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Meta-Analysis
. 2019 Aug 2;2(8):e198398.
doi: 10.1001/jamanetworkopen.2019.8398.

Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

Richard Ofori-Asenso  1 , Ken L Chin  1   2 , Mohsen Mazidi  3 , Ella Zomer  1 , Jenni Ilomaki  1   4 , Andrew R Zullo  5   6 , Danijela Gasevic  1   7 , Zanfina Ademi  1 , Maarit J Korhonen  4   8 , Dina LoGiudice  9 , J Simon Bell  1   4   10 , Danny Liew  1
Affiliations
Meta-Analysis

Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

Richard Ofori-Asenso et al. JAMA Netw Open. .

Abstract

Importance: Frailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level.

Objective: To estimate the global incidence of frailty and prefrailty among community-dwelling adults 60 years or older.

Data sources: MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Plus, and AMED (Allied and Complementary Medicine Database) were searched from inception to January 2019 without language restrictions using combinations of the keywords frailty, older adults, and incidence. The reference lists of eligible studies were hand searched.

Study selection: In the systematic review, 2 authors undertook the search, article screening, and study selection. Cohort studies that reported or had sufficient data to compute incidence of frailty or prefrailty among community-dwelling adults 60 years or older at baseline were eligible.

Data extraction and synthesis: The methodological quality of included studies was assessed using The Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence and Incidence Studies. Meta-analysis was conducted using a random-effects (DerSimonian and Laird) model.

Main outcomes and measures: Incidence of frailty (defined as new cases of frailty among robust or prefrail individuals) and incidence of prefrailty (defined as new cases of prefrailty among robust individuals), both over a specified duration.

Results: Of 15 176 retrieved references, 46 observational studies involving 120 805 nonfrail (robust or prefrail) participants from 28 countries were included in this systematic review. Among the nonfrail individuals who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail, with the pooled incidence rate being 43.4 (95% CI, 37.3-50.4; I2 = 98.5%) cases per 1000 person-years. The incidence of frailty was significantly higher in prefrail individuals than robust individuals (pooled incidence rates, 62.7 [95% CI, 49.2-79.8; I2 = 97.8%] vs 12.0 [95% CI, 8.2-17.5; I2 = 94.9%] cases per 1000 person-years, respectively; P for difference < .001). Among robust individuals in 21 studies who survived a median follow-up of 2.5 (range, 1.0-10.0) years, 30.9% (9974 of 32 268) became prefrail, with the pooled incidence rate being 150.6 (95% CI, 123.3-184.1; I2 = 98.9%) cases per 1000 person-years. The frailty and prefrailty incidence rates were significantly higher in women than men (frailty: 44.8 [95% CI, 36.7-61.3; I2 = 97.9%] vs 24.3 [95% CI, 19.6-30.1; I2 = 8.94%] cases per 1000 person-years; prefrailty: 173.2 [95% CI, 87.9-341.2; I2 = 99.1%] vs 129.0 [95% CI, 73.8-225.0; I2 = 98.5%] cases per 1000 person-years). The incidence rates varied by diagnostic criteria and country income level. The frailty and prefrailty incidence rates were significantly reduced when accounting for the risk of death.

Conclusions and relevance: Results of this study suggest that community-dwelling older adults are prone to developing frailty. Increased awareness of the factors that confer high risk of frailty in this population subgroup is vital to inform the design of interventions to prevent frailty and to minimize its consequences.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Zomer reported receiving grants and/or personal fees from Amgen, AstraZeneca, Pfizer, and Shire. Dr Zullo reported being supported in part by a Brown University Office of the Vice President for Research Seed Funding Award, receiving an Agency for Healthcare Research and Quality award, and receiving grants from Sanofi Pasteur. Dr Bell reported receiving grants from the National Health and Medical Research Council, Dementia Australia Research Foundation, Victorian Government Department of Health and Human Services, and aged care provider organizations. Dr Liew reported receiving grants from Pfizer, AbbVie, AstraZeneca, and CSL-Behring and personal fees and/or other financial support from Bayer and Novartis. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Diagram of the Study Selection Process
AMED indicates Allied and Complementary Medicine Database; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Figure 2.
Figure 2.. Forest Plot of the Incidence Rates (per 1000 Person-Years) of Frailty Among Community-Dwelling Older Adults
Weights are from random-effects analysis. Forty-five studies were included.
Figure 3.
Figure 3.. Forest Plot of the Incidence Rates (per 1000 Person-Years) of Prefrailty Among Community-Dwelling Older Adults
Weights are from random-effects analysis. Twenty-one studies were included.
See this image and copyright information in PMC

Comment in

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