Frailty and decline in independent living in older adults: differences between the Baltic and Nordic countries

The associations between frailty and functional decline, as well as a reduced ability to live independently in older age, have been widely studied; however, trajectories may differ between regions. The aim of the study was to assess changes in the ability to live independently over a two-year period across different stages and components of frailty, and to examine regional differences among adults aged 65 years and older in the Baltic and Nordic countries. A longitudinal analysis was conducted using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including two waves (2020 and 2022) of community-dwelling adults aged ≥ 65 years from Baltic and Nordic countries. Frailty status and components were assessed at baseline. Outcomes included new limitations in Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) over a two-year follow-up. Multivariate logistic regression models were used to examine associations between frailty status, components, and new limitations, adjusting for sociodemographic and health-related factors. Frailty and pre-frailty were more prevalent in the Baltic countries, alongside poorer socioeconomic and health profiles. Over two years, new IADL limitations occurred in 5.9% of participants in the Baltic and 6.4% in the Nordic countries, while new ADL limitations occurred in 4.6% and 4.7%, respectively. Pre-frailty was associated with new IADL limitations in both regions, and exhaustion remained the only component independently associated in both regions. New ADL limitations were associated with frailty, pre-frailty, weight loss, and low physical activity in the Nordic countries only. Frailty is an important risk factor for limitations in the ability to live independently, with a particularly high burden observed in the Baltic countries. Despite weaker associations with new limitations compared with the Nordic countries, the higher prevalence of frailty, poorer health profiles, and lower levels of physical activity in the Baltic countries highlight a substantial need for early identification and targeted prevention.