Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jan;25(1):102-107.
doi: 10.1111/ggi.15025. Epub 2024 Nov 24.

Frailty as a predictor of mortality in the oldest old: A systematic review and meta-analysis

Justina Angel Tan  1 , Jin Hean Koh  2 , Reshma Aziz Merchant  2   3 , Li Feng Tan  1   2
Affiliations
Meta-Analysis

Frailty as a predictor of mortality in the oldest old: A systematic review and meta-analysis

Justina Angel Tan et al. Geriatr Gerontol Int. 2025 Jan.

Abstract

Aim: Frailty is highly prevalent in old age and is associated with a high risk of mortality. Few studies have evaluated frailty as a predictor of mortality in the oldest old. This systematic review and meta-analysis aims to determine the mortality risk associated with frailty in this age group.

Methods: An electronic systemic literature search was performed in May 2023 on three databases (Medline/PubMed, Embase, and Cochrane Library) for studies investigating the risk of mortality with frailty. A meta-analysis was done to calculate pooled mortality estimates.

Results: Frail participants had significantly lower overall survival (OS) compared with non-frail participants (hazard ratio [HR]: 1.81; 95% confidence interval [CI]: 1.32 to 2.50; P < 0.01, I2 = 100%; risk ratio [RR]: 4.15; 95% CI: 2.50 to 6.88; P < 0.01, I2 = 97%). Among participants aged 90 and above, a higher percentage of male participants was associated with poorer OS in frail participants. While the pooled association of frailty with OS remained significant across studies in participants aged less than 90 years old (HR: 2.09; 95% CI: 1.55 to 2.82; I2 = 75%), frailty was not significantly associated with OS in studies for participants aged 90 and above. The pooled association of frailty with OS was only significant for the Fried Frailty Phenotype (HR: 2.73; 95% CI: 1.05 to 7.12; I2 = 93%) and not for the Frailty Index. The pooled association also remained significant among studies that adjusted for age (HR: 1.74; 95% CI: 1.50 to 2.02; I2 = 0%) and sex (HR: 1.77; 95% CI: 1.48 to 2.11; I2 = 94%) as a covariate.

Conclusions: Frailty was significantly associated with a poorer OS in participants below the age of 90. This association was not statistically significant in those older than 90 years, with sex-differentiated effects observed. Geriatr Gerontol Int 2025; 25: 102-107.

Keywords: aging; elderly; frailty.

PubMed Disclaimer

References

    1. Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M156. https://doi.org/10.1093/gerona/56.3.m146.
    1. Dent E, Martin FC, Bergman H, Woo J, Romero‐Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet 2019; 394: 1376–1386. https://doi.org/10.1016/S0140-6736(19)31785-4.
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–762. https://doi.org/10.1016/S0140-6736(12)62167-9.
    1. Koh JH, Lim CYJ, Tan LTP et al. Prevalence and association of sarcopenia with mortality in patients with head and neck cancer: a systematic review and meta‐analysis. Ann Surg Oncol 2024; 31: 6049–6064. https://doi.org/10.1245/s10434-024-15510-7.
    1. Koh JH, Tan LTP, Lim CYJ et al. Association of head and neck CT‐derived sarcopenia with mortality and adverse outcomes: a systematic review. Arch Gerontol Geriatr 2024; 126: 105549. https://doi.org/10.1016/j.archger.2024.105549.

LinkOut - more resources