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Objectives: To investigate factors predicting frailty for one year in pre-frail patients with rheumatoid arthritis (RA).Method: A total of 298 RA patients who were pre-frail in 2020 were evaluated in this structured, retrospective observational study. Of the 298 patients, 42 who were frail and 256 who were not in 2021 were assigned to the frailty and non-frailty groups, respectively. After comparing characteristics of both groups using univariate analysis, predictive factors of frailty were assessed by logistic regression analysis. The proportion of frail patients in 2021 by DAS28-ESR level in 2020 was examined by the Cochran-Armitage trend test and chi-squared test. After dividing pre-frail patients into those with DAS28-ESR ≥3.2 and DAS28-ESR <3.2 in 2020, one-year change in DAS28-ESR in the frailty and non-frailty groups for both subgroups were compared by the paired t-test.Results: The frailty group was older (mean: 71.0 vs. 65.4 years) and had a higher DAS28-ESR (mean: 3.22 vs. 2.70) than the non-frailty group. DAS28-ESR was identified as a predictive factor for frailty (OR: 1.49). Among patients with DAS28-ESR ≥3.2 in 2020, DAS28-ESR improved in the non-frailty group in 2021 (mean: 3.97 in 2020 vs. 3.13 in 2021) but did not in the frailty group (3.97 in 2020 vs. 3.81 in 2021). Among those with DAS28-ESR <3.2 in 2020, DAS28-ESR was unchanged in the non-frailty group in 2021 (2.15 in 2020 vs. 2.23 in 2021) but increased in the frailty group (2.53 in 2020 vs. 3.23 in 2021).Conclusions: Disease activity at baseline is an independent predictor of frailty one year later in pre-frail patients with RA. [ABSTRACT FROM AUTHOR]

In the context of the present global aging phenomenon, the senior population and pace of aging in China have emerged as prominent issues on the worldwide stage. Frailty, a complicated condition that is closely linked to the clinical syndrome of advancing age, poses a considerable health risk to older individuals. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, pre-frailty was defined as >0.10 to <0.25, and frailty was defined as ≥0.25. To look at the connection between modifiable risk factors and frailty progression among individuals in the pre-frailty population. Using pre-frailty patients as characterized by the 32-frailty index, the study focused on middle-aged and elderly persons from China and ultimately recruited 5,411 participants for analysis. The relationship between modifiable factors and changes in pre-frailty status throughout follow-up was investigated. Modifiable factors were body mass index (BMI), abdominal obesity, smoking status, alcohol use, and sleep status. We employed logistic regression to examine the relationships between modifiable risk factors and changes in pre-frailty status, as well as the associations between modifiable factors scores and the corresponding pre-frailty progression. Additionally, we generated the modifiable factors scores and examined how these related to modifications in the pre-frailty stage. In this study, after a mean follow-up of 6 years, (OR = 0.59, 95%CI: 0.48–0.71) for BMI ≥ 25 kg/m2 and (OR = 0.74, 95%CI: 0.63–0.89) for concomitant abdominal obesity were significantly associated with lower reversal to a healthy state; (OR = 1.24, 95%CI:1.07–1.44) and (OR = 1.25, 95%CI: 1.10–1.42) for the group that negatively progressed further to frailty were significantly associated with increased frailty progression profile. Subsequently, investigation of modifiable factor scores and changes of pre-frailty status found that as scores increased further, frailty developed (OR = 1.12, 95%CI:1.05–1.18), with scores of 3 and 4 of (OR = 1.38, 95%CI: 1.08–1.77) and (OR = 1.52, 95%CI:1.09–2.14). Finally, we also performed a series of stratified analyses and found that rural unmarried men aged 45 to 60 years with less than a high school degree were more likely to develop a frailty state once they developed abdominal obesity. In pre-frailty individuals, maintaining more favorable controllable variables considerably enhances the chance of return to normal and, conversely, increase the risk of progressing to the frailty. • Study the relationship between modifiable risk factors and reversal or progression of frailty in pre-frailty individuals. • The assessment of frailty was conducted using a 32-item frailty index. • We proceeded to classify the outcome into three categories:return to normal, pre-frailty, and frailty progression. • Our study population was not restricted to the elderly population aged 60 years and older. [ABSTRACT FROM AUTHOR]

Frailty is a syndrome characterized by reduced physiological reserves, increased vulnerability to stressors and adverse health outcomes. Frailty can change the prognosis and treatment approach of several chronic diseases, including heart failure (HF). The aim of this study was to conduct a systematic review and meta-analysis assessing the association of HF with frailty and pre-frailty. We employed PRISMA guidelines for reporting the results. We searched PubMed, Web of Science, and Embase from 01/01/2002 to 29/11/2019.The quality of the studies was evaluated with the Newcastle Ottawa Scale. Pooled estimates were obtained through random-effect models and Mantel-Haenszel weighting. Homogeneity (I2) and publication bias were assessed. We selected 54 studies (52 cross-sectional, one longitudinal, and one with both designs). The pooled prevalence of pre-frailty in individuals with HF was 46% (95% CI = 38–53; I2 = 93.1%) and 40% (95% CI = 31–48; I2 = 97%) for frailty. The proportion of pre-frail individuals with HF was 20% (95%CI = 15–25; I2 = 99.2%) and the proportion of frail individuals with HF was 31% (95% CI = 17–45; I2 = 98.7%). Two studies using the same frailty definition reported estimates for the association between frailty and HF (pooled OR = 3.44; 95% CI = 0.75–15.73; I2 = 95.8%). In conclusion, frailty and pre-frailty are frequent in people with HF. Persons with HF have 3.4-fold increased odds of frailty. Longitudinal studies examining bidirectional pathophysiological pathways between HF and frailty are needed to further clarify this relationship and to assess if specific treatment for HF may prevent or delay the onset of frailty and vice versa. • Frailty and pre-frailty are common among individuals affected by heart failure. • Frailty may help risk stratification in patients with heart failure. • Studies investigating their longitudinal association are lacking. [ABSTRACT FROM AUTHOR]

• We provide a tentative definition of pre-frailty for use by healthcare professionals providing care for older adults in any setting in order to prevent onset of frailty and functional decline. • We discuss the importance of pre-frailty as public health target and the need for a standardised and globally accepted definition. • An international Delphi method bringing together experts in this area is needed to evaluate and establish a consensus definition of pre-frailty. There is as yet no widely-accepted definition of pre-frailty. We aimed to identify and examine definitions of pre-frailty in the literature to characterise important features and factors contributing to the construct using a systematic review approach with a qualitative analysis. PubMed, PsycINFO, Embase, Cochrane Library, ASSIA, and CINAHL databases were searched for studies conducted in any settings providing a definition or description of pre-frailty, published in English, between January 2000 and July 2018. Seventy-seven studies met the inclusion criteria. No consensus definition of pre-frailty was evident in the literature. Four main themes were identified using thematic analysis: (1) Pre-frailty as a prodromal, multi-factorial concept; (2) Physical, social, cognitive and nutritional subtypes; (3) Operational definitions; and (4) Outcomes. We propose a comprehensive definition suggesting that pre-frailty is a multi-dimensional concept, an early and reversible risk-state before frailty that can lead to negative healthcare outcomes, which is defined operationally by existing frailty screening and assessment tools. [ABSTRACT FROM AUTHOR]

Abstract The aim of this study was to compare the effects of two exercise intensities on exergame training program in muscle strength, functional capacity and perceptual parameters in pre-frail older women. Thirty-four women (69.5 ± 5.4 years) were randomly assigned to either moderate- (MG: 11–13 perceived exertion) or vigorous-exercise intensity group (VG: 14–16 perceived exertion). Muscle strength and functional capacity were evaluated before and after 3 months of training. The affective responses were measured once a week and perceived benefit was evaluated after training period. The MG improved the average power at 60°/s from pre- to post-training (p < 0.002) on the knee extensor (pre = 100.0 ± 15.9 W; post = 115.2 ± 22.6 W), flexor (pre = 22.3 ± 6.1 W; post = 29.1 ± 7.9 W) and plantiflexor muscles (pre = 11.4 ± 5.9 W; post = 21.2 ± 4.2 W). MG presented greater average power at post-training than VG for knee extensor (20%) and flexor muscles (23%) (p < 0.039). There was main time effect of peak torque at 180°/s for knee extensor (pre = 74.15 ± 14.28 N·m/kg; post = 81.31 ± 18.4 N·m/kg), flexor (pre = 43.01 ± 12.43 N·m/kg; post = 48.3 ± 9.11 N·m/kg) and plantiflexor muscles (pre = 29.2 ± 13.76 N·m/kg; post = 36.87 ± 9.7 N·m/kg) as well as average power (pre = 41.15 ± 15.67 W; post = 48.42 ± 11.8 W) and work (pre = 99.92 ± 38.53 J; post = 117.03 ± 25.56 J) on the knee flexor muscles (p < 0.046). MG improved timed up and go performance from pre- to post-training (pre = 10.0 ± 0.32 s; post = 8.1 ± 1.6 s, p = 0.001), whereas both groups improved 10 m-walk performance (pre = 1.33 ± 0.25 s, post = 1.5 ± 0.24 s; p = 0.003). Positive affect (2.64 ± 0.02) and pleasure (15.8 ± 0.6) for MG were greater than VG at post-training (2.36 ± 0.03; p < 0.001; 14.4 ± 0.5; p < 0.03). Therefore, regardless of the exercise intensity, exergame training improved muscle strength and functional capacity in pre-frail older women. However, positive affect and pleasure were reported only when older women practiced exergame with moderate exercise intensity. [ABSTRACT FROM AUTHOR]

Highlights • Frailty defined by frailty index was associated with a 2.31 fold risk of 3-year mortality compared with robust elderly aged 70–84 years. • Both frailty (HR 2.24) and pre-frailty (HR 1.51) defined by frailty phenotype were associated with increased risk of mortality. • Frailty, defined by either phenotype or index, is associated with increased risks of mortality in a Chinese population. Abstract Background: To explore the associations of frailty phenotype and frailty index (FI) defined frailty and pre-frailty with mortality in a Chinese elderly population. Methods: Data of 1788 community-dwelling elders aged 70–84 years from the ageing arm of Rugao Longevity and Ageing Study, a prospective cohort study, were used. Frailty phenotype was defined using modified Fried's phenotype (FP) criteria and FI was constructed using 45 health deficits. Mortality was ascertained using the Death Registry of Rugao's Civil Affairs Bureau. Results: During 3-year follow-up, 149 (8.3%) of the 1788 elderly subjects died. For frailty phenotype, about 9.5% of the elderly were frail and 43% were pre-frail. For FI, frail (FI > 0.21) was approximately 27.5%, and pre-frail (FI: 0.1–0.21) was approximately 51.3%. Highest mortality was observed among frail participants defined by both FP and FI criteria (all Log Rank P < 0.05). Frailty defined by the frailty index was associated with a 2.31 fold (95% CI 1.16–4.6) risk of all-cause death compared with robust elderly. Compared with the robust elderly, not only frailty (HR 2.24, 95% CI 1.31–3.83) defined by frailty phenotype but also pre-frailty (HR 1.51, 95% CI 1.03–2.21) was associated with risk of all-cause mortality. Conclusions: Frailty, defined by either phenotype or index, is associated with increased risks of mortality in elderly Chinese community population. [ABSTRACT FROM AUTHOR]

Objectives: Greater understanding of changes in the degree of frailty is important for clarifying the natural history of frailty and may help clinical decision-making regarding preventive interventions. The objectives of this study were to explore natural frailty transition rates at 1-year follow-up and to identify the main determinants of such transitions.Study Design: Prospective longitudinal study covering a representative sample of community-dwelling older adults aged ≥65 years (n = 749) at baseline, and transition information at 1-year follow-up (n = 537).Mean Outcome Measures: The assessment of frailty status was based on phenotypic criteria (unintentional weight loss, weakness, exhaustion, slow walking speed, low physical activity). Frailty transitions (progressed, regressed, no change, or death) and associated factors were assessed.Results: Most participants remained unchanged from their baseline status (57.1% non-frail, 83.4% pre-frail, 66.7% frail). Regarding frailty transitions, 42.9% of non-frail older adults at baseline had progressed to a pre-frail status by the 1-year follow-up, and 7.9% of pre-frail older adults had become frail. Importantly, 33.3% of frail older adults regressed to a pre-frail status and 8.7% of pre-frail adults had regressed to a non-frail status. Non-frail females tended to progress to pre-frailty significantly more than males (p = 0.006), and mortality was higher among participants classified as frail at baseline (10.7%). Logistic regression showed that the main determinants of worsening frailty were hearing impairment (OR 3.180; 95% CI 1.078-9.384), congestive heart failure (OR 10.864; 95% CI 1.379-85.614), and polypharmacy (OR 2.572, 95% CI 1.096-6.037).Conclusion: Our results confirm the dynamic of frailty and the bidirectional nature of frailty transitions, and indicate the need for preventing and treating these conditions in later life in order to minimize the burden of frailty. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of this study was to investigate the nutritional markers (Vitamin D, homocysteine, n−3PUFA) status of older subjects aged 70 years and older with subjective memory complaint, according to their physical and cognitive function. Main outcome measures This study is a secondary analysis of the MAPT study. Subjects were classified into four groups: 1) Physical limitation with cognitive impairment (PLCI), 2) cognitive impairment (CI), 3) physical limitation (PL) and 4) no physical or cognitive deficits (NPCD). Baseline nutritional characteristics of the four groups according to Vitamin D (n = 732), Omega-3 polyunsaturated fatty acid (n−3PUFA) (n = 1537) and plasma total homocysteine (tHcy) (n = 729) status were investigated. Analysis was performed taking continuous and dichotomized value for Vitamin D insufficiency ([25(OH)D] < 30 ng/ml, high homocysteine level (tHcy ≥ 15 μmol/L) and low n−3PUFA (DHA + EPA ≤ 4.82%) nutritional markers for clinical relevance. Results PLCI group showed the lowest mean level of Vitamin D and highest level tHcy compared to the other groups. In multivariate analysis, taking continuous nutritional markers, only high Vitamin D was associated with reduced likelihood of PLCI (OR 0.97, 95% CI (0.95 to 0.99) P = 0.011). While taking the dichotomized values the group with low levels of n−3PUFA showed higher likelihood of PL only (OR 1.55, 95% CI (1.12 to 2.15), P = 0.009). Furthermore, our sensitivity analysis for Vitamin D with cut-off [25(OH)D] < 20 ng/ml,(i.e., Vitamin D deficiency), showed more likelihood of PL (OR 1.62, 95% CI (1.01 to 2.60) P = 0.046), CI (OR 1.90, 95% CI (1.16 to 3.10) P = 0.010), and highest likelihood of PLCI (OR 1.99, 95% CI (1.21 to 3.28) P = 0.006). Conclusion In older adults with subjective memory complaints, Vitamin D deficiency status may present higher likelihood of functional deficits, including coexisting or separate physical and cognitive decline. While older adults with low level of n−3PUFA were more likely to demonstrate physical decline only. Highlights • Nutritional status of older adults with coexisting physical and cognitive limitation is least studied, which we have explored to some extent. • Vitamin D deficient older adults may have higher likelihood of coexisting physical limitation with cognitive impairment. • Older adults with Low levels of Omega-3 polyunsaturated fatty acid have higher likelihood of physical limitation only. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) is a risk factor for cardiovascular disease, diabetes, and all-cause mortality. Frailty is a condition of decreased multi-system physiological reserve where one has increased vulnerability to stressors. This study aimed to examine if MetS is associated with prevalent and incident frailty over a 4-year follow-up period in an aged population. This study used data from waves 1 (2009–2011) and 3 (2014–2015) of The Irish Longitudinal Study on Ageing. Those aged <50 years or without baseline health assessment data were excluded. Baseline MetS status was determined using the National Cholesterol Education Program Third Adult Treatment Panel criteria. Frailty status was identified at both waves, operationalised using Fried's frailty phenotype (FP) and Rockwood's frailty index (FI). Ordinal logistic regression examined the cross-sectional association between MetS and prevalent frailty status. Those with prevalent pre-frailty or frailty were excluded and ordinal logistic regression models examined the association between MetS and incident frailty. Lastly, MetS' longitudinal associations with the five individual components of Fried's FP were examined. Models were adjusted for age, sex, education, smoking, chronic disease history and renal function. Ordinal logistic regression models (n > 5100), showed MetS was associated with prevalent frailty as assessed by both FP (odds ratio (OR) 1.29, p < 0.001) and FI (OR 1.65, p < 0.001). Of those who were non-frail at baseline, 2247 participants had longitudinal FP data, while 3546 participants had longitudinal FI data. Models demonstrated that MetS was associated with an increased likelihood of incident frailty for both FP (OR 1.57, p < 0.001) and FI (OR 1.29, p = 0.014). MetS was found to be associated with incident low physical activity (OR 1.57, p = 0.001) and incident unintentional weight loss (OR 1.59, p = 0.025). MetS in those ≥50 years was found to be associated with an increased likelihood of incident frailty over a 4-year period, by 57 % when measured by FP and 29 % by FI. MetS should be considered a risk factor for frailty and be taken into considered in any comprehensive geriatric assessment given frailty's dynamic nature and MetS being potentially modifiable. [ABSTRACT FROM AUTHOR]

Objective: To investigated the cross-sectional association between peripheral sensory nerve function and frailty among community-dwelling men, and examine whether type 2 diabetes (T2D) modifies this association.Methods: A sample of 349 men [mean age = 77.1 ± 6.4 years; 37 % with T2D] who previously (1990-1998) participated in the Bezafibrate Infarction Prevention (BIP) trial, underwent assessment of frailty and legs vibratory thresholds (LVT), a measure of peripheral sensory nerve function, as part of the BIP Neurocognitive study during 2011-2013. LVT was assessed using a graduated tuning fork and frailty was assessed using the Fried criteria. An ordered logistic regression model was used to assess the link between LVT and degrees of frailty and to test for effect modification by T2D.Results: Overall, 117 (33.5 %) of patients were non-frail, 134 (38.4 %) pre-frail, and 98 (28.1 %) frail. A significant interaction between LVT and T2D with regard to frailty was found. Among men with T2D, estimated OR (95%CI) for increasing frailty at the 1st, 2nd, and 3rd as compared to the top LVT quartile were 13.5 (3.4-54.3), 5.9 (1.5-23.5), and 4.4 (1.20-16.0), respectively. Among men without T2D, the estimated ORs for increasing frailty in patients at the 1st, 2nd, and 3rd quartiles compared to the top LVT quartile were 2.8 (1.1-7.4), 1.6 (0.6-4.1), and 2.5 (1.0-6.5), respectively.Conclusion: Frailty is significantly associated with worsening peripheral sensory nerve function, particularly among men with T2D. [ABSTRACT FROM AUTHOR]

The pathogenesis of frailty and the role of inflammation is poorly understood. We examined the evidence considering the relationship between inflammation and frailty through a systematic review and meta-analysis. A systematic literature search of papers providing data on inflammatory biomarkers and frailty was carried out in major electronic databases from inception until May 2016. From 1856 initial hits, 35 studies (32 cross-sectional studies n = 3232 frail, n = 11,483 pre-frail and n = 8522 robust, and 563 pre-frail + robust; 3 longitudinal studies n = 3402 participants without frailty at baseline) were meta-analyzed. Cross-sectional studies reported that compared to 6757 robust participants, both 1698 frail (SMD = 1.00, 95%CI: 0.40–1.61) and 8568 pre-frail (SMD = 0.33, 95%CI: 0.04–0.62) participants had significantly higher levels of C-reactive protein (CRP). Frailty (n = 1057; SMD = 1.12, 95%CI: 0.27–2.13) and pre-frailty (n = 4467; SMD = 0.56, 95%CI: 0.00–1.11) were associated with higher serum levels of interleukin-6 compared to people who were robust (n = 2392). Frailty and pre-frailty were also significantly associated with elevated white blood cell and fibrinogen levels. In three longitudinal studies, higher serum CRP (OR = 1.06, 95%CI: 0.78–1.44,) and IL-6 (OR = 1.19, 95%CI: 0.87–1.62) were not associated with frailty. In conclusion, frailty and pre-frailty are associated with higher inflammatory parameters and in particular CRP and IL-6. Further longitudinal studies are needed. [ABSTRACT FROM AUTHOR]

• Given the growing importance of the early identification of frailty to prevent subsequent functional decline and disability at both individual and population-level, we have conducted an international delphi study to identify defining characteristics of pre-frailty. • The final consensus statement produced by this international collaboration of experts in the field describes pre-frailty as an aged-associated, multi-factorial, multi-dimensional, and non-linear prodromal risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies, and socioeconomic inequalities, predisposing to the development of frailty. • Further study is required to fully operationalise this definition of pre-frailty for use in clinical practice including the development of improved screening and assessment tools. : Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent intermediate state before frailty becomes established. Despite being widely-used in the literature and increasingly in clinical practice, it is poorly understood. : To establish consensus on the construct and approaches to diagnose and manage pre-frailty. : We conducted a modified (electronic, two-round) Delphi consensus study. The questionnaire included statements concerning the concept, aspects and causes, types, mechanism, assessment, consequences, prevention and management of pre-frailty. Qualitative and quantitative analysis methods were employed. An agreement level of 70% was applied. : Twenty-three experts with different backgrounds from 12 countries participated. In total, 70 statements were circulated in Round 1. Of these, 52.8% were accepted. Following comments, 51 statements were re-circulated in Round 2 and 92.1% were accepted. It was agreed that physical and non-physical factors including psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life. Experts considered pre-frailty to be an age-associated multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It can be reversed or attenuated by targeted interventions. Brief, feasible, and validated tools and multidimensional assessment are recommended to identify pre-frailty. : Consensus suggests that pre-frailty lies along the frailty continuum. It is a multidimensional risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies and socioeconomic disadvantages, predisposing to the development of frailty. More research is needed to agree an operational definition and optimal management strategies. [ABSTRACT FROM AUTHOR]

Abstract: Reduced muscle mass and strength are likely fundamental components of frailty. The purpose of this study was to measure daily muscle activity and quiescence in non-frail, pre-frail, and frail older women using portable electromyography (EMG). Thirty-three community-dwelling older Greek women were categorized as non-frail (n =10, 74±4years), pre-frail (n =11, 75±4years), and frail (n =12, 81±6years) based upon the frailty phenotype. Surface EMG over a 9-hour typical day was recorded from the biceps brachii, triceps brachii, vastus lateralis, and biceps femoris of the dominant side. Burst and gap analysis was used to quantify muscle activity and quiescence. The total duration of the muscles that were active (~2.5h) and quiescent (~4h) did not differ across frailty groups. However, the number of bursts was 28% fewer and the mean burst duration was 26% longer in frail women compared with the non-frail women. In addition, muscle activity was greater in the arm muscles than the thigh muscles across all groups (e.g. ~60% greater burst percentage). Burst number and duration indicate that muscle activity differs across stages of frailty in older women and is greater in the upper compared with lower limbs. [ABSTRACT FROM AUTHOR]

Low grip work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When grip work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow to identify pre-frailty earlier. Therefore, this study aimed to investigate whether the combination of grip work and self-perceived fatigue is related to pre-frailty in well-functioning older adults aged 80 and over. Four-hundred and five community-dwelling older adults aged 80 and over (214 robust and 191 pre-frail) were assessed for muscle endurance (grip Work corrected for body weight (GW_bw)), self-perceived fatigue (MFI-20) and frailty state (Fried Frailty Index, FFI). A Capacity to Perceived Vitality ratio (CPV) was calculated by dividing GW_bw by the MFI-20 scores. ANCOVA analysis (corrected for age and gender) was used to compare robust and pre-frail older adults, and binary logistic regressions were applied to analyze the relationship between CPV and pre-frailty status. Pre-frail older adults who scored negative on the exhaustion item of the FFI still showed significantly lower GW (p < 0.001), CPV ratios (p < 0.001) and higher self-perceived fatigue (p < 0.05) compared to the robust ones. The likelihood for pre-frailty related significantly to higher age, being men and lower CPV ratios. In women, every unit increase in CPV ratio decreased the likelihood for pre-frailty by 78% (OR 0.22; 95% CI: 0.11–0.44), for men this effect was less strong (34%, OR 0.66; 95% CI: 0.47–0.93). Pre-frail community-dwelling persons aged 80 years and over without clinical signs of exhaustion on the FFI still experience significantly higher fatigue levels (lower Grip Work, higher self-perceived fatigue and lower CPV levels) compared to robust ones. CPV ratio could therefore be a good tool to identify subclinical fatigue in the context of physical (pre-)frailty. • Non-exhausted pre-frail elderly report higher fatigue levels than non-frail ones. • Combined Grip Work and self-perceived fatigue predicts pre-frailty. • Capacity-to-Perceived Vitality ratio (CPV) captures early signs of fatigue. [ABSTRACT FROM AUTHOR]