Risk factors/signs of frailty

We are just starting to understand the concept of frailty, its complexity and relationship with risk factors. This area is continually being explored, investigated and changing. At present, we know that risk factors for the development and progression of frailty should not be viewed in isolation, as they are not mutually exclusive and many risk factors have a bi-directional relationship with frailty. Research continues in this area.

The following are examples of our current understanding of frailty, risk factors and what this means for people and populations.

Risk Factors


Social class There is a strong link between socioeconomic deprivation and multimorbidity: multimorbidity occurs 10–15 years earlier in people living in the most deprived areas than it does in those living in the most affluent areas.
Leaving school early The prevalence of frailty is significantly more common in those with low level of education compared to high levels.
Manual trade There is a significant relationship between frailty risk and life-course occupations in advanced age (e.g. intrinsically harder, manual or blue-collar employment).
Obesity and exercise The prevalence of frailty is significantly higher is those who are obese. For example, 32.7% versus 22.8% respectively.
Nutrition, alcohol and smoking

Smoking is a predictor of worsening frailty status in community-dwelling population. Smoking cessation may potentially be beneficial for preventing or reversing frailty.

An increasing adherence to the Mediterranean Diet was associated with decreasing risk of frailty.

Multiple LTC risk Frail people are over five times more likely than non-frail people to say they have three or more chronic diseases. For example, 55.9% versus 10.1% respectively.
Polypharmacy People have nearly 2 times the odds of frailty with polypharmacy (5 or more medicine) and nearly 5 times the odds of frailty with excessive polypharmacy (10 or more medicines) respectively.
Depression and anxiety Frail people are nearly six times more likely than non-frail people to say they have emotional or mental health problems moderately interfering with their daily activities. For example, 80.1% versus 18.8% respectively.
Social isolation Frail people are over 5 times more likely to say they feel lonely, 4 times more likely to feel depressed or sad much of the time and over 5 times more likely to feel dissatisfied with life.
Bereavement Frail people who suffer a life-event (bereavement) are 2.6 times increase risk of mortality compared to non-frail people suffering a life-event.
Functional dependence Frail people are 2.5 times more likely to have headaches, musculoskeletal pain compared to non-frail people. Two thirds of frail people experience frequent or ongoing pain and 80% indicate it interfered moderately with daily living activities.
Hospital stays Half of frail older people discharged home within 72hrs from such settings are readmitted and one-third die within a year, with the majority of these events occurring in the first 90 days.
Recovery after long stays Individuals with frailty who are discharged from hospital experience increased mortality and resource use, even after short ‘ambulatory’ admissions.

For more detail see the following report for risk factors associated with frailty.  Provided by our colleagues at NEQOS.

See Frailty Toolkit document page 30-38