[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-426316-105":59,"doc-detail-426316-en":134},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":127,"head_meta":129,"extra_data":131,"updated_unix":133},105,"en","beyond-unidirectional-decline-identifying-nonlinear-frailty-and-multimorbidity-trajectories-in-older-adults","BEYOND UNIDIRECTIONAL DECLINE - Identifying Nonlinear Frailty and Multimorbidity Trajectories in Older Adults","","Frailty and multimorbidity jointly drive adverse outcomes in older adults, yet their dynamic trajectories remain insufficiently mapped due to survival selection bias that distorts longitudinal progression. This study uses 12 waves from NHATS (2011–2023) to model joint frailty and multimorbidity pathways while explicitly accounting for mortality-related attrition. A dual-process approach combines multivariate latent class trajectory modeling with competing risks survival adjustment. Seven trajectories were identified, including stable, progressive, and nonlinear patterns, showing unexpected heterogeneity. Mortality-adjusted results support clinically actionable risk stratification and personalized care planning.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/beyond-unidirectional-decline-identifying-nonlinear-frailty-and-multimorbidity-trajectories-in-older-adults/426316/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/beyond-unidirectional-decline-identifying-nonlinear-frailty-and-multimorbidity-trajectories-in-older-adults/426316.png","ImageObject",300,407,{"name":92,"@type":93},"McGucket","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-13","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"Why do researchers say frailty and multimorbidity trajectories are underexplored in older adults?","Question",{"text":112,"@type":113},"Dynamic trajectories are underexplored because survival selection bias can systematically exclude high-risk individuals, distorting longitudinal progression patterns.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were frailty and multimorbidity measured in the study?",{"text":117,"@type":113},"Frailty was assessed annually using Fried phenotypic criteria, and multimorbidity was measured as cumulative chronic conditions across 12 NHATS waves.",{"name":119,"@type":110,"acceptedAnswer":120},"What modeling strategy was used to address survival selection bias?",{"text":121,"@type":113},"The study extended group-based trajectory modeling with a dual-process design: a multivariate latent class model for progression typologies and a competing risks survival model to account for mortality-related attrition.",{"name":123,"@type":110,"acceptedAnswer":124},"What was the key insight about unidirectional frailty trajectories?",{"text":125,"@type":113},"The findings challenge unidirectional assumptions: one trajectory showed frailty decline despite extreme multimorbidity progression, and other trajectories differed in timing despite similar multimorbidity burdens.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},426316,1790766131,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":81},1236954412713,"https://us-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Innovation in Aging, 2025, Vol. 9, No. S2 323  \nAbstract citation ID: igaf122.1088  \nBEYOND UNIDIRECTIONAL DECLINE: IDENTIFYING  \nNONLINEAR FRAILTY AND MULTIMORBIDITY  \nTRAJECTORIES IN OLDER ADULTS  \nYanran Deng1, Yan Luo2, Yuming Chen1, Zhou Yang3, and Beibei Xu4, 1. Peking University Health Science Center, Beijing, Beijing, China (People’s Republic), 2. The University of Hong Kong, Hong Kong, China (People’s Republic), 3. Peking University Cancer Hospital & Institute, Beijing, Beijing, China (People’s Republic), 4. Peking University, Beijing, Beijing, China (People’s Republic)  \nFrailty and multimorbidity jointly drive adverse outcomes in older adults. However, their dynamic trajectories remain underexplored due to survival selection bias—where mortality systematically excludes high-risk individuals, distorting longitudinal progression patterns. This study aims to delineate joint trajectories of frailty and multimorbidity, and characterize their temporal synergies while accounting for the addressing selective survival effects.  \nUsing 12 waves (2011-2023) of the National Health and Aging Trends Study (NHATS), we annually assessed frailty (Fried phenotypic criteria) and multimorbidity (cumulative chronic conditions).  \nTo overcome survival selection bias inherent in aging cohorts, we extended group-based trajectory modeling through dual-process specification: a multivariate latent class model identifying progression typologies, coupled with a competing risks survival model.  \nShared parameters dynamically adjusted trajectory estimates for mortality-related attrition, ensuring unbiased characterization of temporal synergies. Among the 4,960 participants from theNHATS 2011 cohort included in this analysis, 2,931 (survey-weighted 57.2%) were female, and 2,070 died during follow-up (average annual attrition rate: 4.3%). Seven joint trajectories were identified, revealing three dominant patterns: stable phenotypes (Stable Low Risk, Persistent High Multimorbidity), progressive escalators (Late-Onset Frailty, Early Accelerated Frailty, Delayed Escalation), and nonlinear progressors (High Baseline Attenuation, Critical-State Reversal). Notably, Critical-State Reversal demonstrated frailty decline despite extreme multimorbidity progression, while Early Accelerated Frailty and Late-Onset Frailty diverged in progression timing despite comparable multimorbidity burdens, challenging assumptions of unidirectional frailty trajectories in aging.  \nThis study identifies seven distinct trajectories, and reveals unexpected heterogeneity in aging processes. These mortality-adjusted trajectories may offer a clinically actionable framework for risk stratification and personalized care planning.","cbCaigAr4chsuypA","https://ap.wps.com/l/cbCaigAr4chsuypA","pdf",334289,"English","# Abstract\n## Study objective and rationale\n## Data and measures\n## Modeling approach to address survival bias\n## Findings: joint trajectories\n## Clinical implications","[{\"question\":\"Why do researchers say frailty and multimorbidity trajectories are underexplored in older adults?\",\"answer\":\"Dynamic trajectories are underexplored because survival selection bias can systematically exclude high-risk individuals, distorting longitudinal progression patterns.\"},{\"question\":\"How were frailty and multimorbidity measured in the study?\",\"answer\":\"Frailty was assessed annually using Fried phenotypic criteria, and multimorbidity was measured as cumulative chronic conditions across 12 NHATS waves.\"},{\"question\":\"What modeling strategy was used to address survival selection bias?\",\"answer\":\"The study extended group-based trajectory modeling with a dual-process design: a multivariate latent class model for progression typologies and a competing risks survival model to account for mortality-related attrition.\"},{\"question\":\"What was the key insight about unidirectional frailty trajectories?\",\"answer\":\"The findings challenge unidirectional assumptions: one trajectory showed frailty decline despite extreme multimorbidity progression, and other trajectories differed in timing despite similar multimorbidity burdens.\"}]","BEYOND UNIDIRECTIONAL DECLINE - Identifying Nonlinear Frailty and Multimorbidity Trajectories in Older Adults | PDF",1790640180]