Transitions between frailty states among community-dwelling older people: A systematic review and meta-analysis |
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| Institution: | 1. Department of Primary Care and Population Health, University College London, London, UK;2. Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan;3. Department of Epidemiology and Public Health, University College London, London, UK;1. Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, United States;2. School of Medicine, Johns Hopkins University, Baltimore, MD, United States;3. Center for Wireless and Population Health Systems, University of CA, San Diego, United States;4. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States;5. Department of Oncology, Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States;1. Gérontopôle, University Hospital of Toulouse, Toulouse, France;2. INSERM UMR1027, University of Toulouse III Paul Sabatier, Toulouse, France;3. Institute of Psychiatry, King''s College, London, United Kingdom;4. Public Health Foundation of India, New Delhi, India;5. Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland;6. Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Roma, Italy;7. Department of Geriatrics, Neurobiology and Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China;8. National Institute of Geriatrics, Mexico City, Mexico;9. Department of Geriatrics and Rehabilitation, Geneva Medical School and University Hospitals, Geneva, Switzerland;10. Division of Geriatric Medicine, Saint Louis University School of Medicine, Saint Louis, MO;11. HelpAge International, London, United Kingdom;12. Department of Geriatrics, University Hospital of Getafe, Madrid, Spain;13. Foundation for Diabetes Research in Older People, Luton, United Kingdom;14. Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea;1. Gerontology Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium;2. Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium;3. Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium;4. Rehabilitation Sciences Research Department (RERE), Vrije Universiteit Brussel, Brussels, Belgium;5. Fundamental Rights and Constitutionalism Research Group (FRC), Vrije Universiteit Brussel (VUB), Elsene, Belgium;6. Experimental Anatomy (EXAN), Vrije Universiteit Brussel (VUB), Brussels, Belgium;7. Department of Electronics and Informatics ETRO, Vrije Universiteit Brussel (VUB), Elsene, Belgium;1. Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch (UTMB), Galveston, USA;2. Division of Geriatrics, Department of Internal Medicine, UTMB, Galveston, USA;3. Department of Preventive Medicine and Community Health, UTMB, Galveston, USA;1. Research Unit of Physical Activity and Sport at Faculty of Sport Sciences and Physical Education (CIDAF, UID/PDT/04213/2016) – University of Coimbra, Portugal;2. Laboratory of Sport and Exercise Psychology of Faculty of Sport Sciences and Physical Education of University of Coimbra, Portugal;3. School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom;4. CIAMS, University Paris-Sud, Université, Paris-Saclay, 91405, Orsay Cedex, France;5. CIAMS, Université d''Orléans, 45067, Orléans, France;6. Research Team ECRIN, INRA, UMR 1019, Clermont-Ferrand, France;7. Medical Psychology Unit, School of Medicine, Clinical Neuroscience and Mental Health, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal |
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| Abstract: | Frailty is a well-established risk factor for adverse health outcomes. However, comparatively little is known about the dynamic nature of frailty and the extent to which it can improve. The purposes of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age>60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1–10 years), 13.7% (95%CI = 11.7–15.8%) improved, 29.1% (95%CI = 25.9–32.5%) worsened and 56.5% (95%CI = 54.2–58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI = 48.8–59.1%), 40.6% (95%CI = 36.7–44.7%) and 4.5% (95%CI = 3.2–6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI = 18.8–27.6%), 58.2% (95%CI = 55.6–60.7%) and 18.2% (95%CI = 14.9–21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI = 1.6–5.5%), 40.3% (95%CI = 34.6–46.1%) and 54.5% (95%CI = 47.6–61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered. |
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| Keywords: | Frailty Frail elderly Transition Change Systematic review Meta-analysis |
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