{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:01:15Z","timestamp":1792443675282,"version":"4.5.0"},"reference-count":51,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2017,9,21]],"date-time":"2017-09-21T00:00:00Z","timestamp":1505952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study aimed to compare the prevalence of frailty across three Chinese populations: Hong Kong, Taiwan-urban and Taiwan-rural. Contributing factors to disparities in frailty were also examined. Data were derived from the Osteoporotic Fractures in Men (MrOs) and Women (MsOs) (Hong Kong) Study (n = 4000) and the Taiwan Longitudinal Study on Aging (n = 2392). Frailty was defined as an index calculated from 30 multiple deficits. The ratio of the frailty index to life expectancy at birth (FI\/LE) was used as an indicator of compression of morbidity. Frailty was more prevalent in Taiwan-urban (33.1%) and Taiwan-rural (38.1%) compared to Hong Kong (16.6%, p &lt; 0.05) and was higher in women (22.6\u201349.7%) than in men (10.5\u201327.5%, p &lt; 0.05). The ratios of FI\/LE were higher in Taiwan-urban and Taiwan-rural (both 0.27) compared to Hong Kong (0.20, p &lt; 0.05). Multivariate analyses revealed that older age, being a woman and low levels of physical activity were common risk factors for frailty across the three populations. Alcohol use was inversely associated with frailty in both Hong Kong and Taiwan-urban populations, but not in Taiwan-rural. Living alone was associated with frailty in Hong Kong men, but not in Hong Kong women or Taiwanese people. For all study populations, older age and being a woman constituted the highest attributable factor. This comparison provides useful data to inform government policies.<\/jats:p>","DOI":"10.3390\/ijerph14101096","type":"journal-article","created":{"date-parts":[[2017,9,21]],"date-time":"2017-09-21T12:17:40Z","timestamp":1505996260000},"page":"1096","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Frailty and Its Contributory Factors in Older Adults: A Comparison of Two Asian Regions (Hong Kong and Taiwan)"],"prefix":"10.3390","volume":"14","author":[{"given":"Ruby","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China"},{"name":"The Chinese University of Hong Kong Jockey Club Institute of Ageing, Shatin, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Chi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Leung","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, Shatin, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2437-5918","authenticated-orcid":false,"given":"Susan C.","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7593-3081","authenticated-orcid":false,"given":"Jean","family":"Woo","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China"},{"name":"The Chinese University of Hong Kong Jockey Club Institute of Ageing, Shatin, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wang, H.H., Wang, J.J., Wong, S.Y., Wong, M.C., Li, F.J., Wang, P.X., Zhou, Z.H., Zhu, C.Y., Griffiths, S.M., and Mercer, S.W. (2014). Epidemiology of multimorbidity in China and implications for the healthcare system: Cross-sectional survey among 162,464 community household residents in southern China. BMC Med., 12.","DOI":"10.1186\/s12916-014-0188-0"},{"key":"ref_2","first-page":"1333","article-title":"Basic ADL disability and functional limitation rates among older Americans from 2000 to 2005: The end of the decline?","volume":"64","author":"Yu","year":"2009","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1093\/geronb\/gbt012","article-title":"Trends in ADL and IADL disability in community-dwelling older adults in Shanghai, China, 1998\u20132008","volume":"68","author":"Feng","year":"2013","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/geronb\/gbq088","article-title":"Mortality and morbidity trends: Is there compression of morbidity?","volume":"66","author":"Crimmins","year":"2011","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1056\/NEJM198007173030304","article-title":"Aging, natural death, and the compression of morbidity","volume":"303","author":"Fries","year":"1980","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1056\/NEJM199804093381506","article-title":"Aging, health risks, and cumulative disability","volume":"338","author":"Vita","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.2105\/AJPH.2008.135731","article-title":"James Fries: Healthy aging pioneer","volume":"98","author":"Swartz","year":"2008","journal-title":"Am. J. Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/gerona\/59.3.M255","article-title":"Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care","volume":"59","author":"Fried","year":"2004","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1001\/archinternmed.2007.113","article-title":"Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women","volume":"168","author":"Ensrud","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1111\/j.1532-5415.2010.02764.x","article-title":"Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation","volume":"58","author":"Song","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1093\/ageing\/afs051","article-title":"The frailty index in Europeans: Association with age and mortality","volume":"41","author":"Kenny","year":"2012","journal-title":"Age Ageing"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/wvn.12222","article-title":"Frailty as a predictor of future fracture in older adults: A systematic review and meta-analysis","volume":"14","author":"Chen","year":"2017","journal-title":"Worldviews Evid. Based Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Woo, J., Zheng, Z., Leung, J., and Chan, P. (2015). Prevalence of frailty and contributory factors in three Chinese populations with different socioeconomic and healthcare characteristics. BMC Geriatr., 15.","DOI":"10.1186\/s12877-015-0160-7"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1093\/gerona\/62.7.738","article-title":"A comparison of two approaches to measuring frailty in elderly people","volume":"62","author":"Rockwood","year":"2007","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_17","first-page":"675","article-title":"Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries","volume":"64","author":"Cuenoud","year":"2009","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1111\/j.1532-5415.2012.04054.x","article-title":"Prevalence of frailty in community-dwelling older persons: A systematic review","volume":"60","author":"Collard","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s10654-014-9891-6","article-title":"Frailty prevalence and 10-year survival in community-dwelling older adults: Results from the ESTHER cohort study","volume":"29","author":"Saum","year":"2014","journal-title":"Eur. J. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.jamda.2015.01.087","article-title":"Frailty screening in the community using the FRAIL scale","volume":"16","author":"Woo","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_21","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":"Kojima","year":"2017","journal-title":"J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/ajag.12310","article-title":"Prevalence of the geriatric syndromes and frailty in older men living in the community: The Concord Health and Ageing in Men Project","volume":"35","author":"Noguchi","year":"2016","journal-title":"Australas. J. Ageing"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Harttgen, K., Kowal, P., Strulik, H., Chatterji, S., and Vollmer, S. (2013). Patterns of frailty in older adults: Comparing results from higher and lower income countries using the survey of health, ageing and retirement in Europe (SHARE) and the study on global ageing and adult health (SAGE). PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0075847"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1007\/s00198-005-1968-3","article-title":"Bone mineral density and the risk of peripheral arterial disease in men and women: Results from Mr. and Ms. Os, Hong Kong","volume":"16","author":"Wong","year":"2005","journal-title":"Osteoporos. Int."},{"key":"ref_26","unstructured":"Bureau of Health Promotion, Department of Health, and the Executive Yuan, R.O.C. (2017, July 18). Taiwan Longitudinal Study on Aging (TLSA), Available online: https:\/\/mybox.ncku.edu.tw\/navigate\/s\/423DD76530AE4EC1877B26351D4B55F2GSY."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"Mini-Mental State\u2014Practical method for grading cognitive state of patients for clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1300\/J018v05n01_09","article-title":"Geriatric depression scale (GDS)","volume":"5","author":"Yesavage","year":"1986","journal-title":"Clin. Gerontol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/j.1532-5415.1975.tb00927.x","article-title":"A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients","volume":"23","author":"Pfeiffer","year":"1975","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1111\/jgs.13817","article-title":"Reducing the risks of morbidity, disability, and mortality using successful aging strategies","volume":"63","author":"Hsu","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_31","unstructured":"Centre for Health Protection (2017, July 18). Life Expectancy at Birth (Male and Female), 1971\u20132015, Available online: http:\/\/www.chp.gov.hk\/en\/data\/4\/10\/27\/111.html."},{"key":"ref_32","unstructured":"Ministry of the Interior (2017, July 18). Life Expectancy, Available online: http:\/\/www.moi.gov.tw\/stat\/chart.aspx?ChartID."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1177\/096228020101000301","article-title":"The concept of attributable risk in epidemiology: Yesterday, today and tomorrow","volume":"10","author":"Gefeller","year":"2001","journal-title":"Stat. Methods Med. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/0277-9536(94)00404-H","article-title":"Gender differences in the relationship between social network support and mortality\u2014A longitudinal-study of an elderly cohort","volume":"41","author":"Shye","year":"1995","journal-title":"Soc. Sci. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1177\/1359105310368177","article-title":"Gender differences in social network size and satisfaction in adults in their 70s","volume":"15","author":"McLaughlin","year":"2010","journal-title":"J. Health Psychol."},{"key":"ref_36","first-page":"59","article-title":"Risk of mortality following widowhood: Age and sex differences by mode of death","volume":"43","author":"Smith","year":"1996","journal-title":"Soc. Biol."},{"key":"ref_37","unstructured":"The Hong Kong Council of Social Service (2017, July 18). Percentage of Elderly Aged 65 and over Living Alone. Available online: http:\/\/socialindicators.org.hk\/en\/indicators\/elderly\/31.11\/percentage_of_elderly_aged_65_and_over_living_alone.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1111\/j.1532-5415.2005.53405.x","article-title":"Frailty: Emergence and consequences in women aged 65 and older in the Women\u2019s Health Initiative Observational Study","volume":"53","author":"Woods","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1093\/gerona\/glv125","article-title":"Patterns of alcohol consumption and risk of frailty in community-dwelling older adults","volume":"71","author":"Ortola","year":"2016","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1093\/ageing\/afw103","article-title":"C-reactive protein level partially mediates the relationship between moderate alcohol use and frailty: The health and retirement study","volume":"45","author":"Shah","year":"2016","journal-title":"Age Ageing"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1093\/gerona\/glp076","article-title":"Nonlinear multisystem physiological dysregulation associated with frailty in older women: Implications for etiology and treatment","volume":"64","author":"Fried","year":"2009","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3103","DOI":"10.1111\/j.1582-4934.2009.00733.x","article-title":"Inflammation and frailty measures in older people","volume":"13","author":"Hubbard","year":"2009","journal-title":"J. Cell Mol. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.mad.2012.05.005","article-title":"Frailty and the role of inflammation, immunosenescence and cellular ageing in the very old: Cross-sectional findings from the Newcastle 85+ study","volume":"133","author":"Collerton","year":"2012","journal-title":"Mech. Ageing Dev."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/gerona\/gln001","article-title":"Physical activity as a preventative factor for frailty: The health, aging, and body composition study","volume":"64","author":"Peterson","year":"2009","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jamda.2016.01.019","article-title":"A multicomponent exercise intervention that reverses frailty and improves cognition, emotion, and social networking in the community-dwelling frail elderly: A randomized clinical trial","volume":"17","author":"Cabo","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_46","first-page":"383","article-title":"Interventions to prevent or reduce the level of frailty in community-dwelling older adults: A scoping review of the literature and international policies","volume":"46","author":"Puts","year":"2017","journal-title":"Age Ageing"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"873","DOI":"10.2147\/CIA.S130794","article-title":"Effects of multi-domain interventions in (pre) frail elderly on frailty, functional, and cognitive status: A systematic review","volume":"12","author":"Dedeyne","year":"2017","journal-title":"Clin. Interv. Aging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1093\/gerona\/62.7.722","article-title":"Frailty in relation to the accumulation of deficits","volume":"62","author":"Rockwood","year":"2007","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Searle, S.D., Mitnitski, A., Gahbauer, E.A., Gill, T.M., and Rockwood, K. (2008). A standard procedure for creating a frailty index. BMC Geriatr., 8.","DOI":"10.1186\/1471-2318-8-24"},{"key":"ref_50","first-page":"52","article-title":"Health cumulative deficit index and its validity among the Chinese elderly","volume":"5","author":"Gu","year":"2009","journal-title":"Popul. Econ."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Yang, F., and Gu, D.N. (2016). Predictability of frailty index and its components on mortality in older adults in China. BMC Geriatr., 16.","DOI":"10.1186\/s12877-016-0317-z"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/10\/1096\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:45:33Z","timestamp":1760208333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/10\/1096"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,21]]},"references-count":51,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2017,10]]}},"alternative-id":["ijerph14101096"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14101096","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,21]]}}}