Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis | Geriatrics | JAMA Network Open | JAMA Network
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    1 Comment for this article
    What is the status of Frail Older Adults in Low Income Regions?
    Jagadish Chhetri, M.D | Department of Neurobiology, Neurology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China; NSGG, Kathmandu, Nepal
    In this meta-analysis on the global incidence of frailty and prefrailty, the authors have shown that there is a very high risk of being frail or prefrail in old age. Moreover, it is quite worrying to see that older people in Low and middle income countries (LMICs) had higher risk (almost double) of developing frailty or prefrailty compared to the high income countries (HICs).

    In the last decade, the concept of frailty has profoundly captured the attention of researchers and clinicians worldwide. “Frailty” originally considered as a mere research entity is now acknowledged as a modern geriatric giant
    as it could lead to many adverse outcomes in old age including repeated hospitalizations, high healthcare cost, disability and death. Hence, many HICs have long been working on reducing the burden of frailty by conducting researches extensively to identify modifiable risk factors of frailty, and even by establishing frailty clinics for screening and providing possible intervention techniques. While on the other hand there is very limited evidence of frailty in LMICs, particularly in the low income countries (LICs) (both in literature and clinical practice), although there has been indication of almost half of the older population in these regions to be frail, which is alarming.

    In this context, perhaps it is about time to consider frailty as a public health priority, even in the lowest income regions, so as to lower the unseen burden of frailty. Training of the clinicians to identify frail older patients in the community, and conduct studies to investigate country specific risk-factors could be the first step to address the negative consequences of frailty. Implementation of public health strategies based on these findings could further lower the risk of developing frailty or prefrailty in the LICs.
    Original Investigation
    August 2, 2019

    Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
    • 2Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
    • 3Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
    • 4Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
    • 5Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
    • 6Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
    • 7Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
    • 8Institute of Biomedicine, University of Turku, Turku, Finland
    • 9Department of Aged Care, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
    • 10Centre for Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
    JAMA Netw Open. 2019;2(8):e198398. doi:10.1001/jamanetworkopen.2019.8398
    Key Points español 中文 (chinese)

    Question  What is the incidence of frailty and prefrailty among community-dwelling adults 60 years or older?

    Findings  In this systematic review and meta-analysis involving data from more than 120 000 older adults from 28 countries, the incidence of frailty and prefrailty was estimated as 43.4 and 150.6 new cases per 1000 person-years, respectively. The frailty and prefrailty incidence rates varied by sex, diagnostic criteria, and country income level.

    Meaning  Results of this study suggest that the risk of developing frailty and prefrailty is high among community-living older adults; as such, appropriate interventions are needed.


    Importance  Frailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level.

    Objective  To estimate the global incidence of frailty and prefrailty among community-dwelling adults 60 years or older.

    Data Sources  MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Plus, and AMED (Allied and Complementary Medicine Database) were searched from inception to January 2019 without language restrictions using combinations of the keywords frailty, older adults, and incidence. The reference lists of eligible studies were hand searched.

    Study Selection  In the systematic review, 2 authors undertook the search, article screening, and study selection. Cohort studies that reported or had sufficient data to compute incidence of frailty or prefrailty among community-dwelling adults 60 years or older at baseline were eligible.

    Data Extraction and Synthesis  The methodological quality of included studies was assessed using The Joanna Briggs Institute’s Critical Appraisal Checklist for Prevalence and Incidence Studies. Meta-analysis was conducted using a random-effects (DerSimonian and Laird) model.

    Main Outcomes and Measures  Incidence of frailty (defined as new cases of frailty among robust or prefrail individuals) and incidence of prefrailty (defined as new cases of prefrailty among robust individuals), both over a specified duration.

    Results  Of 15 176 retrieved references, 46 observational studies involving 120 805 nonfrail (robust or prefrail) participants from 28 countries were included in this systematic review. Among the nonfrail individuals who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail, with the pooled incidence rate being 43.4 (95% CI, 37.3-50.4; I2 = 98.5%) cases per 1000 person-years. The incidence of frailty was significantly higher in prefrail individuals than robust individuals (pooled incidence rates, 62.7 [95% CI, 49.2-79.8; I2 = 97.8%] vs 12.0 [95% CI, 8.2-17.5; I2 = 94.9%] cases per 1000 person-years, respectively; P for difference < .001). Among robust individuals in 21 studies who survived a median follow-up of 2.5 (range, 1.0-10.0) years, 30.9% (9974 of 32 268) became prefrail, with the pooled incidence rate being 150.6 (95% CI, 123.3-184.1; I2 = 98.9%) cases per 1000 person-years. The frailty and prefrailty incidence rates were significantly higher in women than men (frailty: 44.8 [95% CI, 36.7-61.3; I2 = 97.9%] vs 24.3 [95% CI, 19.6-30.1; I2 = 8.94%] cases per 1000 person-years; prefrailty: 173.2 [95% CI, 87.9-341.2; I2 = 99.1%] vs 129.0 [95% CI, 73.8-225.0; I2 = 98.5%] cases per 1000 person-years). The incidence rates varied by diagnostic criteria and country income level. The frailty and prefrailty incidence rates were significantly reduced when accounting for the risk of death.

    Conclusions and Relevance  Results of this study suggest that community-dwelling older adults are prone to developing frailty. Increased awareness of the factors that confer high risk of frailty in this population subgroup is vital to inform the design of interventions to prevent frailty and to minimize its consequences.