NATIONAL TRENDS AND ONE-YEAR TRANSITIONS IN FRAILTY AMONG US ADULTS, 2019-2024
Author(s)
Adriana Panayi, MD1, Tobias Niederegger, MD2, Dany Matar, MD3, Jule Brandt, cand. med.2, Steffen Wahler, MA, MD4, Gabriel Hundeshagen, MD5.
1University of Zurich, Zurich, Switzerland, 2Heidelberg University Medical Faculty, Heidelberg, Germany, 3Johns Hopkins Medical School, Boston, MA, USA, 4Member, St. Bernward, Hamburg, Germany, 5BG Klinik Ludwigshafen, Ludwigshafen, Germany.
1University of Zurich, Zurich, Switzerland, 2Heidelberg University Medical Faculty, Heidelberg, Germany, 3Johns Hopkins Medical School, Boston, MA, USA, 4Member, St. Bernward, Hamburg, Germany, 5BG Klinik Ludwigshafen, Ludwigshafen, Germany.
OBJECTIVES: Frailty is associated with morbidity, mortality, and healthcare utilization, yet nationally representative US evidence on incidence, transitions, and reversal remains limited. This study estimated frailty prevalence trends from 2019 to 2024, quantified one-year transitions between frailty states, and identified predictors of progression and reversal, with attention to age-specific patterns.
METHODS: We analyzed National Health Interview Survey (NHIS) cross-sectional cycles from 2019 to 2024 and the 2019-2020 NHIS Longitudinal Cohort. Adults were classified using a 25-item deficit accumulation Frailty Index as robust, pre-frail, or frail. Survey-weighted prevalence trends, age-standardized estimates, age-stratified transition matrices, and multivariable logistic regression assessed frailty dynamics and predictors.
RESULTS: Across annual NHIS samples of 27,651 to 32,629 adults, robust prevalence declined from 57.0% in 2019 to 53.2% in 2024, while pre-frailty increased from 24.8% to 27.3% and frailty from 18.1% to 19.5%. The increase was most pronounced among adults aged 18-29 years, where frailty rose from 6.8% to 10.2%, an approximately 50% relative increase. Among adults aged ≥80 years, frailty increased from 45.2% to 48.0%. In the longitudinal cohort (n=10,412), annual frailty incidence was 6.6%, pre-frail-to-frail progression was 16.9%, and frailty reversal occurred in 24.2% of frail adults. Incidence increased with age, ranging from 3.9% in adults aged 18-29 years to 18.6% in those aged ≥80 years. Reversal remained substantial, including 27.8% among adults aged 18-29 years and 24.1% among those aged ≥80 years. Baseline Frailty Index was the strongest predictor of incident frailty, progression, and lower reversal likelihood.
CONCLUSIONS: Frailty burden shifted upward among US adults between 2019 and 2024, with a disproportionate increase in young adults. Pre-frailty represents a high-yield intervention window, while substantial reversal rates suggest opportunities for prevention and recovery-focused interventions.
METHODS: We analyzed National Health Interview Survey (NHIS) cross-sectional cycles from 2019 to 2024 and the 2019-2020 NHIS Longitudinal Cohort. Adults were classified using a 25-item deficit accumulation Frailty Index as robust, pre-frail, or frail. Survey-weighted prevalence trends, age-standardized estimates, age-stratified transition matrices, and multivariable logistic regression assessed frailty dynamics and predictors.
RESULTS: Across annual NHIS samples of 27,651 to 32,629 adults, robust prevalence declined from 57.0% in 2019 to 53.2% in 2024, while pre-frailty increased from 24.8% to 27.3% and frailty from 18.1% to 19.5%. The increase was most pronounced among adults aged 18-29 years, where frailty rose from 6.8% to 10.2%, an approximately 50% relative increase. Among adults aged ≥80 years, frailty increased from 45.2% to 48.0%. In the longitudinal cohort (n=10,412), annual frailty incidence was 6.6%, pre-frail-to-frail progression was 16.9%, and frailty reversal occurred in 24.2% of frail adults. Incidence increased with age, ranging from 3.9% in adults aged 18-29 years to 18.6% in those aged ≥80 years. Reversal remained substantial, including 27.8% among adults aged 18-29 years and 24.1% among those aged ≥80 years. Baseline Frailty Index was the strongest predictor of incident frailty, progression, and lower reversal likelihood.
CONCLUSIONS: Frailty burden shifted upward among US adults between 2019 and 2024, with a disproportionate increase in young adults. Pre-frailty represents a high-yield intervention window, while substantial reversal rates suggest opportunities for prevention and recovery-focused interventions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH65
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Disease Classification & Coding, Public Health
Disease
Geriatrics, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)