Frailty Trajectories and Socioeconomic Vulnerability in Community-Dwelling Older Adults

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.