Risk Factors of Progression to Frailty: Findings from the Singapore Longitudinal Ageing Study

  • C. Y. Cheong
  • M. S. Z. Nyunt
  • Q. Gao
  • X. Gwee
  • R. W. M. Choo
  • K. B. Yap
  • S. L. Wee
  • Tze-Pin NgEmail author



To investigate risk factors of incident physical frailty.


A population-based observational longitudinal study.


Community-dwelling elderly with age 55 years and above recruited from 2009 through 2011 in the second wave Singapore Longitudinal Ageing Study-2 (SLAS-2) were followed up 3–5 years later.


A total of 1297 participants, mean age of 65.6 ±0.19, who were free of physical frailty.


Incident frailty defined by three or more criteria of the physical phenotype used in the Cardiovascular Health Study was determined at follow-up. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological factors, and biochemical markers.


A total of 204 (15.7%) participants, including 81 (10.87%) of the robust and 123 (22.28%) of the prefrail transited to frailty at follow-up. Age, no education, MMSE score, diabetes, prediabetes and diabetes, arthritis, ≥5 medications, fair and poor self-rated health, moderate to high nutritional risk (NSI ≥3), Hb (g/dL), CRP (mg/L), low B12, low folate, albumin (g/L), low total cholesterol, adjusted for sex, age and education, were significantly associated (p<0.05) with incident frailty. In stepwise selection models, age (year) (OR=1.07, 95%CI=1.03–1.10, p<0.001), albumin (g/L) (OR=0.85, 95%CI=0.77–0.94, p=0.002), MMSE score (OR=0.88, 95%CI=0.78–0.98, p=0.02), low folate (OR=3.72, 95%CI=1.17–11.86, p=0.03, and previous hospitalization (OR=2.26, 95%CI=1.01–5.04,p=0.05) were significantly associated with incident frailty.


The study revealed multiple modifiable risk factors, especially related to poor nutrition, for which preventive measures and early management could potentially halt or delay the development of frailty.

Key words

Frailty transition risk factors longitudinal 



We thank the following voluntary welfare organizations for their support: Geylang East Home for the Aged, Presbyterian Community Services, St Luke’s Eldercare Services, Thye Hua Kwan Moral Society (Moral Neighbourhood Links), Yuhua Neighbourhood Link, Henderson Senior Citizens’ Home, NTUC Eldercare Co-op Ltd, Thong Kheng Seniors Activity Centre (Queenstown Centre) and Redhill Moral Seniors Activity Centre.

Declaration of Sources of Funding: The study was supported by research grants from the Agency for Science Technology and Research (A*STAR) Biomedical Research Council (BMRC) [Grant: 08/1/21/19/567] and from the National Medical Research Council [Grant: NMRC/1108/2007].

Declaration of Conflict of interest: The authors declare that they have no conflicts of interest.

Ethical standards: Ethics approval was obtained from the National University of Singapore Institutional Review Board.


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Copyright information

© Serdi and Springer-Verlag International SAS, part of Springer Nature 2019

Authors and Affiliations

  • C. Y. Cheong
    • 1
    • 3
  • M. S. Z. Nyunt
    • 2
  • Q. Gao
    • 2
  • X. Gwee
    • 2
  • R. W. M. Choo
    • 3
  • K. B. Yap
    • 4
  • S. L. Wee
    • 3
    • 5
  • Tze-Pin Ng
    • 2
    • 3
    • 6
    Email author
  1. 1.Department of Geriatric MedicineKhoo Teck Puat HospitalSingaporeSingapore
  2. 2.Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Geriatric Education and Research InstituteSingaporeSingapore
  4. 4.Department of Geriatric MedicineNg Teng Fong General HospitalSingaporeSingapore
  5. 5.Faculty of Health and Social SciencesSingapore Institute of TechnologySingaporeSingapore
  6. 6.Gerontology Research ProgrammeNational University of Singapore, Department of Psychological Medicine, NUHS Tower BlockSingaporeSingapore

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