Transitions between frailty states among community-dwelling older people: A systematic review and meta-analysis

Abstract

Frailty is a well-established risk factor for adverse health outcomes. However, little is known about the dynamic nature of frailty and the extent it can improve. The purposes of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age>60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1-10 years), 13.7% (95%CI=11.7-15.8%) improved, 29.1% (95%CI=25.9-32.5%) worsened and 56.5% (95%CI=54.2-58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI=48.8-59.1%), 40.6% (95%CI=36.7-44.7%) and 4.5% (95%CI=3.2-6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI=18.8-27.6%), 58.2% (95%CI=55.6-60.7%) and 18.2% (95%CI=14.9-21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI=1.6-5.5%), 40.3% (95%CI=34.6-46.1%) and 54.5% (95%CI=47.6-61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered.

Loneliness as a risk factor for frailty transition among older Chinese people

“…Another cohort study in older Italian adults found that women were more likely to progress into worsened physical frailty than men with a mean follow-up of 4.4 years [71]. Our study showed that, compared with men, women were more likely to change frailty status, either improving or worsening, a nding that agrees with a recent systematic review [68] and requires further con rmation by more studies. Thus, frailty interventions may have different e cacies in men and women.…”

“…During the 6-year follow-up, loneliness was found to be positively related to remaining in the frail status, but no signi cant relationship was found in the 3-year follow-up. This nding was supported by a previous study showing that a longer follow-up period was associated with lower rates of remaining in the same frailty state [68].…”

<p>Frailty syndrome: implications and challenges for health care policy</p>

“…The population-based lowest 20% of the handgrip strength, gait speed, and physical activity need to be calculated based on the population distributions. Calculation of the Frailty Index requires the recording of various types of deficits (typically more than [30][31][32][33][34][35][36][37][38][39][40] and dividing the number of deficits present by the number of deficits considered, which may take ~20-30 minutes, 19 Kojima et al…”

“…33 Although the mean prevalence of frailty gradually increases with age, 28,[34][35][36][37] the individual course of frailty varies and the level of frailty can be reduced even in old age. 4,38 Several longitudinal population-based studies have showed that 8.3%-17.9% of older adults actually improved their frailty status [39][40][41][42][43][44] and that some of them made frequent and dynamic transitions over time. 45…”

Physical Fitness in Hospitalized Frail Elderly Patients

“…A frail person runs the risk of rapid deterioration when exposed to external stressors, such as acute illness 13,29 , which is illustrated in Figure 4. However, frailty is a dynamic syndrome where deterioration is common, but the individual course of frailty varies and the degree of frailty can be improved even in old age 25,33 .…”