":"Indian Journal of Gerontology"},{"issue":"8","key":"pgph.0003903.ref032","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.je.2016.09.008","article-title":"Prevalence of frailty in Japan: A systematic review and meta-analysis.","volume":"27","author":"G Kojima","year":"2017","journal-title":"J Epidemiol."},{"issue":"11","key":"pgph.0003903.ref033","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1093\/gerona\/glv133","article-title":"Frailty in Older Adults: A Nationally Representative Profile in the United States","volume":"70","author":"K Bandeen-Roche","year":"2015","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"11","key":"pgph.0003903.ref034","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17114077","article-title":"Prevalence and Potential Predictors of Frailty among Community-Dwelling Older Persons in Northern Thailand: A Cross-Sectional Study.","volume":"17","author":"P Thinuan","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pgph.0003903.ref035","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12877-023-03730-7","article-title":"Prevalence and association of frailty with SARS-CoV-2 infection in older adults in Southern Switzerland-Findings from the Corona Immunitas Ticino Study.","volume":"23","author":"M Jiang","year":"2023","journal-title":"BMC Geriatr."},{"issue":"4","key":"pgph.0003903.ref036","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1093\/ageing\/afab039","article-title":"Abdominal obesity, body mass index and the risk of frailty in community-dwelling older adults: a systematic review and meta-analysis.","volume":"50","author":"L Yuan","year":"2021","journal-title":"Age Ageing"},{"issue":"4","key":"pgph.0003903.ref037","first-page":"326","article-title":"Relationship among Age, Education and Frailty in Older Persons.","volume":"12","author":"F Bellelli","year":"2023","journal-title":"J Frailty Aging."},{"issue":"6","key":"pgph.0003903.ref038","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1590\/0004-282X20130039","article-title":"Frailty and cognitive impairment among community-dwelling elderly.","volume":"71","author":"MA Alencar","year":"2013","journal-title":"Arq Neuropsiquiatr."},{"issue":"4","key":"pgph.0003903.ref039","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1001\/archinte.166.4.418","article-title":"Transitions between frailty states among community-living older persons","volume":"166","author":"TM Gill","year":"2006","journal-title":"Arch Intern Med"},{"issue":"1","key":"pgph.0003903.ref040","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1186\/s12877-022-03578-3","article-title":"Transitions of self-management behaviors and frailty status among community-dwelling older adults: a national longitudinal population-based cohort study.","volume":"22","author":"TL To","year":"2022","journal-title":"BMC Geriatr."},{"issue":"1","key":"pgph.0003903.ref041","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1186\/s12877-023-03978-z","article-title":"The improvement effect of working through the Silver Human Resources Center on pre-frailty among older people: a two-year follow-up study.","volume":"23","author":"K Morishita-Suzuki","year":"2023","journal-title":"BMC Geriatr."}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T18:54:15Z","timestamp":1735671255000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0003903"}},"subtitle":[],"editor":[{"given":"Man Thi Hue","family":"Vo","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,12,31]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0003903","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,31]]}}}