Residents of assisted living communities are more than twice as likely to be frail as those living in private homes, according to new research published in Journals of Gerontology: Medical Sciences.

Johns Hopkins Bloomberg School of Public Health researchers, conducting a large-scale survey, also found that 15% of older Americans living in assisted living communities or in their homes are frail, and another 45% are considered “pre-frail,” or at heightened risk of becoming physically diminished. Frailty, with symptoms of weakness, exhaustion and limited mobility, makes these adults more vulnerable to falls, chronic disease and disability, the survey authors say.

Among the survey’s other findings: 

  • Prevalence increased with age, with 9% of those aged 65 to 69 years found to be frail compared with 38% of those aged 90 or older.
  • Among the frail, more than half had fallen in the previous year, and more than one-third had fallen several times, with 40% of those who had fallen being hospitalized.
  • Frailty was more common in older people and among women and the poor. 
  • Wide regional differences exist in the United States, with residents of the central southern states more than three times as likely to be frail than those living in the western states. Additional research is needed to ascertain why.
  • Significant racial differences exist, with blacks and Hispanics nearly twice as likely to be frail as whites. Additional research is needed to ascertain why.

As frailty becomes better understood, the researchers hope clinicians will develop recommendations that specifically address risks associated with frailty—for instance, having people engage in strengthening activities before major surgery. Such recommendations, if adapted by older people who had not yet slipped into advanced frailty, could help delay or even prevent its onset, they say.

The so-called pre-frail are a prime target of study to help researchers understand the progression of frailty so that doctors can develop recommendations—for instance, changes in diet or exercise—that could extend a person’s robust years.

“We would love for frailty assessment to become a standard component of assessment of older Americans,” study leader Karen Bandeen-Roche, PhD, chair of the school’s Department of Biostatistics, said in a statement. “Understanding frailty could potentially help us extend people’s quality of life into their later years.”