To develop a frailty index (FI) for predicting mortality and falls using The China Health and Retirement Longitudinal Study (CHARLS) data over 9 years.
Methods
We analyzed the 2011–2020 waves of CHARLS, employing a genetic algorithm (GA) for optimization. The outcomes focused on 9-year mortality and 2-year falls. Validation analyses included descriptive characteristics, concurrent correlation, predictive performance, calibration, and clinical utility assessments.
Results
The study included 6805 participants aged over 60 with a mean age of 68.4 years. The GA-FI, comprising 10 deficits, showed improved performance in all comparisons despite a modest AUC of 0.658 for predicting 9-year mortality. Although GA-FI improved falls prediction, together with other frailty measures the AUCs were consistently below 0.6, indicating challenges in predicting 2-year falls.
Discussion
The GA-FI is a valuable frailty measure in future CHARLS studies, and the identified deficits may guide frailty interventions and health education initiatives.
BakerP. S.BodnerE. V.AllmanR. M. (2003). Measuring life-space mobility in community-dwelling older adults. Journal of the American Geriatrics Society, 51(11), 1610–1614. https://doi.org/10.1046/j.1532-5415.2003.51512.x
2.
BennettJ. A.Winters-StoneK. M.DobekJ.NailL. M. (2013). Frailty in older breast cancer survivors: Age, prevalence, and associated factors. Oncology Nursing Forum, 40(3), E126–E134. https://doi.org/10.1188/13.ONF.E126-E134
3.
CaiY.XuW.XiaoH.LiuH.ChenT. (2020). Correlation between frailty and adverse outcomes among older community-dwelling Chinese adults: The China health and retirement longitudinal study. The Journal of Nutrition, Health and Aging, 24(7), 752–757. https://doi.org/10.1007/s12603-020-1368-6
4.
CarterB.KeevilV. L.AnandA.OsuaforC. N.GoudieR. J. B.PrellerJ.LowryM.ClunieS.ShenkinS. D.McCarthyK.HewittJ.QuinnT. J. (2022). The prognostic and discriminatory utility of the clinical frailty scale and modified frailty index compared to Age. Geriatrics (Basel), 7(5), 87. https://doi.org/10.3390/geriatrics7050087
5.
CesariM.GambassiG.van KanG. A.VellasB. (2014). The frailty phenotype and the frailty index: Different instruments for different purposes. Age Ageing, 43(1), 10–12. https://doi.org/10.1093/ageing/aft160
6.
ChenY. (2024). Childhood and adult socioeconomic status influence on late-life healthy longevity: Evidence from the Chinese longitudinal healthy longevity survey. Frontiers in Public Health, 12, 1352937. https://doi.org/10.3389/fpubh.2024.1352937
7.
ChimukangaraM.HelmM. C.FrelichM. J.BoslerM. E.ReinL. E.SzaboA.GouldJ. C. (2017). A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surgical Endoscopy, 31(6), 2509–2519. https://doi.org/10.1007/s00464-016-5253-7
8.
CleggA.BatesC.YoungJ.RyanR.NicholsL.Ann TealeE.MohammedM. A.ParryJ.MarshallT. (2016). Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing, 45(3), 353–360. https://doi.org/10.1093/ageing/afw039
DavisD. L. (2023). Shoulder dysfunction and mobility limitation in aging. Advances in Geriatric Medicine and Research, 5(3), e230008. https://doi.org/10.20900/agmr20230008
11.
DentE.KowalP.HoogendijkE. O. (2016). Frailty measurement in research and clinical practice: A review. European Journal of Internal Medicine, 31, 3–10. https://doi.org/10.1016/j.ejim.2016.03.007
12.
DentE.MartinF. C.BergmanH.WooJ.Romero-OrtunoR.WalstonJ. D. (2019). Management of frailty: Opportunities, challenges, and future directions. Lancet, 394(10206), 1376–1386. https://doi.org/10.1016/S0140-6736(19)31785-4
13.
FangB.HuangJ.ZhaoX.LiuH.ChenB.ZhangQ. (2022). Concurrent and lagged associations of social participation and frailty among older adults. Health & Social Care in the Community, 30(6), e4812–e4820. https://doi.org/10.1111/hsc.13888
14.
FaulknerK. A.CauleyJ. A.ZmudaJ. M.GriffinJ. M.NevittM. C. (2003). Is social integration associated with the risk of falling in older community-dwelling women?The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 58(10), M954–M959. https://doi.org/10.1093/gerona/58.10.M954
15.
FriedL. P.TangenC. M.WalstonJ.NewmanA. B.HirschC.GottdienerJ.SeemanT.TracyR.KopW. J.BurkeG.McBurnieM. A.Cardiovascular Health Study Collaborative ResearchG. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology: Series A, 56(3), M146–M156. https://doi.org/10.1093/gerona/56.3.m146
16.
GobbensR. J.van AssenM. A.LuijkxK. G.ScholsJ. M. (2012). The predictive validity of the Tilburg Frailty Indicator: Disability, health care utilization, and quality of life in a population at risk. Gerontologist, 52(5), 619–631. https://doi.org/10.1093/geront/gnr135
17.
Gonzalez-BautistaE.Román-PérezS.Manrique-EspinozaB. S.Salinas-RodríguezA.Santos-LunaR. (2024). Frailty was associated with atmospheric NO2 levels: A geospatial approach. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 79(9), glae168. https://doi.org/10.1093/gerona/glae168
18.
HoogesteynK.MeijerE.VrijA. (2020). Examining witness interviewing environments. Journal of Investigative Psychology and Offender Profiling, 17(3), 238–249. https://doi.org/10.1002/jip.1549
19.
KimD. J.MassaM. S.PotterC. M.ClarkeR.BennettD. A. (2022). Systematic review of the utility of the frailty index and frailty phenotype to predict all-cause mortality in older people. Systematic Reviews, 11(1), 187. https://doi.org/10.1186/s13643-022-02052-w
20.
KingK. E.FillenbaumG. G.CohenH. J. (2017). A cumulative deficit laboratory test-based frailty index: Personal and neighborhood associations. Journal of the American Geriatrics Society, 65(9), 1981–1987. https://doi.org/10.1111/jgs.14983
21.
KinnucanE.MolcjanM. T.WrightD. M.SwitzerJ. A. (2018). A prospective look at the link between frailty and shoulder function in asymptomatic elderly individuals. Geriatric Orthopaedic Surgery & Rehabilitation, 9, 2151459318777583. https://doi.org/10.1177/2151459318777583
22.
KojimaG. (2015). Frailty as a predictor of future falls among community-dwelling older people: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 16(12), 1027–1033. https://doi.org/10.1016/j.jamda.2015.06.018
23.
KojimaG.IliffeS.WaltersK. (2018). Frailty index as a predictor of mortality: A systematic review and meta-analysis. Age and Ageing, 47(2), 193–200. https://doi.org/10.1093/ageing/afx162
24.
LinT.ZhaoY.XiaX.GeN.YueJ. (2020). Association between frailty and chronic pain among older adults: A systematic review and meta-analysis. European Geriatric Medicine, 11(6), 945–959. https://doi.org/10.1007/s41999-020-00382-3
25.
LiuH.ChenB.LiY.Morrow-HowellN. (2022). Neighborhood resources associated with frailty trajectories over time among community-dwelling older adults in China. Health Place, 74, 102738. https://doi.org/10.1016/j.healthplace.2021.102738
MitnitskiA. B.MogilnerA. J.RockwoodK. (2001). Accumulation of deficits as a proxy measure of aging. The Scientific World Journal, 1, 323–336. https://doi.org/10.1100/tsw.2001.58
28.
MorleyJ. E.MalmstromT. K.MillerD. K. (2012). A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. The Journal of Nutrition, Health and Aging, 16(7), 601–608. https://doi.org/10.1007/s12603-012-0084-2
29.
OrfilaF.Carrasco-RibellesL. A.AbellanaR.Roso-LlorachA.CegriF.ReyesC.ViolanC. (2022). Validation of an electronic frailty index with electronic health records: eFRAGICAP index. BMC Geriatrics, 22(1), 404. https://doi.org/10.1186/s12877-022-03090-8
PetersonM. J.GiulianiC.MoreyM. C.PieperC. F.EvensonK. R.MercerV.CohenH. J.VisserM.BrachJ. S.KritchevskyS. B.GoodpasterB. H.RubinS.SatterfieldS.NewmanA. B.SimonsickE. M.HealthA.Body Composition Study ResearchG. (2009). Physical activity as a preventative factor for frailty: The health, aging, and body composition study. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 64(1), 61–68. https://doi.org/10.1093/gerona/gln001
32.
PhillipsD.GreenH.PetrosyanS.ShaoK.WilkensJ.LeeJ. (2021). Harmonized CHARLS documentation. Center for Economic and Social Research, Los Angeles.
33.
RisbridgerS.WalkerR.GrayW. K.KamaruzzamanS. B.Ai-VyrnC.HairiN. N.KhooP. L.PinT. M. (2022). Social participation's association with falls and frailty in Malaysia: A cross-sectional study. Journal of Frailty & Aging, 11(2), 199–205. https://doi.org/10.14283/jfa.2021.31
34.
RockwoodK.MitnitskiA. (2007). Frailty in relation to the accumulation of deficits. The Journals of Gerontology: Series A, Biological Sciences and Medical Sciences, 62(7), 722–727. https://doi.org/10.1093/gerona/62.7.722
35.
RolfsonD. B.MajumdarS. R.TsuyukiR. T.TahirA.RockwoodK. (2006). Validity and reliability of the Edmonton Frail Scale. Age Ageing, 35(5), 526–529. https://doi.org/10.1093/ageing/afl041
36.
SatakeS.SendaK.HongY. J.MiuraH.EndoH.SakuraiT.KondoI.TobaK. (2016). Validity of the K ihon Checklist for assessing frailty status. Geriatrics & Gerontology International, 16(6), 709–715. https://doi.org/10.1111/ggi.12543
37.
SearleS. D.MitnitskiA.GahbauerE. A.GillT. M.RockwoodK. (2008). A standard procedure for creating a frailty index. BMC Geriatrics, 8, 24. https://doi.org/10.1186/1471-2318-8-24
38.
StefanacciR. G.PhillipsC. (2025). Shifting paradigms in fall management for long-term care: From prevention to injury mitigation. Journal of the American Medical Directors Association, 26(6), Article 105582. https://doi.org/10.1016/j.jamda.2025.105582
39.
StevensJ. A.MackK. A.PaulozziL. J.BallesterosM. F. (2008). Self-reported falls and fall-related injuries among persons aged>or=65 years--United States, 2006. Journal of Safety Research, 39(3), 345–349. https://doi.org/10.1016/j.jsr.2008.05.002
40.
TheouO.HavivaC.WallaceL.SearleS. D.RockwoodK. (2023). How to construct a frailty index from an existing dataset in 10 steps. Age and Ageing, 52(12), afad221. https://doi.org/10.1093/ageing/afad221
41.
VellasB.BalardyL.Gillette-GuyonnetS.Abellan Van KanG.Ghisolfi-MarqueA.SubraJ.BismuthS.OustricS.CesariM. (2013). Looking for frailty in community-dwelling older persons: The Gerontopole Frailty Screening Tool (GFST). The Journal of Nutrition, Health and Aging, 17(7), 629–631. https://doi.org/10.1007/s12603-013-0363-6
42.
WangY.ChenZ.ZhouC. (2021). Social engagement and physical frailty in later life: does marital status matter?BMC Geriatrics, 21, 1–11. https://doi.org/10.1186/s12877-021-02194-x
43.
XuY.CaoW.HeZ.WuN.CaiM.YangL.LiuS.JiaW.HeH.WangY. (2024). Development and validation of a risk prediction model for frailty in patients with chronic diseases. Gerontology and Geriatric Medicine, 10, 23337214241282895. https://doi.org/10.1177/23337214241282895
44.
XueQ. L.FriedL. P.GlassT. A.LaffanA.ChavesP. H. (2008). Life-space constriction, development of frailty, and the competing risk of mortality: The Women's health and aging study I. Am J Epidemiol, 167(2), 240–248. https://doi.org/10.1093/aje/kwm270
45.
YangY.LeeL. C. (2010). Dynamics and heterogeneity in the process of human frailty and aging: Evidence from the U.S. older adult population. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 65B(2), 246–255. https://doi.org/10.1093/geronb/gbp102
46.
ZhaoY.ChenX.WangY.MengQ.BoH.ChenC. (2023). China Health and Retirement Longitudinal Study Wave 5 (2020) User Guide. National School of Development, Peking University.
47.
ZucchelliA.MarengoniA.RizzutoD.Calderon-LarranagaA.ZucchelliM.BernabeiR.OnderG.FratiglioniL.VetranoD. L. (2020). Using a genetic algorithm to derive a highly predictive and context-specific frailty index. Aging (Albany NY), 12(8), 7561–7575. https://doi.org/10.18632/aging.103118
