Document Type : Research articles


1 Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran

2 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences

3 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IRAN


Background: The global incidence rate of frailty syndrome among older adults aged 60 years and over has been estimated to be 43.4 cases per 1000 persons/years.
Objectives: This study aimed to determine the prevalence of pre-frailty and frailty syndromes in community-dwelling older adults and assess the correlated sociodemographic factors.
Methods: All elderly people recruited in the second phase of the Amirkola Health and Ageing Cohort Project, including 2135 older adults aged ?60 years living in Amirkola, North of Iran, were invited to participate in this study using the census method. The standard "FRAIL" scale was used to assess the frailty syndrome. The individuals who obtained a score of three or more and one or two were classified as frail and pre-frail cases, respectively.
Results: Totally, 2010 older adults with a mean age of 70.41±7.65 years were included in this study. Out of them, 672 (33.4%; 95% CI: 31.37-35.50%) cases met the criteria for frailty syndrome, and 874 (43.5%) individuals were regarded as pre-frail. The prevalence of frailty was significantly higher in females (50.8%; 95% CI: 47.58-54.05%), compared to males (18.7%; 95% CI: 16.41-21.05%). Multivariate logistic regression analysis revealed that age ?85 (OR=7.27; 95% CI: 4.12-24.46) and female gender (OR=2.67; 95% CI: 2.30-9.95) had the highest effect on frailty in older adults.
Conclusion: One out of every three elderly people (aged ?60) in Amirkola, North of Iran, had frailty syndrome. Older age, female gender, lower education level, low level of satisfaction with income, marital status (single), living alone, and unemployment increased the risk of frailty in older adults.


  1. Wleklik M, Uchmanowicz I, Jankowska EA, Vitale C, Lisiak M, Drozd M, et al. Multidimensional approach to frailty. Front Psychol. 2020;11:564. doi: 10.3389/fpsyg.2020.00564. [PubMed: 32273868].
  2. Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433-41. doi: 10.2147/CIA.S45300. [PubMed: 24672230].
  3. Uchmanowicz I, Lisiak M, Wleklik M, Gurowiec P, Kałużna-Oleksy M. The relationship between frailty syndrome and quality of life in older patients following acute coronary syndrome. Clin Interv Aging. 2019;14:805-16. doi: 10.2147/CIA.S204121. [PubMed: 31190767].
  4. Khezrian M, Myint PK, McNeil C, Murray AD. A review of frailty syndrome and its physical, cognitive and emotional domains in the elderly. Geriatrics (Basel). 2017;2(4):36. doi: 10.3390/geriatrics2040036. [PubMed: 31011046].
  5. Kojima G, Liljas AEM, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk Manag Healthc Policy. 2019;12:23-30. doi: 10.2147/RMHP.S168750. [PubMed: 30858741].
  6. Ofori-Asenso R, Chin KL, Mazidi M, Zomer E, Ilomaki J, Zullo AR, et al. Global incidence of frailty and prefrailty among community-dwelling older adults: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(8):e198398. doi: 10.1001/jamanetworkopen.2019.8398. [PubMed: 31373653].
  7. Pengpid S, Peltzer K. Prevalence and associated factors of frailty in community-dwelling older adults in Indonesia, 2014-2015. Int J Environ Res Public Health. 2019;17(1):10. doi: 10.3390/ijerph17010010. [PubMed: 31861327].
  8. Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2018;8(3):e018195. doi: 10.1136/bmjopen-2017-018195. [PubMed: 29496895].
  9. Faller JW, Pereira DN, de Souza S, Nampo FK, Orlandi FS, Matumoto S. Instruments for the detection of frailty syndrome in older adults: a systematic review. PLoS One. 2019;14(4):e0216166. doi: 10.1371/journal.pone.0216166. [PubMed: 31034516].
  10. Cunha AIL, Veronese N, de Melo Borges S, Ricci NA. Frailty as a predictor of adverse outcomes in hospitalized older adults: a systematic review and meta-analysis. Ageing Res Rev. 2019;56:100960. doi: 10.1016/j.arr.2019.100960. [PubMed: 31518686].
  11. Hanlon P, Nicholl BI, Jani BD, Lee D, McQueenie R, Mair FS. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants. Lancet Public Health. 2018;3(7):e323-32. doi: 10.1016/S2468-2667(18)30091-4. [PubMed: 29908859].
  12. Bijani A, Ghadimi R, Mikaniki E, Kheirkhah F, Mozaffarpur SA, Motallebnejad M, et al. Cohort profile update: the Amirkola health and ageing project (AHAP). Caspian J Intern Med. 2017;8(3):205-12. doi: 10.22088/cjim.8.3.205. [PubMed: 28932373].
  13. Alizadeh L, Salehi L. Older people's perspectives on health, physical activity and nutritional behaviors. Health Promot Perspect. 2015;5(4):288-95. doi: 10.15171/hpp.2015.034. [PubMed: 26933648].
  14. Shamsabadi A, Delbari A, Sadr AS, Mehraeen E, Mohammadzadeh N, Niakan Kalhori SR. Questionnaire development and validation for designing a health telemonitoring system for frail elderly people. Digit Health. 2019;5:2055207619838940-. doi: 10.1177/2055207619838940. [PubMed: 30944727].
  15. Mazoochi F, Gobbens RJ, Lotfi MS, Fadayevatan R. Diagnostic accuracy of the Tilburg frailty indicator (TFI) for early frailty detection in elderly people in Iran. Arch Gerontol Geriatr. 2020;91:104187. doi: 10.1016/j.archger.2020.104187. [PubMed: 32777633].
  16. Hosseini SR, Cumming RG, Kheirkhah F, Nooreddini H, Baiani M, Mikaniki E, et al. Cohort profile: the Amirkola Health and Ageing Project (AHAP). Int J Epidemiol. 2014;43(5):1393-400. doi: 10.1093/ije/dyt089. [PubMed: 23918798].
  17. Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. J Am Med Dir Assoc. 2017;18(12):1082-6. doi: 10.1016/j.jamda.2017.07.005. [PubMed: 28866353].
  18. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56. doi: 10.1093/gerona/56.3.m146. [PubMed: 11253156].
  19. Alqahtani BA, Nasser TA. Assessment of frailty in Saudi community-dwelling older adults: validation of measurements. Ann Saudi Med. 2019;39(3):197-204. doi: 10.5144/0256-4947.2019.197. [PubMed: 31215244].
  20. Akın S, Mazıcıoglu MM, Mucuk S, Gocer S, Deniz Şafak E, Arguvanlı S, et al. The prevalence of frailty and related factors in community-dwelling Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res. 2015;27(5):703-9. doi: 10.1007/s40520-015-0337-0. [PubMed: 25762157].
  21. Eyigor S, Kutsal YG, Duran E, Huner B, Paker N, Durmus B, et al. Frailty prevalence and related factors in the older adult-FrailTURK Project. Age (Dordr). 2015;37(3):9791-. doi: 10.1007/s11357-015-9791-z. [PubMed: 25948502].
  22. Çakmur H. Frailty among elderly adults in a rural area of Turkey. Med Sci Monit. 2015;21:1232-42. doi: 10.12659/MSM.893400. [PubMed: 25925800].
  23. Al-Kuwaiti SJ, Aziz F, Blair I. Frailty in community-dwelling older people in Abu Dhabi, United Arab Emirates: a cross-sectional study. Front Public Health. 2015;3:248. doi: 10.3389/fpubh.2015.00248. [PubMed: 26579508].
  24. Yadav UN, Tamang MK, Thapa TB, Hosseinzadeh H, Harris MF, Yadav KK. Prevalence and determinants of frailty in the absence of disability among older population: a cross sectional study from rural communities in Nepal. BMC Geriatr. 2019;19(1):283. doi: 10.1186/s12877-019-1290-0. [PubMed: 31640571].
  25. Khamis R, Sabbah H, Sabbah S, Peters L, Droubi N, Sabbah I. Evaluating the psychometric properties of the Arabic version of the Groningen frailty indicator among Lebanese elderly people. J Egypt Public Health Assoc. 2019;94(1):28. doi: 10.1186/s42506-019-0028-3. [PubMed: 32813111].
  26. Arakawa Martins B, Visvanathan R, Barrie H, Huang CH, Matsushita E, Okada K, et al. Frailty prevalence using Frailty Index, associated factors and level of agreement among frailty tools in a cohort of Japanese older adults. Arch Gerontol Geriatr. 2019;84:103908. doi: 10.1016/j.archger.2019.103908. [PubMed: 31319367].
  27. Vaingankar JA, Chong SA, Abdin E, Picco L, Chua BY, Shafie S, et al. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontoly Int. 2017;17(10):1444-54. doi: 10.1111/ggi.12891. [PubMed: 27576598].
  28. Jurschik P, Nunin C, Botigué T, Escobar MA, Lavedán A, Viladrosa M. Prevalence of frailty and factors associated with frailty in the elderly population of Lleida, Spain: the FRALLE survey. Arch Gerontol Geriatr. 2012;55(3):625-31. doi: 10.1016/j.archger.2012.07.002. [PubMed: 22857807].
  29. 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):10-7. [PubMed: 24258362].
  30. Runzer-Colmenares FM, Samper-Ternent R, Al Snih S, Ottenbacher KJ, Parodi JF, Wong R. Prevalence and factors associated with frailty among Peruvian older adults. Arch Gerontol Geriatr. 2014;58(1):69-73. doi: 10.1016/j.archger.2013.07.005. [PubMed: 23978328].
  31. Thompson MQ, Theou O, Karnon J, Adams RJ, Visvanathan R. Frailty prevalence in Australia: findings from four pooled Australian cohort studies. Australas J Ageing. 2018;37(2):155-8. doi: 10.1111/ajag.12483. [PubMed: 29314622].
  32. 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):1487-92. doi: 10.1111/j.1532-5415.2012.04054.x. [PubMed: 22881367].
  33. Ng TP, Feng L, Nyunt MS, Larbi A, Yap KB. Frailty in older persons: multisystem risk factors and the Frailty Risk Index (FRI). J Am Med Dir Assoc. 2014;15(9):635-42. doi: 10.1016/j.jamda.2014.03.008. [PubMed: 24746590].
  34. Heuberger RA. The frailty syndrome: a comprehensive review. J Nutr Gerontol Geriatr. 2011;30(4):315-68. doi: 10.1080/21551197.2011.623931. [PubMed: 22098178].
  35. Franse CB, van Grieken A, Qin L, Melis RJF, Rietjens JA, Raat H. Socioeconomic inequalities in frailty and frailty components among community-dwelling older citizens. PLoS One. 2017;12(11):e0187946. doi: 10.1371/journal.pone.0187946. [PubMed: 29121677].
  36. Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14(1):1. doi: 10.1186/1471-2318-14-1. [PubMed: 24393272].
  37. Castell MV, Sánchez M, Julián R, Queipo R, Martín S, Otero Á. Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care. BMC Fam Pract. 2013;14(1):86. doi: 10.1186/1471-2296-14-86. [PubMed: 23782891].
  38. Mohd Hamidin FA, Adznam SNA, Ibrahim Z, Chan YM, Abdul Aziz NH. Prevalence of frailty syndrome and its associated factors among community-dwelling elderly in East Coast of Peninsular Malaysia. SAGE Open Med. 2018;6:2050312118775581. doi: 10.1177/2050312118775581. [PubMed: 29872529].
  39. Pegorari MS, Tavares DM. Factors associated with the frailty syndrome in elderly individuals living in the urban area. Rev Lat Am Enfermagem. 2014;22(5):874-82. doi: 10.1590/0104-1169.0213.2493. [PubMed: 25493685].
  40. Mouodi S, Bijani A, Hosseini SR, Hajian-Tilaki K. Gender differences in the health status of elderly living alone compared to those who are not alone: evidence of the AHAP study, North of Iran. Caspian J Intern Med. 2016;7(2):126-32. [PubMed: 27386065].
  41. Ocampo-Chaparro JM, Reyes-Ortiz CA, Castro-Flórez X, Gómez F. Frailty in older adults and their association with social determinants of Health. The SABE Colombia Study. Colomb Med. 2019;50(2):89-101. doi: 10.25100/cm.v50i2.4121. [PubMed: 31607766].
  42. Gu D, Yang F, Sautter J. Socioeconomic status as a moderator between frailty and mortality at old ages. BMC Geriatr. 2016;16:151. doi: 10.1186/s12877-016-0322-2. [PubMed: 27506542].