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which was initially conducted in 2011，and was followed by tracking once every 2 to 3 years with multi-stage PPS sampling for
middle-aged and elderly groups in 28 provincial administrative regions of China，covering 150 counties and 450 villages. The
surveyees were coded，and matched，then 2 267 cases（≥ 60 years old） involved in the four waves of surveys were selected as
the sample. Frailty was assessed by the frailty index （FI）. Mplus was used to construct three types of unconditional latent growth
models，and the optimal fitting model was selected to determine the developmental trajectory of frailty of Chinese older people，
and was used to develop the conditional latent growth model. The effects of time-invariant factors （gender，education level） and
time-varying factors （physical activity，smoking，alcohol consumption，sleep） on frailty were examined. Results The latent
growth model with undefined curve fit the data better，and was selected as the optimal model to determine the frailty development
2
trajectory. The results of χ （3）=36.16，CFI=0.992，TLI=0.984，RMSEA=0.070，SRMR=0.022，indicating that the frailty
prevalence in older adults showed a trend of curvilinear increase. The values of intercept（initial level），slope（growth），and
the variation of them of the model were significantly higher than 0 （P<0.01），indicating that there were significant individual
differences in the initial level and growth rate of frailty. Gender and education level were negatively associated with the initial level
of frailty（β=-0.113，-0.173，P<0.01） . They were also negatively associated with the growth of frailty（β=-0.181，-0.151，
P<0.01）. Compared with men，women had higher initial level and faster growth rate of frailty（P<0.05）. Compared to those
with higher education level，those with lower education level had higher initial level and faster growth rate of frailty（P<0.05）.
Physical activity and sleep were negatively associated with frailty in all waves of surveys（P<0.05）. Smoking was positively
associated with frailty in 2011，2015，2018 waves of surveys（P<0.05）. Alcohol consumption was positively associated with
frailty in 2013 and 2015 waves of surveys （P<0.05）. Conclusion The frailty in Chinese older people showed a trajectory of
curvilinear increase，and its initial level and growth rate had significant individual differences. Comparatively speaking，being
female and having lower education level were associated with increased risk of having frailty. Moderate- and high-level physical
activity and adequate sleep were associated with decreased risk of having frailty or alleviating frailty. Long-term smoking and
drinking too much could exacerbate frailty.
【Key words】 Frailty；Aged；Development trajectory；Latent growth model

联合国发布的《世界人口展望——2019》指出，全球 65
1 为何开展本研究？
岁以上的老年人到 2050 年将超过 15 亿，每 6 个人中将有 1
随着老龄化态势的进一步加剧，衰弱已成为影响老年
个老年人，全球老龄化态势进一步加剧 ［1］ 。衰弱正是在老龄
人健康的重要社会问题。近年来国内对衰弱的研究逐渐增
化背景下所提出的，是健康老龄化的重要挑战 ［2］ 。衰弱所引
多，但面对这一议题的探讨还不够完善，相关研究仍以小
发的不良事件 ［3］ ，给患者本身、家庭和社会带来了巨大负担 ［4］ 。
范围的横断面调查为主，这类研究虽提供了大量有价值的
关于衰弱的研究首先在国外兴起，从衰弱概念的探讨 ［5］ ，再
信息，但忽略了衰弱的发展轨迹以及个体差异。
到衰弱评估工具的开发 ［6］ ，目前国外已有多项研究采用纵向
2 如何开展本研究？
追踪数据对老年人衰弱进行了考察，指出衰弱有不同的发展
本研究运用中国健康与养老追踪调查（CHARLS）数
轨迹 ［7-8］ 。而我国在衰弱领域的研究起步较晚，目前主要以
据识别衰弱并分析衰弱的发展轨迹以及个体差异如何影响
衰弱评估、影响因素以及综述类研究为主。研究显示我国老
衰弱的变化，从而掌握我国老年人衰弱的发展规律，为我
年人的衰弱发生率有逐年升高的趋势 ［9］ ，农村老年人的衰弱
国积极应对老龄化和推动形成老年人群体的非医疗健康干
发生率高于城市 ［10-11］ ，医院及养老院等特定机构老年人的衰
预模式提供理论依据。
弱发生率则更高 ［12］ 。老年人衰弱影响因素研究主要围绕人口
学因素 ［13-14］ 及生活方式 ［15-16］ 开展，且多为横断面研究。通 全国性抽样数据，采用衰弱指数（frailty index，FI）评估我国
过文献梳理，发现还存在以下不足：（1）我国关于衰弱的研 老年人的衰弱水平，通过构建潜变量增长模型（latent growth
究多采用小范围的横断面数据，尽管这类研究提供了大量有 model，LGM）考察老年人衰弱的发展轨迹，并在了解衰弱发
价值的信息，但所得结论不适合外推且无法反映衰弱的发展 展轨迹的基础上，进一步纳入性别、教育程度作为时间恒定
轨迹以及个体之间的差异。（2）既往研究多基于横断面数据 因素，PA、吸烟、饮酒、睡眠作为时间变化因素，构建条件
考察人口学特征及生活方式对衰弱的影响，忽略了这些因素 LGM，从而对衰弱过程中表现出的个体差异进行解释。一方
在衰弱发展过程中的作用。（3）体力活动（PA）作为预防和 面丰富我国在老年人衰弱领域的研究，另一方面也通过全国
延缓衰弱最有效的首选方式，在我国还鲜有关于 PA 与衰弱关 范围内的纵向追踪数据识别影响衰弱的因素，为我国老年人
系的研究，尤其缺乏基于纵向追踪数据观察 PA 对衰弱影响方 的衰弱干预实践提供较横断面研究更具说服力的证据。
面的研究。 1 资料与方法
鉴于上述发现，本研究基于中国健康与养老追踪调查 1.1 资料来源 本研究的资料来源于 CHARLS 2011 年、2013
（China Health and Retirement Longitudinal Study，CHARLS）的 年、2015 年、2018 年数据，该调查于 2011 年开展，随后每