Hanlon, Peter, Nicholl, Barbara I, Jani, Bhautesh Dinesh et al. · The Lancet. Public health · 2018 · DOI
This large study looked at nearly 500,000 people aged 37-73 to understand 'frailty'—a condition where people become weak and tired more easily. The researchers found that frailty is associated with having multiple health conditions and an increased risk of death over 7 years. Importantly, they discovered that chronic fatigue syndrome was one of the top five conditions linked to frailty, suggesting that frailty affects not just elderly people but also middle-aged adults with long-term illnesses.
This study provides epidemiological evidence that ME/CFS is among the most strongly associated conditions with frailty in middle-aged adults, validating patient experience of profound disability. For ME/CFS researchers and clinicians, the finding that frailty—independent of condition count—predicts mortality underscores the need to assess functional decline and physical weakness as distinct clinical outcomes in ME/CFS cohorts.
This study does not establish that frailty *causes* mortality or that the specific mechanisms linking ME/CFS to frailty are understood. The association between ME/CFS and frailty is correlational and may reflect shared underlying pathophysiology, disease severity, or unmeasured confounders. The study also does not distinguish whether frailty in ME/CFS patients reflects post-exertional malaise, deconditioning, or other disease-specific processes.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Hanlon, Peter, Nicholl, Barbara I, Jani, Bhautesh Dinesh, Lee, Duncan, McQueenie, Ross, & Mair, Frances S (2018). Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants.. The Lancet. Public health. https://doi.org/10.1016/S2468-2667(18)30091-4
BibTeX
@article{mecfsatlas-hanlon-2018-frailty-pre,
author = {Hanlon, Peter and Nicholl, Barbara I and Jani, Bhautesh Dinesh and Lee, Duncan and McQueenie, Ross and Mair, Frances S},
title = {Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants.},
journal = {The Lancet. Public health},
year = {2018},
doi = {10.1016/S2468-2667(18)30091-4},
note = {PubMed: 29908859},
url = {https://www.mecfsatlas.com/evidence/hanlon-2018-frailty-pre},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/hanlon-2018-frailty-pre
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