Frailty syndrome in institutionalized older adults in Brazil

prevalence, components, associated factors, and implications for long-term care

Abstract

Objective: to analyze the prevalence, components, associated factors, and outcomes of frailty syndrome among older adults in long-term care institutions across the five Brazilian regions. Methods: a cross-sectional, descriptive, and analytical study involving 4,166 residents. Data collection took place between 2015 and 2018. Frailty was measured using a self-reported instrument, validated in Brazil, based on the Fried phenotype: unintentional weight loss, fatigue, reduced strength, slow walking speed, and low physical activity. The original classification categorized individuals as non-frail (0 components), pre-frail (1–2 components), and frail (≥3 components). For the logistic regression models, pre-frail and frail individuals were grouped into a single category: "with frailty" (≥1 component). Regional logistic regression models were adjusted. Results: the proportion of individuals with at least one frailty component ranged from 81.3% to 85.7%. According to the original phenotypic classification, frailty (≥3 components) ranged from 43.5% in the North region to 52.2% in the Southeast region, while pre-frailty ranged from 30.4% to 42.1%. The most frequent component was slow walking speed (65.5%–72.2%), followed by low physical activity (47.7%–58.8%). Functional dependence was associated with the "with frailty" category in all regions, with odds ratios (OR) ranging from 3.61 to 12.57. Multimorbidity and depressive symptoms showed associations in the Northeast and Central-West regions; age ≥80 years was associated in the South region; longer duration of institutionalization in the Central-West region; and hospitalization in the Central-West and Southeast regions. Conclusion: frailty was highly prevalent, with regional heterogeneity in the associated factors. Its consistent association with functional dependence underscores the need for periodic screening, multidimensional assessment, and multicomponent interventions. Structured exercise programs can improve frailty, physical function, and cognition – even among nursing home residents – supporting the integration of preventive and rehabilitative strategies into institutional care.