The Prevalence of Frailty Among Older Adults Living With Dementia: A Systematic Review

Abstract

Objectives: To investigate the prevalence of frailty in older adults living with dementia and explore the differences in medication use according to frailty status.

Design: Systematic review of published literature from inception to August 20, 2020.

Setting and participants: Adults age ≥65 years living with dementia in acute-care, community and residential care settings.

Methods: A systematic search was performed in Embase, Medline, International Pharmaceutical Abstracts, APA PscyInfo, CINAHL, Scopus, and Web of Science. Two reviewers independently screened records and conducted quality assessment using the Newcastle-Ottawa Scale.

Results: Sixteen articles met the inclusion criteria, with 7 studies conducted in acute care setting and 9 studies in community-dwelling adults. Five studies recruited people with dementia exclusively, and 11 studies were conducted in older populations that included individuals with dementia diagnosis. Among studies conducted in acute care setting, the prevalence of frailty ranged from 50.8% to 91.8% compared with studies in community-dwelling setting, which reported a prevalence of 24.3% to 98.9%. With respect to medication exposure, 3 studies documented medication use according to frailty status but not dementia status. Higher medications use, measured as total number of medications was reported in frail [7.0 ± 4.0 (SD) -12.0 ± 9.0 (SD)] compared with nonfrail participants [6.1 ± 3.1(SD) -10.4 ± 3.8 (SD)].

Conclusions and implications: Current data suggests a wide range of frailty prevalence in individuals with dementia. Future studies should systematically document frailty in adults living with dementia and its impact on medication use.

Keywords: Frailty; dementia; medication use; multimorbidity; older adults.