Abstract Background The gap between the average life expectancy and healthy life expectancy remains wide. Understanding the natural history of frailty development is necessary to prevent and treat frailty to overcome this gap. This study elucidated the trajectories of 5 frailty assessment components using group-based multitrajectory modeling. Methods Overall, 845 community-dwelling older adults (aged 65–91 years; 433 males and 412 females) who underwent longitudinal frailty assessments at least 3 times were included in the analysis. The mean follow-up period (±SD, range) was 7.1 (±2.3, 3.8–11.3) years. In each wave, the physical frailty was assessed for the following 5 partially modified components of the Cardiovascular Health Study criteria: shrinking, weakness, exhaustion, slowness, and low activity. Using group-based multitrajectory modeling, we identified subgroups that followed distinctive trajectories regarding the 5 frailty components. Results Five frailty trajectory groups were identified: weakness-focused frail progression group (Group 1 [G1]; 10.9%), robust maintenance group (Group 2 [G2]; 43.7%), exhaustion-focused prefrail group (Group 3 [G3]; 24.3%), frail progression group (Group 4 [G4]; 6.7%), and low activity–focused prefrail group (Group 5 [G5]; 14.4%). The Cox proportional hazards model analysis showed that G1, G4, and G5 had significantly higher mortality risks after adjusting for sex and age (G2 was the reference group). Conclusion Based on the natural history of frailty, the 5 distinctive trajectory groups showed that some individuals remained robust, while others remained predominantly prefrail or progressed primarily owing to physical mobility decline. Therefore, identifying individuals belonging to these progressive frailty groups and providing interventions according to the characteristics of each group may be beneficial.

中文翻译：

---

社区居住的日本老年人衰弱的自然历史轨迹

摘要 背景平均预期寿命与健康预期寿命之间的差距仍然很大。了解衰弱发展的自然史对于预防和治疗衰弱以克服这一差距是必要的。本研究使用基于组的多轨迹建模阐明了 5 个衰弱评估组件的轨迹。 方法总体而言，分析中纳入了 845 名接受过至少 3 次纵向衰弱评估的社区老年人（年龄 65-91 岁；433 名男性和 412 名女性）。平均随访期（±SD，范围）为 7.1（±2.3，3.8-11.3）年。在每一波中，根据心血管健康研究标准的以下 5 个部分修改的部分来评估身体虚弱程度：萎缩、虚弱、疲惫、缓慢和活动量低。使用基于群体的多轨迹建模，我们确定了遵循 5 个虚弱成分的独特轨迹的亚组。 结果确定了五个衰弱轨迹组：以虚弱为重点的衰弱进展组（第 1 组 [G1]；10.9%）、稳健维持组（第 2 组 [G2]；43.7%）、以疲惫为重点的衰弱前组（第 3 组 [G3]；10.9%）。 24.3%）、衰弱进展组（第 4 组 [G4]；6.7%）和以低活动为重点的衰弱前组（第 5 组 [G5]；14.4%）。Cox比例风险模型分析显示，调整性别和年龄后，G1、G4和G5的死亡风险显着较高（G2为参考组）。 结论根据衰弱的自然史，5 个独特的轨迹组表明，一些人仍然健壮，而另一些人主要仍然处于脆弱状态，或者主要由于身体活动能力下降而出现进展。因此，识别属于这些进行性衰弱群体的个体并根据每个群体的特征提供干预措施可能是有益的。