The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis

Abstract

Background One of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological, physical, and social functioning. Hospitalization is one of the most stressful events for older people who are becoming frail. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults. Methods A systematic review and meta-analysis of research was conducted using the Medline, Embase, Cochrane, ProQuest, CINAHL, SCOPUS and Web of Science electronic databases for papers published between 2000 and 2019. Randomized controlled studies were included that were aimed at the management of frailty in hospitalized older adults. The outcomes which were examined included frailty; physical, psychological, and social domains; length of stay in hospital; re-hospitalization; mortality; patient satisfaction; and the need for post discharge placement. Results After screening 7976 records and 243 full-text articles, seven studies (3 interventions) were included, involving 1009 hospitalized older patients. The quality of these studies was fair to poor and the risk of publication bias in the studies was low. Meta-analysis of the studies showed statistically significant differences between the intervention and control groups for the management of frailty in hospitalized older adults (ES = 0.35; 95% CI: 0. 067–0.632; z = 2.43; P < 0.015). However, none of the included studies evaluated social status, only a few of the studies evaluated other secondary outcomes. The analysis also showed that a Comprehensive Geriatric Assessment unit intervention was effective in addressing physical and psychological frailty, re-hospitalization, mortality, and patient satisfaction. Conclusions Interventions for hospitalized frail older adults are effective in management of frailty. Multidimensional interventions conducted by a multidisciplinary specialist team in geriatric settings are likely to be effective in the care of hospitalized frail elderly. Due to the low number of RCTs carried out in a hospital setting and the low quality of existing studies, there is a need for new RCTs to be carried out to generate a protocol appropriate for frail older people.

Cognitive Impairment in Frail Hypertensive Elderly Patients: Role of Hyperglycemia

“…These data must be contextualized in a frailty condition with hypertension, in which cognitive impairment has a strong impact on functional disability and loss of independence [66,67]. The management of frailty in older adults is extremely challenging [68][69][70] and comorbidities such as hypertension play an instrumental role in increasing the risk of mortality, hospitalization, and disability [71,72]. In this scenario, such a delicate balance is heavily disturbed by HG.…”

The degree of frailty as a translational measure of health in aging

“…Severe frailty typically occurs more often in women 25 , is observed in 12-24% of older adults and is age related 26 . Increasingly, frailty is seen as modifiable, even potentially preventable, thereby making it a target of treatment [27][28][29][30][31] . Trials of nutrition and physical exercise face challenges in relation to blinding, types of controls and measurement of dosing that can be more challenging than pharmaceutical studies, especially for well-tolerated compounds 27 .…”

“…These challenges must be faced in sufficiently large, locally adapted, randomized controlled trials if the prospect of prevention or even mitigation is to be more than aspirational. For this, multicomponent programs will be important, including taking the social context into account 29 , something not always done 31 . Even so, caution is required: one indication that the path to success may be quite long is signaled by a multicomponent trial of metformin and exercise-instead of increasing, metformin attenuated some of the benefit associated with exercise 32 .…”

“…Intermittent fasting in late life reduces frailty components in males not females. Effects of dietary restriction depend on increased renal H 2 S production; H 2 S levels were increased by intermittent fasting and correlated with lower frailty in males only.Multicomponent interventions that target such features31 , such as the Hospital Elder Life Program, are effective in improving outcomes…”

Self-reported morbidities, nutritional characteristics, and associated factors in institutionalized and non-institutionalized older adults

“…Throughout the world, elderly population is growing rapidly. It is predicted to reach 2 billion persons by 2050, raising serious concerns for the planning and management of health systems [ 1 , 2 ]. Furthermore, the global interest in successful aging is now focused on how to keep people incessantly at home or in the community.…”