The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients

BackgroundFrailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators.MethodsSystematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality.ResultsNinety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 8/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators.ConclusionsFrailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.     

Psychosocial Correlates of Frailty Among HIV-Infected and HIV-Uninfected Adults

Abstract

Frailty is a geriatric condition characterized by increased vulnerability to physical impairments and limitations that may lead to disabilities and mortality. Although studies in the general population suggest that psychosocial factors affect frailty, less is known about whether similar associations exist among people living with HIV (PLWH). The purpose of this study was to examine psychosocial correlates of frailty among PLWH and HIV-uninfected adults. Our sample included 127 adults (51% PLWH) participating in the Multi-Dimensional Successful Aging among HIV-Infected Adults study at the University of California San Diego (average age 51?years, 80% male, 53% White). Frailty was assessed via the Fried Frailty Index. Psychosocial variables significant in bivariate models were included in principal component analysis to generate factor variables summarizing psychosocial correlates. Multivariate logistic regression models were fit to examine the independent effects of factor variables and their interaction terms with HIV status. In bivariate models, frailty was associated with multiple psychosocial variables, for example, grit, optimism, personal mastery, social support, emotional support. Factor analysis revealed that psychosocial variables loaded on two factors—Positive Resources/Outlook and Support by Others. The multivariate model showed significant main effects of Support by Others and HIV status, and interactive effects HIV X Positive Resources/Outlook, such that Positive Resources/Outlook was negatively associated with frailty for PLWH but not for HIV-uninfected individuals. These analyses indicate that psychosocial factors may be associated with frailty among PLWH. Positive resources and outlook may play a role in frailty prevention. Future longitudinal studies are needed to establish causal links.     

Associations between Frailty in Older Adults and Malnutrition in Rural Areas: 2019 Updated Version of the Asian Working Group for Sarcopenia

PurposeThe purpose of this study was to evaluate the prevalence of frailty among an older adult population living in rural communities and to determine if frailty is associated with nutritional status after adjusting for sarcopenia and depression.Materials and MethodsThis research used baseline data from the Namgaram-2 study. Frailty was evaluated using the Kaigo-Yobo checklist in an older Korean population. The nutritional statuses of older people were measured using the Korean version of the mini nutritional assessment (MNA). The recent criteria of the Asian Working Group for Sarcopenia were applied for diagnosis of sarcopenia, and depression was assessed using the Geriatric Depression Scale-Short Form.ResultsThe prevalence of frailty was 18.8% (male: 9.6%; female: 23.4%) and was significantly higher in individuals in their 80s [male, 35.3% (p<0.001); female, 42.3% (p<0.001)], those of poor economic status [male, 18.2% (p=0.012); female, 34.9% (p<0.001)], those with hypertension [female, 27.7% (p=0.008)], those with sarcopenia [male, 34.1% (p<0.001); female, 37.2% (p<0.001)], those with depression [male, 46.4% (p<0.001); female, 51.7% (p<0.001)], and those at high risk of malnutrition [male, 44.4% (p<0.001); female, 51.7% (p<0.001)]. After adjusting for demographic variables, including hypertension, diabetes, sarcopenia and depression, frailty was significantly associated with nutritional status [male: odds ratio (OR)=6.73, 95% confidence interval (CI), 1.84–24.65; female: OR=4.83, 95% CI, 2.88–8.11].ConclusionFor older adults, MNA is a suitable tool of use in assessing both nutritional status and frailty. Moreover, the nutritional status of older adults appears to be associated with frailty, even after corrections for physical and psychological function.     

Oxidative stress,genomic features and DNA repair in frail elderly: A systematic review

Frailty is an emerging geriatric syndrome characterized by higher vulnerability to stressors, with an increased risk of adverse health outcomes such as mortality, morbidity, disability, hospitalization, and institutionalization. Although it is generally recognized to have a biological basis, no particular biological trait has been consistently associated to frailty status so far. In this work, epidemiological studies evaluating association of frailty status with alterations at cellular level − namely oxidative stress, genomic instability and DNA damage and repair biomarkers −were revised and compared. A total of 25 studies fulfilled inclusion/exclusion criteria and, consequently, were included in the review. Variations of oxidative stress biomarkers were often associated to frailty status in older people. On the contrary, genomic instability seems not to be linked to frailty. The only study which addressed the possible relationship between DNA repair modulations and frailty status also failed in finding association. Despite the large number of cellular alterations known to be associated with frailty, studies on this issue are still very scarce and limited to some of the possible cellular targets. The established link between DNA repair, genomic instability, and age and age-related disorders, encourage deeper investigations on this line.     

Falls and potential therapeutic interventions among elderly and older adult patients with cancer: a systematic review

ObjectivesThe aim of this study was to perform a systematic review for previous publications that have assessed the incidence, risk factors, and favorable procedures to prevent and manage falls among cancer survivors of elderly and older adults.MaterialsThis systematic review was undertook using PubMed, SCOPUS, Web of Science, Medline, and Cochrane Database of clinical studies and systematic reviews to determine the incidence, risk factors, favorable inpatient and outpatient management, and non-pharmacological interventions for falls among elderly and older adult patients with cancer from 2010 to October, 2020.ResultsAfter the comprehensive screening, clinical studies, meta-analysis, systematic reviews, and established guidelines were included in this review. Only 5 clinical studies (3 randomized and 2 single-arm studies), 5 systematic reviews, and 6 established guidelines were considered eligible. The five systematic reviews provide risk factors of falls and the 6 guidelines provide assessment & prevention modalities of falls, however, the 6 clinical studies provide the non-pharmacological intervention for falling among cancer survivors. Many factors associated are demonstrated among wide range of elderly individuals. Earlier falls were reliably listed as an important risk factor of falls in the two inpatient and outpatient environments including both general older people and geriatric cancer populations.ConclusionsThis review concludes that the assessment of falls among older individuals with cancer is the most important way for determining who could need additional observation and treatment program. Health professions involving physical therapy and occupational therapy have an important function for promoting health well-being in elderly and older adults with cancer.     

Frailty for predicting all-cause mortality in elderly acute coronary syndrome patients: A meta-analysis

BackgroundFrailty has been identified as a risk factor for mortality in patients with acute coronary syndrome (ACS). This meta-analysis aimed to evaluate the association between frailty and all-cause mortality outcome in patients with ACS.MethodsPubmed and Embase databases were searched up to September 26, 2018 for the observational studies evaluating the association between frailty and all-cause mortality in elderly ACS patients. Outcome measures were in-hospital death, short-term all-cause mortality (≤6 months),and long-term all-cause mortality (≥12 months).The impact of frailty on all-cause mortality was summarized as hazard ratios (HR) with 95% confidence intervals (CI) for the frail versus nonfrail patients.ResultsA total of 9 cohort studies involving 2475 elderly ACS patients were included. Meta-analysis showed that ACS patients with frailty had an increased risk of in-hospital death (HR 5.49; 95% CI 2.19–13.77), short-term all-cause mortality (HR 3.56; 95% CI 1.96–6.48), and long-term all-cause mortality (HR 2.44; 95% CI 1.92–3.12) after adjustment for confounding factors. In addition, prefrailty was also associated with an increased all-cause mortality (HR 1.65; 95% CI 1.01–2.69).ConclusionsThis meta-analysis demonstrates that frailty independently predicts all-cause mortality in elderly ACS patients. Elderly ACS patients should be assessed the frailty status for improving risk stratification.     

Epidemiological and clinical significance of cognitive frailty: A mini review

Since the operational definition of “cognitive frailty” was first proposed in 2013 by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, several studies have been carried out using this cognitive frailty model. In this review, we examined the available clinical and epidemiological evidence for cognitive frailty. Despite its low prevalence (1.0–1.8%) in the community setting, cognitive frailty has been associated with a high risk of disability, poor quality of life, and death; while cognitive frailty appears to be associated with a high risk of dementia, there is no clear evidence for this association. Again, while the prevalence of cognitive frailty appears to have increased in the clinical setting, to date, very few studies evaluated the impact of cognitive frailty. While a new definition of cognitive frailty was proposed in 2015 to incorporate “reversible” and “potential reversible” subtypes, there is a paucity of epidemiological evidence to support this definition. In conclusion, there is no consensus on the definition of cognitive frailty for use in clinical and community settings or on which measures to be used for detecting cognitive impairment. Further study is required to formulate effective preventive strategies for disability in the elderly.     

Impact of frailty on all-cause mortality and major bleeding in patients with atrial fibrillation: A meta-analysis

BackgroundConflicting results have been reported on the impact of frailty on adverse outcomes in patients with atrial fibrillation (AF). The aim of this meta-analysis was to evaluate the impact of frailty on death and major bleeding in patients with AF.MethodsWe comprehensively searched PubMed and Embase databases until June 30, 2021 for the relevant studies that investigated the impact of frailty on all-cause mortality and major bleeding in AF patients. Pooled multivariable-adjusted risk ratio (RR) and 95% confidence intervals (CI) was estimated for the frail vs. nonfrail patients using a random-effect model.ResultsTen studies involving 97,413 patients with AF satisfied the inclusion criteria. The prevalence of frailty in patients with AF ranged between 5.9% and 89.5%. Meta-analysis indicated that frailty was associated with higher risk of all-cause mortality (RR 2.77; 95% CI 1.68–4.57) and major bleeding (RR 1.83; 95% CI 1.24–2.71). Subgroup analysis showed that the impact of frailty on all-cause mortality was consistently found in each subgroup.ConclusionFrailty independently predicts all-cause mortality and major bleeding in patients with AF. Determination of frailty status may play an important role in risk classification of AF patients. However. lack of standardized definition of frailty is the most important limitations of this meta-analysis.     

Frailty and mortality,disability and mobility loss in a Spanish cohort of older adults: The FRADEA Study

BackgroundOriginal Fried's frailty criteria have not demonstrated their prognostic validity of mortality, disability and mobility loss in European cohorts.ObjectivesTo analyze whether frailty implies increased risk of death, incident disability in basic (BADL) or instrumental (IADL) activities of daily living, or mobility impairment.DesignConcurrent cohort study.SettingAlbacete City, Spain.Participants993 participants over age 70 from the FRADEA Study.MeasurementsMortality, BADL and mobility using the Barthel Index, and IADL using the Lawton IADL Index, were recorded. BADL disability was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding, while deterioration of mobility was defined as loss of ability to perform transfers, walk, or use stairs, and IADL disability as losing any of the activities included in the Lawton Index. The risk of presenting adverse events was determined by Cox and Kaplan–Meier proportional hazard analysis and logistic regression adjusted for age, sex, function, and comorbidity.ResultsMean follow-up was 534 days (SD 153), during which 105 participants (10.6%) died. Mean time to death was 363 days (SD 218), while 192 (25.4%) lost at least one BADL, 492 (60%) at least one IADL, and 222 (28.9%) lost mobility. Frail subjects had a greater adjusted risk of death (HR 5.5, CI 95% 1.5–20.2), of losing BADL (HR 2.5, CI 95% 1.3–4.8), of losing mobility (HR 2.7, CI 95% 1.5–5.0), and of losing IADL (HR 1.9, CI 95% 1.1–3.3) than non-frail patients.ConclusionFried's frailty criteria are associated with death, incident disability, and mobility impairment in a Spanish cohort of older adults.     

Fruit and vegetable intake and risk of frailty: A systematic review and dose response meta-analysis

PurposeThis systematic review and dose-response meta-analysis of observational studies was conducted to summarize available findings on the association between fruits and vegetables (FVs) consumption and risk of frailty.MethodsOnline databases including Medline, Scopus, and Embase were searched to detect related publications up to February 2021. Study selection and data extraction were performed by two investigators working in parallel. In most included studies, frailty was defined according to the Fried criteria. Overall, 14 articles with 18,616 subjects with frailty and 101,969 controls were included. To combined data, a random effect model was used. Dose–response associations were also evaluated.ResultsFourteen studies (10 cohorts and four cross-sectional) were included. Pooled effect size for the highest versus lowest category of FVs consumption showed an inverse association with risk of frailty (RR _cohort = 0.65; 95% CI: 0.50–0.84; I² = 81%, n = 7). Every one serving (200 g) per day increment in FVs intake was associated with a 14% lower risk of frailty. The risk of frailty decreased linearly up to FVs consumption of 3.5 servings/d, with flattening the curve at higher intake. Pooled analysis regarding fruits and vegetables separately did not indicate a significant association with the risk of frailty. Indeed, the results of the meta-analysis correspond only to the cohort studies. Based on the NutriGrade score, the quality of evidence for a protective effect of FV on frailty was "moderate".ConclusionsFVs consumption was associated with a decreased risk of frailty. Further large-scale prospective cohort studies are needed to reach more confident conclusions.     

Associations between loneliness and physical frailty in community-dwelling older adults: A systematic review and meta-analysis

ObjectivesOlder adults may be at increased risk of loneliness. Frailty is also common in older adults, however, associations between loneliness and frailty have been understudied. This systematic review and meta-analysis aimed to explore evidence on how loneliness and frailty are correlated.MethodsA systematic search of the literature was conducted using 4 electronic databases in February 2022 for any studies published in 2000 or later that provided cross-sectional or longitudinal associations between loneliness and physical frailty in community-dwelling older adults. A meta-analysis was attempted to combine data when possible.ResultsFrom 1386 studies identified by the initial search, 16 studies were included for this review. Standardized mean difference (SMD) meta-analysis based on mean loneliness score across 3 frailty groups provided by 6 cross-sectional studies showed that worse frailty status was significantly associated with a higher degree of loneliness (SMD between frail and robust, frail and prefrail, and prefrail and robust were 0.77 (95% confidence interval (CI)= 0.57–0.96), 0.37 (95%CI=0.25–0.50), and 0.30 (95%CI=0.20–0.40), respectively.) Meta-analyses combining cross-sectional data from 6 studies revealed that frailty was significantly associated with a higher risk of loneliness compared with robustness (3 studies: pooled OR=3.51, 95%CI=2.70–4.56 for frailty, pooled OR=1.88, 95%CI=1.57–2.25 for prefrailty) and compared with non-frailty (4 studies: pooled OR=2.05, 95%CI=1.76–2.39). A meta-analysis involving two longitudinal studies showed that baseline loneliness was associated with a significantly higher risk of worsening frailty (2 studies: pooled OR=1.41, 95%CI=1.16–1.72).ConclusionsThis systematic review and meta-analysis was the first, to our knowledge, to quantitatively demonstrate significant cross-sectional and longitudinal associations between loneliness and frailty in community-dwelling older adults.     

The anorexia of ageing: Physiopathology,prevalence, associated comorbidity and mortality. A systematic review

The physiological processes of ageing and factors prevalent in the elderly such as comorbidities and polypharmacy often cause loss of appetite in the elderly, which we call anorexia of ageing. Social factors, together with changes in the sensory organs, can be important causes of a reduction in both appetite and ingestion. This review assesses the regulation of appetite in the elderly and the development of anorexia of ageing. It also examines the prevalence of this type of anorexia, its associated comorbidities and mortality rates. We have reviewed 27 studies, with a total of 6208 patients. These reported changes in the secretion and response of both central and peripheral hormones that regulate appetite. Anorexia, very prevalent among hospitalized and institutionalized elderly people, is associated with comorbidity and represents a predictive factor for mortality. No treatment for it has been proved to be effective. The mechanism regulating ingestion in elderly people is complex and difficult to resolve. Comorbidity as a cause or a consequence of anorexia of ageing has become a research field of great interest in geriatrics. A correct nutritional evaluation is a fundamental part of an integrated geriatric assessment.     

Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults

Study ObjectivesTo determine whether actigraphy-measured sleep was independently associated with risk of frailty and mortality over a 5-year period among older adults.MethodsWe used data from Waves 2 (W2) and 3 (W3) (2010–2015) of the National Social Life, Health and Aging Project, a prospective cohort of community-dwelling older adults born between 1920 and 1947. One-third of W2 respondents were randomly selected to participate in a sleep study, of whom N = 727 consented and N = 615 were included in the analytic sample. Participants were instructed to wear a wrist actigraph for 72 h (2.93 ± 0.01 nights). Actigraphic sleep parameters were averaged across nights and included total sleep time, percent sleep, sleep fragmentation index, and wake after sleep onset. Subjective sleep was collected via questionnaire. Frailty was assessed using modified Fried Frailty Index. Vital status was ascertained at the time of the W3 interview. W3 frailty/mortality status was analyzed jointly with a four-level variable: robust, pre-frail, frail, and deceased. Associations were modeled per 10-unit increase.ResultsAfter controlling for baseline frailty (robust and pre-frail categories), age, sex, education, body mass index, and sleep time preference, a higher sleep fragmentation index was associated with frailty (OR = 1.70, 95% CI: 1.02–2.84) and mortality (OR = 2.12, 95% CI: 1.09–4.09). Greater wake after sleep onset (OR = 1.24, 95% CI: 1.02–1.50) and lower percent sleep (OR = 0.41, 95% CI: 0.17–0.97) were associated with mortality.ConclusionsAmong community-dwelling older adults, actigraphic sleep is associated with frailty and all-cause mortality over a 5-year period. Further investigation is warranted to elucidate the physiological mechanisms underlying these associations.     

Frailty in people living with HIV

The life expectancy of people living with HIV (PLHIV) has dramatically improved with effective and well-tolerated antiretroviral therapy. This presents a new challenge in caring for this patient population, with up to 28% of older PLHIV being identified as frail. Studies suggest that the prevalence of frailty is higher in PLHIV compared to the general population, and that the onset of frailty occurs at an earlier age. Frail individuals often present with multiple and non-specific health complaints, fluctuating disability, falls and delirium, and are at higher risk for multiple adverse outcomes, post-operative complications, poor responses to vaccination and functional decline. They tend to require longer hospital admissions, are more likely to require nursing home care, and are at greater risk of mortality. The degree of frailty can fluctuate over time. Limited evidence exists to support the reversal of frailty, but epidemiological evidence suggests that interventions to assess and manage co-morbidities, reducing risk factors such as smoking, increasing exercise and optimising BMI, and improving personal and community resources, are all likely to reduce the risk of frailty. Physicians who care for PLHIV need to recognise and manage frailty in this patient population. This includes an understanding of: when to intervene aggressively in the management of an older patient with a new HIV diagnosis to delay or prevent permanent debility and frailty; when to acknowledge that the patient has become frail; and the role of geriatric medicine in addressing the specific issues and needs of this patient, such as maximising functional ability, preventing falls, reducing social isolation and improving quality of life.     

Relationship between depression and frailty in older adults: A systematic review and meta-analysis

AimDepression and frailty are prevalent and burdensome in older age. However, the relationships between these entities are unclear and no quantitative meta- analysis exists. We conducted a systematic review and meta-analysis to investigate the associations between depression and frailty.MethodsTwo authors searched major electronic databases from inception until November-2016 for cross-sectional/longitudinal studies investigating depression and frailty. The strength of the reciprocal associations between frailty and depression was assessed through odds ratios (ORs) adjusted for potential confounders.ResultsFrom 2306 non duplicated hits, 24 studies were included. The overall prevalence of depression in 8023 people with frailty was 38.60% (95% CI 30.07–47.10, I² = 94%). Those with frailty were at increased odds of having depression (OR adjusted for publication bias 4.42, 95%CI 2.66–7.35, k = 11), also after adjusting for potential confounders (OR = 2.64; 95%CI: 1.59–4.37, I² = 55%, k = 4). The prevalence of frailty in 2167 people with depression was 40.40% (95%CI 27.00–55.30, I² = 97%). People with depression were at increased odds of having frailty (OR = 4.07, 95%CI 1.93–8.55, k = 8). The pooled OR for incident frailty, adjusted for a median of 7 confounders, was 3.72 (95%CI 1.95–7.08, I² = 98%, k = 4), whilst in two studies frailty increased the risk of incident depression with an OR = 1.90 (95%CI 1.55–2.32, I² = 0%).ConclusionThis meta-analysis points to a reciprocal interaction between depression and frailty in older adults. Specifically, each condition is associated with an increased prevalence and incidence of the other, and may be a risk factor for the development of the other. However, further prospective investigations are warranted.     

Study protocol: High-protein nutritional intervention based on β-hydroxy-β-methylbutirate,vitamin D3 and calcium on obese and lean aged patients with hip fractures and sarcopenia. The HIPERPROT-GER study

Introduction

Loss of muscle strength is associated with falls, which, in turn, are the main cause of hip fractures in elderly people. The factors that most influence loss of strength in elderly people are a decrease in muscle mass, i.e. sarcopenia, and an increase in fat, i.e. obesity.

Methods

A prospective randomized clinical trial among patients who have undergone an operation for a traumatic hip fracture and who are aged 65 or above will be implemented. We shall compare a control diet against a high-protein diet enriched with β-hydroxy-βmethylbutirate, calcium and vitamin D. The diet will be administered during 30 days of hospitalization in the orthopaedic geriatric rehabilitation unit. There will be 50 patients in each arm of the study. The main objective is to assess whether the experimental diet, together with rehabilitation, improves functional recovery, measured on the Barthel index. Secondary objectives are to assess changes in body composition and the prevalence of sarcopenia, obesity and mortality one year after the hip fracture. We shall also assess whether there is a relationship between specific inflammatory markers, sarcopenia and functional recovery.

Conclusions

Ageing is accompanied by changes in body composition that increase the risk of falls and progressive functional loss. These factors are a public health problem because they are highly associated with disability in older people. The present study seeks to gain knowledge of those factors that are most often associated with the onset of disability and those that can be modified through diet.     

Impact of frailty on all-cause mortality or major amputation in patients with lower extremity peripheral artery disease: A meta-analysis

BackgroundFrailty has been increasingly identified as a risk factor of adverse outcomes in vascular disease. However, its impact on the survival and amputation in patients with lower extremity peripheral artery disease (PAD) remains controversial. This meta-analysis aimed to examine the value of frailty in predicting all-cause mortality or major amputation in patients with lower extremity PAD.MethodsPubMed, Embase, Web of Sciences, and Scopus databases (up to April 7, 2022) were comprehensively searched to identify relevant studies that investigated the association between frailty and all-cause mortality or major amputation in patients with lower extremity PAD. The impact of frailty on adverse outcomes was summarized by pooling the fully adjusted hazard ratio (HR) with 95% confidence intervals (CI) using a random effect (DerSimonian-Laird) model.ResultsSeven studies reporting on eight articles that involved 122,892 patients were included. The prevalence of frailty ranged from 42% to 80% based on the frailty tool used. Meta-analysis showed that frailty was associated with an increased risk of 30-day all-cause mortality (HR 2.11; 95% CI 1.41–3.15; I² =47.6%, p = 0.148, Tau-squared=0.058) and long-term all-cause mortality (HR 1.86; 95% CI 1.25–2.76; I² =76.1%, p = 0.002, Tau-squared=0.118). However, no clear association was observed between frailty and major amputation (HR 1.07; 95% CI 0.83–1.36; I² =23.0%, p = 0.273, Tau-squared=0.019).ConclusionFrailty independently predicts short and long-term all-cause mortality but not major amputation in patients with lower extremity PAD. Frailty status may play an important role in risk stratification of lower extremity PAD.     

Prevalence of frailty in patients with lower extremity peripheral arterial disease: A systematic review and meta-analysis

BackgroundIncreasing studies have reported on the prevalence of frailty in patients with peripheral artery disease (PAD). The aim of this systematic review and meta-analysis was to estimate the pooled prevalence of frailty in patients with lower extremity PAD.MethodsTwo authors systematically searched PubMed and Embase databases from their inception to August 8, 2022. Original articles that reported the prevalence of frailty in patients with lower extremity PAD were included. The prevalence of frailty in patients with lower extremity PAD was pooled using a random-effect model. Meta-regression, subgroup, and sensitivity analyses were conducted to explore the heterogeneity.ResultsEighteen studies reported on 17 articles involving 1,726,343 patients with lower extremity PAD were identified. The pooled prevalence of frailty in patients with lower extremity PAD was 49 % (95 % confidence interval [CI] 37–61 %), with significant heterogeneity between studies (I ² = 100 %, p < 0.001). Multivariable meta-regression showed that only the severity of PAD (coefficient 0.270; 95 % CI 0.017–0.523, p = 0.039) was significantly associated with the heterogeneity. In subgroup analysis, the pooled prevalence of frailty was higher in critical limb ischemia or chronic limb-threatening ischemia (54 %) than all PAD (48 %); the pooled prevalence of frailty was 64 %, 51 %, and 54 % for Modified Frailty Index-5, Modified Frailty Index-11, and Clinical Frailty Scale, respectively. The pooled prevalence of frailty appeared to be lower in male (39 %) than the female patients (47 %).ConclusionsThe prevalence of frailty was higher in patients with lower extremity PAD, suggesting frailty is a common condition. This finding highlights the significance of assessing frailty in patients with lower extremity PAD.     

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR = 1.70 [95%CI, 1.18–2.45]; I² = 66%) and pre-frail (HR = 1.23 [95%CI, 1.07–1.36]; I² = 67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.