Association between Age-Friendly Environment, Sarcopenia and Frailty among Older Adults in China: A Longitudinal Study

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BACKGROUND: Sarcopenia and frailty are interrelated complex geriatric syndromes that are associated with an increased risk of negative health outcomes. The construction of an age-friendly environment (AFE) is a key strategy for promoting health aging, but its associations with sarcopenia and frailty remain unclear. This study aimed to explore the association between AFE and the incidence of sarcopenia and frailty in older adults. METHODS: A total of 3,261 participants aged ≥60 years were included from the China Health and Retirement Longitudinal Study (CHARLS). Using a World Health Organization (WHO) AFE framework modified for Chinese context, we constructed an 8-domain, 35-component community environment score. Sarcopenia was defined according to the 2019 consensus guidelines by the Asian Working Group for Sarcopenia, while frailty status was assessed using the frailty index (FI). The longitudinal association between AFE score and the risk of developing incident sarcopenia and frailty was evaluated using Cox proportional hazards regression models. RESULTS: Over a 4-year follow-up, 297 (9.10%) participants developed sarcopenia; and participants with sarcopenia had a higher FI. Compared to the lowest quartile of AFE scores, participants in the highest AFE quartile had a 46% lower risk of incident sarcopenia (HR: 0.54, 95% CI: 0.38-0.77) and a 27% lower risk of incident frailty (HR: 0.73, 95% CI: 0.60-0.90), even after comprehensive confounding adjustment. Subgroup analyses showed a significant interaction between independent ADL and AFE was observed for sarcopenia, while significant interactions by residence and health status were observed for frailty. CONCLUSIONS: Our findings underscore that constructing an age-friendly environment is of great significance for the prevention of incident sarcopenia and frailty among older adults in China.

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