{"doi":"10.3389/fpubh.2024.1382384","title":"The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study","abstract":"<jats:sec><jats:title>Objective</jats:title><jats:p>Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In cross-sectional analysis, BADL [OR = 6.660 (4.519–9.815)], IADL [OR = 5.950 (4.490–7.866)], and ADL [OR = 5.658 (4.278–7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574–9.933)], IADL [OR = 6.042 (4.555–8.016)] and ADL [OR = 5.735 (4.333–7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150–3.379), ADL: HR = 1.920 (1.146–3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085–3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126–2.939)] and IADL [HR = 1.724 (1.103–2.694)].</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.</jats:p></jats:sec>","journal":"Frontiers in Public Health","year":2024,"id":644903,"datarank":0.4887144807032224,"base_score":3.258096538021482,"endowment":3.258096538021482,"self_citation_contribution":0.4887144807032224,"citation_network_contribution":0.0,"self_endowment_contribution":0.4887144807032224,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":25,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":750816,"name":"Xiaoguang Li","orcid":"0000-0003-0926-6561","position":1,"is_corresponding":false},{"id":292339,"name":"Lu Sun","orcid":"0000-0002-6592-1156","position":2,"is_corresponding":false},{"id":492310,"name":"Liu Yang","orcid":"0000-0003-0250-2218","position":3,"is_corresponding":false},{"id":1678874,"name":"Congzhi Wang","orcid":null,"position":4,"is_corresponding":false},{"id":229125,"name":"Ting Yuan","orcid":"0000-0001-6098-8733","position":5,"is_corresponding":false},{"id":1678877,"name":"Yunxiao Lei","orcid":null,"position":6,"is_corresponding":false},{"id":1346179,"name":"Jing Li","orcid":"0000-0003-3209-8973","position":7,"is_corresponding":false},{"id":1464773,"name":"Mingming Liu","orcid":"0000-0002-5410-9111","position":8,"is_corresponding":false},{"id":797975,"name":"Dongmei Zhang","orcid":"0000-0002-3111-8728","position":9,"is_corresponding":false},{"id":1678881,"name":"Ying Hua","orcid":null,"position":10,"is_corresponding":false},{"id":455427,"name":"Haiyang Liu","orcid":"0000-0002-2123-8689","position":11,"is_corresponding":false},{"id":488369,"name":"Lin Zhang","orcid":"0000-0003-0353-4465","position":12,"is_corresponding":false},{"id":369383,"name":"Xiaoping Li","orcid":"0000-0002-6165-6842","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study","abstract":"<jats:sec><jats:title>Objective</jats:title><jats:p>Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In cross-sectional analysis, BADL [OR = 6.660 (4.519–9.815)], IADL [OR = 5.950 (4.490–7.866)], and ADL [OR = 5.658 (4.278–7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574–9.933)], IADL [OR = 6.042 (4.555–8.016)] and ADL [OR = 5.735 (4.333–7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150–3.379), ADL: HR = 1.920 (1.146–3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085–3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126–2.939)] and IADL [HR = 1.724 (1.103–2.694)].</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.</jats:p></jats:sec>","is_dataset_classified":null,"base_score":3.258096538021482,"endowment":3.258096538021482,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"38746004","pmcid":"PMC11091387","openalex_id":"https://openalex.org/W4396534076","authors":[],"funders":[{"funder_name":"NIA NIH HHS","grant_id":"R01 AG037031","title":null},{"funder_name":"FIC NIH HHS","grant_id":"R03 TW008358","title":null},{"funder_name":"National Institutes of Health","grant_id":"5R01AG037031-03","title":"China Health and Retirement Longitudinal Study"},{"funder_name":"National Institutes of Health","grant_id":"5R03TW008358-02","title":"Studies of health, retirement and living arrangements of the aging population in"}],"total_grants":4,"fwci":6.5346,"citation_percentile":0.97668394,"influential_citations":0,"citation_trend":[{"year":2025,"count":16},{"year":2026,"count":9}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://public-pages-files-2025.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1382384/pdf","host_type":"journal"},{"url":"https://public-pages-files-2025.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1382384/pdf","host_type":"publisher"},{"url":"https://www.frontiersin.org/articles/10.3389/fpubh.2024.1382384/full","host_type":"publisher"},{"url":"https://doi.org/10.3389/fpubh.2024.1382384","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/38746004","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11091387","host_type":"repository"},{"url":"https://doaj.org/article/488eb6e2572346c79c0d4852e51d4f68","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC11091387/pdf/fpubh-12-1382384.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11091387","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC11091387?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.3389/fpubh.2024.1382384","host_type":""}],"fields_of_study":["Frailty in Older Adults","Chronic Disease Management Strategies","Intergenerational Family Dynamics and Caregiving","03 medical and health sciences","0302 clinical medicine"],"mesh_terms":["Frailty","East Asian People","Activities of Daily Living","Aged","Aged, 80 and over","China","Cross-Sectional Studies","Female","Follow-Up Studies","Humans","Longitudinal Studies","Male","Middle Aged","Geriatric Assessment","Frail Elderly"],"keywords":["Activities of daily living","Longitudinal study","Gerontology","Medicine","Cohort study","Hazard ratio","Proportional hazards model","Cross-sectional study","Logistic regression","Population","Cohort","Odds ratio","Confidence interval","Physical therapy","Environmental health","Internal medicine","Frailty","Instrumental Activities Of Daily Living","Basic Activities Of Daily Living","Middle-aged And Older Adults","Bidirectional Relationship","Male","China","Frail Elderly","Humans","Longitudinal Studies","Geriatric Assessment","Aged","Aged, 80 and over","East Asian People","Middle Aged","Cross-Sectional Studies","Female","Public Health","Public aspects of medicine","RA1-1270","Follow-Up Studies"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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