Abstract: Objective To investigate the prevalence of frailty among community-dwelling older adults in Nanjing and to examine the association between fatigue and frailty. Methods Based on data from the 2023 survey of community-dwelling older adults in Nanjing, a total of 5484 older adults aged ≥60 years were enrolled through multistage stratified sampling. Fatigue was assessed using the Pittsburgh Fatigability Scale (PFS), with a total score ≥15 indicating fatigue. Frailty was assessed using the Groningen Frailty Indicator (GFI), with a total score ≥3 indicating frailty. A mixed-effects logistic regression model with community as a random intercept was used to analyze the association between fatigue and frailty. Given the relatively high prevalence of frailty (24.9%), robust Poisson regression based on generalized estimating equations (GEE), with community as the clustering unit, was further used to examine the association between continuous PFS scores and frailty prevalence, and prevalence ratios (PRs) with 95%CI were reported. Effect estimates were also converted for every 5-point and 10-point increase in PFS score. Results The prevalence of frailty was 24.9% (95%CI:23.8%-26.1%). Mixed-effects logistic regression showed that fatigue was significantly positively associated with frailty in the unadjusted model (OR=2.04, 95%CI:1.78-2.35, P<0.001). After further adjustment for sociodemographic characteristics, lifestyle factors, chronic diseases, sleep quality, and anxiety/depression, the positive association remained significant (OR=1.61, 95%CI:1.38-1.86, P<0.001). Stratified analysis showed that this association was present across gender and age groups. Robust Poisson regression using GEE indicated a linear dose-response relationship between PFS scores and frailty prevalence: after adjustment, each 1-point increase in PFS score was associated with a PR of 1.02 (95%CI:1.01-1.03, P<0.001), each 5-point increase with a PR of 1.11 (95%CI:1.06-1.16, P<0.001), and each 10-point increase with a PR of 1.23 (95%CI:1.12-1.36, P<0.001). Conclusions Frailty is relatively prevalent among community-dwelling older adults in Nanjing. Fatigue is stably and positively associated with frailty, and higher fatigue score is linearly associated with a higher prevalence of frailty.    

Key words: older adults, frailty, fatigue, community population