Lifecourse frailty in China

Professor Chenkai Wu is Assistant Professor of Global Health in the Global Health Research Center at Duke Kunshan University and Associate Director of MSc of Global Health program. Here he discusses his Age and Ageing paper Linking Early Life Risk Factors to Frailty in Old Age: Evidence from the China Health and Retirement Longitudinal Study.

Frailty is a common clinical syndrome among older adults. Frail people have higher risk of falls, disability, and death; they also have a compromised ability to recover from stressors, such as surgery or loss of spouse. Frailty is preventable and being physically active and adopting a healthy diet may help reduce the chance of becoming frail. Recently, interest in frailty has shifted from looking at risk factors that occur later in life to understanding how early life circumstances contribute to the development of frailty. However, evidence is scarce in low- and middle-income countries, including China—a country that has the largest older population in the world.

We examined whether poor early life circumstances lead to an increased risk of becoming frail in older age. We studied over 6,000 older Chinese men and women (at least 60 years) who were not frail; they were voluntary participants in the China Health and Retirement Longitudinal Study. Frailty was defined as having three or more of the following conditions: slow walking speed, weak grip strength, feeling of low energy, low physical activity, and substantial weight loss. We assessed their life circumstances during childhood and adolescence based on self-reports. We included six dimensions: education (self, maternal, and paternal), family economic status, nutritional status (experience of starvation), domestic violence (female guardian, male guardian, and siblings), neighborhood environment (safety, kindness, closeness, and cleanness), and health (self-rated general health).

Our findings showed that Chinese older adults who had higher personal or paternal education attainment, better childhood neighborhood quality, and better childhood health status were less likely to become frail. Older persons whose fathers had some education were 26% less likely to become frail than those who fathers were illiterate. Those who lived in the neighborhood with the worst quality during childhood showed about four times the risk of becoming frail than those living in the best neighborhood. Improving socioeconomic and health status in early life stages may help prevent or delay frailty in older age.