ABSTRACT
Background: Older adults with frailty may struggle to adapt to prolonged periods of infection prevention measures during COVID- 19. However, few studies have explored how frailty has shaped experiences of living through the COVID-19 pandemic. We aimed to 1) investigate quantitative associations between frailty and each of physical isolation, worry about COVID-19, and loneliness;and 2) qualitatively explore older adults' lived experiences of frailty during the pandemic. Methods: We used a cross-sectional sequential explanatory mixed-methods design. Data were from online questionnaires in the nationwide United States COVID-19 Coping Study from December 2020 through January 2021 (N = 2,451 adults aged ≥55). Frailty was assessed by the 5-item FRAIL scale. We used adjusted population- weighted modified Poisson regression to estimate prevalence ratios for associations between frailty and physical isolation (not leaving home except for essential purposes);worry about COVID-19 (moderate/extremely worried vs. not at all/slightly/somewhat worried);and loneliness (UCLA Loneliness scale, ≥6/9 vs. <6/9). We performed qualitative thematic analysis on open-ended written responses to the question, “How does your health status affect your everyday activities during the pandemic?”. Results: Frailty was associated with increased prevalence of all outcomes in dose-response fashions. Key qualitative themes among pre-frail and frail aging adults included concerns about infection, adherence to COVID-19 prevention measures, changes in social interaction, physical challenges, and changes in exercise and activities. Conclusion: Experiences of aging with frailty during the pandemic have been diverse and encompass isolation, worry, loneliness, and frailty progression, as well as coping strategies and resilience. Individualized strategies that consider the factors influencing frailty are needed to support well-being among aging adults during the pandemic.