Frailty Trajectories and Socioeconomic Vulnerability in Community-Dwelling Older Adults
Abstract
Background: Biopsychosocial frailty is a dynamic, multidimensional condition affecting a growing proportion of older adults. Understanding its trajectories and the role of socioeconomic determinants is essential for evidence-based prevention in primary care. This study examines frailty class transitions and the association between socioeconomic vulnerability and frailty changes and adverse outcomes in community-dwelling older adults.
Methods: A prospective cohort study enrolled community-dwelling older adults aged ≥65 years in Rome (2023–2025), assessed at baseline (T0) and at 6–12 months using the Short Functional Geriatric Evaluation (SFGE) and the SUNFRAIL+ cascade. An Individualized Care Plan was developed for all participants. Fisher’s exact test examined associations between socioeconomic vulnerability and frailty trajectories and hospitalisation.
Results: At baseline (n = 228, mean age 80.0±6.5 years, 67.5% women), 55.7% were robust, 24.6% pre-frail, 17.1% frail and 1.8% very frail. At T1 64.9% remained stable, while improvement and worsening occurred in equal proportions (17.6% each). Pre-frail individuals showed the greatest bidirectionality: 36.4% improved to robust and 23.6% worsened. Socioeconomic vulnerability at SFGE was associated with greater likelihood of frailty class change at T1 (59.5% vs 28.0%, OR = 3.78, p < 0.001), with a significantly higher improvement rate (48.5% vs 13.1%, OR = 6.24, p < 0.001). Also participants positive for socio-economic alerts at SUNFRAIL+ items showed a significantly higher hospitalisation rate at T1 (17.1% vs 5.6%, OR = 3.43, p = 0.029).
Conclusions: Frailty trajectories are bidirectional and strongly influenced by socioeconomic factors. Socioeconomic vulnerability identifies patients both at greater risk of hospitalisation and more likely to benefit from individualised care, supporting systematic socioeconomic screening in primary care settings.
Key messages: • Socioeconomic screening in primary care is essential. Vulnerable older adults show higher frailty improvement rates when given individualized care plans.
• Frailty is bidirectional and influenced by socioeconomic factors. Recognizing this vulnerability identifies patients at a greater risk of hospitalisation.
Related
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- Screening Frailty Among Community-Dwelling Older Adults: A Cross-Sectional Study Comparing the Edmonton Frail Scale and the Clinical-Functional Vulnerability Index-20.
- Practical Approaches to Nutritional Interventions for Malnutrition, Sarcopenia, and Frailty in Community-Dwelling Older Adults and Care Home Populations: A Narrative Review
- Association of dynapenia with adverse physical function trajectories in community-dwelling adults: a CHARLS cohort study
- Longitudinal trajectories of questionnaire-derived health burden and clinical correlates among community-dwelling older adults: a retrospective cohort study in Deyang, China
BibTeX
@article{bisogno2026frailty,
title = {{Frailty Trajectories and Socioeconomic Vulnerability in Community-Dwelling Older Adults}},
author = {M Bisogno and E Carnevale and I D’Antoni and E Langer and D Falco and V Galfano and M Orefice and G Liotta},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.842},
url = {https://doi.org/10.1093/eurpub/ckag169.842},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Frailty Trajectories and Socioeconomic Vulnerability in Community-Dwelling Older Adults
AU - M Bisogno
AU - E Carnevale
AU - I D’Antoni
AU - E Langer
AU - D Falco
AU - V Galfano
AU - M Orefice
AU - G Liotta
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.842
UR - https://doi.org/10.1093/eurpub/ckag169.842
AB - Background: Biopsychosocial frailty is a dynamic, multidimensional condition affecting a growing proportion of older adults. Understanding its trajectories and the role of socioeconomic determinants is essential for evidence-based prevention in primary care. This study examines frailty class transitions and the association between socioeconomic vulnerability and frailty changes and adverse outcomes in community-dwelling older adults. Methods: A prospective cohort study enrolled community-dwelling older adults aged ≥65 years in Rome (2023–2025), assessed at baseline (T0) and at 6–12 months using the Short Functional Geriatric Evaluation (SFGE) and the SUNFRAIL+ cascade. An Individualized Care Plan was developed for all participants. Fisher’s exact test examined associations between socioeconomic vulnerability and frailty trajectories and hospitalisation. Results: At baseline (n = 228, mean age 80.0±6.5 years, 67.5% women), 55.7% were robust, 24.6% pre-frail, 17.1% frail and 1.8% very frail. At T1 64.9% remained stable, while improvement and worsening occurred in equal proportions (17.6% each). Pre-frail individuals showed the greatest bidirectionality: 36.4% improved to robust and 23.6% worsened. Socioeconomic vulnerability at SFGE was associated with greater likelihood of frailty class change at T1 (59.5% vs 28.0%, OR = 3.78, p < 0.001), with a significantly higher improvement rate (48.5% vs 13.1%, OR = 6.24, p < 0.001). Also participants positive for socio-economic alerts at SUNFRAIL+ items showed a significantly higher hospitalisation rate at T1 (17.1% vs 5.6%, OR = 3.43, p = 0.029). Conclusions: Frailty trajectories are bidirectional and strongly influenced by socioeconomic factors. Socioeconomic vulnerability identifies patients both at greater risk of hospitalisation and more likely to benefit from individualised care, supporting systematic socioeconomic screening in primary care settings. Key messages: • Socioeconomic screening in primary care is essential. Vulnerable older adults show higher frailty improvement rates when given individualized care plans. • Frailty is bidirectional and influenced by socioeconomic factors. Recognizing this vulnerability identifies patients at a greater risk of hospitalisation.
SN - 1101-1262
SN - 1464-360X
ER -