Prevalence of Frailty in Community‐Dwelling Older Persons: A Systematic Review

Collard, Rose M.; Boter, Han; Schoevers, Robert A.; Voshaar, Richard C. Oude

doi:10.1111/j.1532-5415.2012.04054.x

Cited by 2,358 publications

(2,089 citation statements)

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“…In patients with significant cardiovascular disease, the prevalence of frailty has been shown to be as high as 60% 2. In this study of older Australian MI patients, 15% of STEMI patients and 34% of NSTEMI patients were classified as frail.…”

Section: Discussionmentioning

confidence: 73%

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Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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BackgroundLittle is known about the prognostic implications of frailty, a state of susceptibility to stressors and poor recovery to homeostasis in older people, after myocardial infarction (MI).Methods and ResultsWe studied 3944 MI patients aged ≥65 years treated at 41 Australian hospitals from 2009 to 2016 in the CONCORDANCE (Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events) registry. Frailty index (FI) was determined using the health deficit accumulation method. All‐cause and cardiac‐specific mortality at 6 months were compared between frail (FI >0.25) and nonfrail (FI ≤0.25) patients. Among 1275 patients with ST‐segment–elevation MI (STEMI), 192 (15%) were frail, and among 2669 non‐STEMI (NSTEMI) patients, 902 (34%) were frail. Compared with nonfrail counterparts, frail STEMI patients received 30% less reperfusion therapy and 22% less revascularization during index hospitalization; frail NSTEMI patients received 30% less diagnostic angiography and 39% less revascularization. Unadjusted 6‐month all‐cause mortality (STEMI: 13% versus 3%; NSTEMI: 13% versus 4%) and cardiac‐specific mortality (STEMI: 6% versus 1.4%, NSTEMI: 3.2% versus 1.2%) were higher among frail patients. After adjustment for known prognosticators, FI was significantly associated with higher 6‐month all‐cause (STEMI: odds ratio: 1.74 per 0.1 FI [95% confidence interval, 1.37–2.22], P<0.001; NSTEMI: odds ratio: 1.62 per 0.1 FI [95% confidence interval, 1.40–1.87], P<0.001) but not cardiac‐specific mortality (STEMI: P=0.99; NSTEMI: P=0.93).ConclusionsFrail patients receive lower rates of invasive cardiac care during MI hospitalization. Increased frailty was independently associated with increased postdischarge all‐cause mortality but not cardiac‐specific mortality. These findings inform identification of frailty during MI hospitalization as a potential opportunity to address competing risks for mortality in this high‐risk population.

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Section: Discussionmentioning

confidence: 73%

“…The overall prevalence of frailty in adults aged ≥65 years has been estimated at ≈10%. However, in patients with significant cardiovascular disease, the prevalence may be as high as 60% 2. Frailty has been associated with increased major adverse cardiac events after myocardial infarction (MI) 3, 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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“…The different measures of frailty include physical phenotype,37 clinical functional assessments,22 and functional assessments in combination with disability or laboratory values; these have all been studied in the general population 7. The prevalence of frailty assessed by physical phenotype is 9.9% and 13.6% when using a broader definition in adults >64 years of age 7. In comparison, a study of 152 cardiac surgery patients using 3 different frailty scales reported a prevalence of 20% to 46%, depending on the method chosen to define frailty 14.…”

Section: Discussionmentioning

confidence: 99%

“…Frailty is a common syndrome described as a diminished resiliency in response to stress as a result of decreased physiological reserve, increased burden of comorbidities, and altered multisystem homeostasis 6. Frailty increases susceptibility to adverse health outcomes and contributes to the difference between chronological and physiological age 7. It is associated with increased mortality, surgical site infections, length of hospital stay, increased healthcare expenditure, and readmission rates in patients presenting for a variety of major noncardiac surgeries 8, 9, 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

104

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BackgroundFrailty is increasing in prevalence and poses a formidable challenge for clinicians. The cardiac surgery literature consists primarily of small single‐center studies with limited follow‐up, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.Methods and ResultsWe conducted a population‐based, retrospective, cohort study in Ontario, Canada, between 2008 and 2015. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator (a multidimensional instrument validated for research using administrative data). The primary outcome was mortality. Mortality rates were calculated using the Kaplan‐Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model. Of 40 083 patients, 8803 (22%) were frail. At 4±2 years of follow‐up, age‐ and sex‐standardized mortality rate per 1000 person‐years was higher in frail (33; 95% confidence interval, 29–36) compared with nonfrail (22; 95% confidence interval, 19–24) patients. Frailty was associated with an increased risk of long‐term mortality (adjusted hazard ratio, 1.20; 95% confidence interval, 1.12–1.28) and greater differences in the survival of patients between 40 and 74 years of age than in those who were ≥85 years old.ConclusionsFrailty was present in a large proportion of patients undergoing coronary artery bypass grafting and was independently associated with long‐term mortality. The adjusted risk of frailty‐related death was inversely proportional to age. Our findings highlight the need for more comprehensive preoperative risk stratification models to assist with optimal selection of operative candidates. In addition, we identified the <75 years age group as a potential target for comprehensive preoperative optimization programs, such as cardiac prehabilitation, nutritional augmentation, and psychosocial support.

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“…Similar to previous studies that tested phenotypic frailty, this result is within the interval detected, which ranges from 4.0 to 59.1%. 31 However, the prevalence of frailty varies widely due to the definition of the concept (which has implications on the assessment instruments used) and the population studied. In the present study, more than half of the sample (50.9%) was classified as pre-frail, which is a similar result to those recorded in earlier studies.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of phenotypic frailty during the aging process in a Portuguese community

Duarte

Paúl²

2015

Rev. bras. geriatr. gerontol.

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The present study is based on the conceptual model defined by Fried which explains phenotypic frailty through the presence of the following criteria: weight loss; exhaustion; low physical activity; slowness and weakness. The aim of the present study was to identify the behaviour of phenotypic frailty and outline the profile of the frail elderly person. In order to do this, a random stratified sample of 339 individuals residing in the community was obtained. A frailty protocol was developed, composed of measures related to the aging process and phenotypic frailty. The results indicated a high prevalence of this syndrome (34.9%). It occurs more frequently among women (40.9%) and at more advanced ages (60.4%). The criteria that appeared most frequently in association with frailty are low physical activity (88.9%) and slowness (86.4%). Frail elderly individuals were characterized by being widow/separated/divorced (46.7%); illiterate (71.1%); living within a family with some degree of dependence (41.6%); living in unsuitable conditions (44.9%); having limited social relations (54.2%) and not receiving social support (37.6%). It can be concluded that frailty is a prevalent condition, and that the profile of the frail individual is associated with a set of characteristics that result in greater vulnerability, which suggests possible areas of intervention to minimize and delay this syndrome.

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Prevalence of Frailty in Community‐Dwelling Older Persons: A Systematic Review

Abstract: Frailty is common in later life, but different operationalization of frailty status results in widely differing prevalence between studies. Improving the comparability of epidemiological and clinical studies constitutes an important step forward.

Cited by 2,358 publications

References 29 publications

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Prevalence of phenotypic frailty during the aging process in a Portuguese community

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