Frailty Screening in Low- and Middle-Income Countries: A Systematic Review

Abstract

Objectives: To conduct a systematic review of frailty screening tools used in low- and middle-income countries (LMICs).

Design: Systematic review.

Setting: LMICs, as defined by the World Bank on June 30, 2014.

Participants: Elderly adults (as defined by the authors) living in LMICs.

Measurements: Studies were included if the population under consideration lived in a LMIC, the study involved an assessment of frailty, the study population was elderly adults, and the full text of the study was available in English. The Medline, Embase, CINAHL and PsychINFO databases were searched up to June 30, 2014.

Results: Seventy studies with data from 22 LMICs were included in the review. Brazil, Mexico, and China provided data for 60 of the 70 studies (85.7%), and 15 countries contributed data to only one study. Thirty-six studies used the Fried criteria to assess frailty, 20 used a Frailty Index, and eight used the Edmonton Frailty Scale; none of the assessment tools used had been fully validated for use in a LMIC.

Conclusion: There has been a rapid increase in the number of published studies of frailty in LMICs over the last 5 years. Further validation of the assessment tools used to identify frail elderly people in LMICs is needed if they are to be efficient in identifying those most in need of health care in such settings.

Keywords: cognitive impairment; disability; elderly; frailty; low- and middle-income country; systematic review.