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

Abstract Background: previous literature has reported that loneliness is a strong predictor of frailty risk, yet less is known about the role of loneliness in frailty transition types. In this study, we examined whether and how loneliness is related to frailty transition among Chinese old people. Methods: our study used participants (aged>=60) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty. Results: greater loneliness at baseline reduced the possibility of remaining robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68 - 0.91, p<0.01), adjusted for all confounding variables. Greater loneliness was associated with an increased risk of worsening physical frailty after years: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01 - 1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08 - 1.66, p<0.01) after 6 years, adjusted for confounding variables. The association between loneliness and change in the frailty index differed in survey periods: loneliness at baselines was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25 - 2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21 - 2.50, p<0.01) after 6 years, but no significant sign was shown in 3 years follow-up. Besides, loneliness at baselines was significantly associated with frailty transition at follow-up among males, even after adjusting for all potential confounding variables. However, a similar association was not observed among females. Conclusion: old people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to suffer from frailty transition than female elderly in China.