Physical frailty, self-rated health, and all-cause mortality: implications for understanding resilience in aging

BACKGROUND: Frailty and poor self-rated health (SRH) as potential indicators of reduced resilience are associated with all-cause mortality. However, it is lesser known whether these associations are independent of each other, physical disability or disease burden, and whether SRH remains predictive of mortality among frail older adults. METHODS: We leveraged the National Health and Aging Trends Study of US Medicare beneficiaries, followed annually from 2011 to 2019. Baseline assessments included physical frailty and SRH (excellent/very good, good, or fair/poor). Cox models examined associations with all-cause mortality, adjusting for demographic characteristics and comorbidities. Sensitivity analyses excluded participants with probable or possible dementia at baseline. RESULTS: Of the 7425 participants at baseline, 14% were physically frail, and 25% reported fair/poor SRH. Although frailty was positively correlated with fair/poor SRH, 12% of frail participants reported excellent/very good health, and 6.6% of those with fair/poor SRH were non-frail. Over a median follow-up of 4.3 years, 29% died. Compared to non-frail participants, pre-frailty and frailty were associated with 1.4- and 2.0-fold increased hazard of mortality, respectively, after adjusting for SRH (p < .001); reporting good and fair/poor SRH was associated with 29% and 59% higher hazard of mortality compared to excellent/very good SRH, respectively, after adjusting for frailty (p < .001). Fair/poor SRH was associated with higher mortality among the frail. Sensitivity analyses yielded similar results. CONCLUSION: Physical frailty and SRH, while related, capture distinct aspects of health. Each independently and jointly predicts mortality, with SRH retaining prognostic value in frail individuals. Incorporating both measures may improve risk stratification and guide tailored interventions.