Measuring frailty in younger populations: a rapid review of evidence

Abstract

Objectives: Frailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care.

Design: A rapid review of primary studies was conducted.

Data sources: Four databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020.

Eligibility criteria: Eligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English.

Data extraction and synthesis: Records were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach.

Results: We identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18-59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care.

Conclusions: Limited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.

Keywords: general medicine (see internal medicine); health policy; primary care.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart.

Figure 2

Proportion (%) of studies with different average sample ages.

Figure 3

(A) Evidence of validity for cumulative deficit frailty indices by study sample mean/median age (years). (B) Evidence of validity for phenotype measures by study sample mean/median age (years).