Tuberculosis comorbidities, multimorbidity and mortality amongst adults in South Africa: A prospective cohort study nested in a trial.

In China,[] older adults are defined as those aged 60 years and above []. By the end of 2024, the population of older adults in China reached approximately 310 million, accounting for 22% of the total population []. By 2035, older adults are expected to account for more than 30% of the population []. With advancing age, physiological reserve capacity progressively declines or becomes dysregulated, leading to increased vulnerability, reduced resilience to stressors, and impaired maintenance of internal homeostasis; consequently, older adults are more likely to develop frailty [,]. Frailty is a complex geriatric syndrome characterized by multifactorial etiologies and diverse influencing factors. Its hallmark features include reduced muscle strength, decreased endurance, and progressive physiological functional decline, which collectively increase the risks of dependency and mortality [,]. Evidence indicates that frailty may be associated with a 15% to 50% increase in all-cause mortality risk [] and that for every 0.1-unit increase in the frailty index, the risk of adverse health outcomes rises by 68% []. Epidemiological studies suggest that the prevalence of frailty is approximately 15% among adults aged 65 years and older, increasing to 25% to 50% among those aged 80 years and above [-]. A systematic review further reported that the prevalence of frailty among community-dwelling older adults in China ranges from 5.9% to 17.4%, with a pooled prevalence of 10.0% []. The progression of frailty leads to a gradual decline in older adults’ ability to live independently and may ultimately result in disability, necessitating reliance on external care and imposing substantial caregiving burdens on families and society []. Projections indicate that by 2050, approximately 91.4 million older adults in China will require long-term care services [], reflecting a growing and sustained demand for formal care provision. Under the influence of the cultural norm of filial piety, the traditional belief of “raising children for old-age support,” and legal as well as moral regulations mandating adult children’s caregiving responsibilities, older adults in China have traditionally relied predominantly on family-based care models [,]. However, as a result of the long-standing one-child policy, family structures have undergone profound changes, with nearly 70% of households nationwide becoming single-child families []. At present, the parents of the first generation of only children have entered old age, and over the next 3 decades, the number of older and oldest-old parents with a single child is expected to continue to increase. China is therefore approaching a peak period of “only-child-supported aging” []. Nevertheless, only children face substantial practical challenges in fulfilling eldercare responsibilities. Due to work-related pressures and obligations related to raising the next generation, they often struggle to provide adequate financial support, daily care, and emotional companionship for their aging parents []. In addition, with accelerating modernization and urbanization, increasing female labor force participation, and rising life expectancy among older adults, the traditional family caregiving function has been further weakened. Against this backdrop, older adults are increasingly compelled to shift from traditional family-based care models to transitional or more formalized, socially provided care arrangements []. This transition necessitates that older adults proactively plan for future care to mitigate potential caregiving risks. Taken together, in the face of the complex care needs associated with frailty, the traditional family care model is no longer sufficient to meet current demands. There is an urgent need for frail older adults to play a more active role by engaging in early planning, mobilizing available resources, and preparing for future care. Preparation for future care (PFC) refers to the process of preparing for potential needs for assistance with activities of daily living resulting from functional decline due to chronic illness or health-related events in the future []. A substantial body of literature indicates that PFC promotes active aging []. Older adults who engage in more systematic planning for future care report a greater sense of control over their lives [], higher life satisfaction [], and lower levels of anxiety and depression []. Moreover, as a form of long-term risk management, PFC enables advance arrangements for future care needs, such as identifying potential caregivers, selecting care institutions, or planning for transitions in care modalities, which can substantially alleviate caregiver burden and generate benefits for caregivers as well []. In contrast, a lack of PFC is associated with higher risks of illness and increased financial and emotional strain []. Therefore, actively guiding older adults to engage in PFC is a critical component of community nursing practice in the cont