Loneliness as a risk factor for frailty transition among Chinese old people

Abstract Background: loneliness has been observed to be associated with subsequent adverse outcomes. Our study aims to investigate whether and how loneliness is related to frailty transition. Methods: our study used 8425 participants (aged>=60) from 2008 and 2011 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely and isolated and grouped into three levels of loneliness: never, seldom and often. Frailty was contrasted in physical frailty and frailty index. Frailty transition as outcome variable has been designed as two types according the mearsurement of frailty: remaining robust or prefrail, improvement, worsening and remaining frail was used to describe the transition of physical frailty, and we created three categories of frailty index change to investigate the association between loneliness and frailty transition. Results: greater loneliness reduced the possibility of remaining robust or prefrail physical frailty state after adjusting: odds ratios (95% CI) was 0.78(0.67-0.90), adjusted for age, gender, components number of frail scale at baseline and all other confounding variables. Greater loneliness was associated with an increased risk of worsening physical frailty after 3 years: compared with those never loneliness, the odds ratios (95% CI) for people who often loneliness were 1.19(1.01-1.40), adjusted for age, gender and components number of frail scale at baseline and all other confounding variables. The association between loneliness and the possibility of remaining robust or prefrail physical frailty states had no gender difference, adjusted for age and components number of frail scale at baseline, whereas loneliness was no longer significant in female participants after adjusting for all covariates. Male participants with often loneliness had an increased risk of worsening physical frailty state even with all covariates. By contrast, loneliness showed no significant relationship with physical frailty improvement and remaining frail. We found no significant relationship with loneliness under the model of the frailty index. Conclusion: old adults with a high level of loneliness tend to be physical frailty state in the future, and male older with a high level of loneliness had an increased risk of worsening physical frailty state.