Frailty and Risks of All-cause and Cause-specific Death in Community-dwelling Adults: a Systematic Review and Meta-analysis

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2022 Sep 2

PMID 36056319

Authors

Yang Peng

Guo-Chao Zhong

Xiaoli Zhou

Lijuan Guan

Lihua Zhou

Affiliations

Soon will be listed here.

Abstract

Background: The associations of frailty with all-cause and cause-specific mortality remain unclear. Therefore, we performed this meta-analysis to fill this gap.

Methods: We searched the PubMed and Embase databases through June 2022. Prospective cohort studies or clinical trials examining frailty were evaluated, and the multiple adjusted risk estimates of all-cause and cause-specific mortality, such as death from cardiovascular disease (CVD), cancer, respiratory illness, dementia, infection, and coronavirus disease 2019 (COVID-19), were included. A random effects model was used to calculate the summary hazard ratio (HR).

Results: Fifty-eight studies were included for the qualitative systematic review, of which fifty-six studies were eligible for the quantitative meta-analysis, and the studies included a total of 1,852,951 individuals and more than 145,276 deaths. Compared with healthy adults, frail adults had a significantly higher risk of mortality from all causes (HR 2.40; 95% CI 2.17-2.65), CVD (HR 2.64; 95% CI 2.20-3.17), respiratory illness (HR 4.91; 95% CI 2.97-8.12), and cancer (HR 1.97; 95% CI 1.50-2.57). Similar results were found for the association between prefrail adults and mortality risk. In addition, based on the studies that have reported the HRs of the mortality risk per 0.1 and per 0.01 increase in the frailty index, we obtained consistent results.

Conclusions: The present study demonstrated that frailty was not only significantly related to an increased risk of all-cause mortality but was also a strong predictor of cause-specific mortality from CVD, cancer, and respiratory illness in community-dwelling adults. More studies are warranted to clarify the relationship between frailty and cause-specific mortality from dementia, infection, and COVID-19.

Trial Registration: PROSPERO (CRD42021276021).

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References

Higueras-Fresnillo S, Cabanas-Sanchez V, Lopez-Garcia E, Esteban-Cornejo I, Banegas J, Sadarangani K . Physical Activity and Association Between Frailty and All-Cause and Cardiovascular Mortality in Older Adults: Population-Based Prospective Cohort Study. J Am Geriatr Soc. 2018; 66(11):2097-2103. DOI: 10.1111/jgs.15542. View

Hoogendijk E, Theou O, Rockwood K, Onwuteaka-Philipsen B, Deeg D, Huisman M . Development and validation of a frailty index in the Longitudinal Aging Study Amsterdam. Aging Clin Exp Res. 2016; 29(5):927-933. PMC: 5589777. DOI: 10.1007/s40520-016-0689-0. View

Lohman M, Sonnega A, Resciniti N, Leggett A . Frailty Phenotype and Cause-Specific Mortality in the United States. J Gerontol A Biol Sci Med Sci. 2020; 75(10):1935-1942. PMC: 7518553. DOI: 10.1093/gerona/glaa025. View

Srinonprasert V, Chalermsri C, Aekplakorn W . Frailty index to predict all-cause mortality in Thai community-dwelling older population: A result from a National Health Examination Survey cohort. Arch Gerontol Geriatr. 2018; 77:124-128. DOI: 10.1016/j.archger.2018.05.002. View

At J, Bryce R, Prina M, Acosta D, Ferri C, Guerra M . Frailty and the prediction of dependence and mortality in low- and middle-income countries: a 10/66 population-based cohort study. BMC Med. 2015; 13:138. PMC: 4481121. DOI: 10.1186/s12916-015-0378-4. View

Woods N, LaCroix A, Gray S, Aragaki A, Cochrane B, Brunner R . Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005; 53(8):1321-30. DOI: 10.1111/j.1532-5415.2005.53405.x. View

Theou O, Rockwood M, Mitnitski A, Rockwood K . Disability and co-morbidity in relation to frailty: how much do they overlap?. Arch Gerontol Geriatr. 2012; 55(2):e1-8. DOI: 10.1016/j.archger.2012.03.001. View

Gobbens R, van Assen M, Luijkx K, Wijnen-Sponselee M, Schols J . The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010; 11(5):344-55. DOI: 10.1016/j.jamda.2009.11.003. View

Veronese N, Cereda E, Stubbs B, Solmi M, Luchini C, Manzato E . Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis. Ageing Res Rev. 2017; 35:63-73. PMC: 6047747. DOI: 10.1016/j.arr.2017.01.003. View

10.

Collard R, Boter H, Schoevers R, Oude Voshaar R . Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60(8):1487-92. DOI: 10.1111/j.1532-5415.2012.04054.x. View

11.

Zhang L, Ji T, Sun F, Li Y, Tang Z, Ma L . A Simplified Frailty Index Predicts Mortality in Older Adults in Beijing. Risk Manag Healthc Policy. 2021; 14:4867-4873. PMC: 8650771. DOI: 10.2147/RMHP.S302354. View

12.

Baek W, Min A . Frailty index and gender-specific mortality in Korean adults: Findings from the Korean Longitudinal Study of Aging (2006-2018). J Adv Nurs. 2022; 78(8):2397-2407. DOI: 10.1111/jan.15168. View

13.

Clegg A, Young J, Iliffe S, Rikkert M, Rockwood K . Frailty in elderly people. Lancet. 2013; 381(9868):752-62. PMC: 4098658. DOI: 10.1016/S0140-6736(12)62167-9. View

14.

Ensrud K, Ewing S, Taylor B, Fink H, Stone K, Cauley J . Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007; 62(7):744-51. DOI: 10.1093/gerona/62.7.744. View

15.

Graham J, Al Snih S, Berges I, Ray L, Markides K, Ottenbacher K . Frailty and 10-year mortality in community-living Mexican American older adults. Gerontology. 2009; 55(6):644-51. PMC: 2783319. DOI: 10.1159/000235653. View

16.

Rockwood K, Mitnitski A . Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2010; 27(1):17-26. DOI: 10.1016/j.cger.2010.08.008. View

17.

Fan J, Yu C, Guo Y, Bian Z, Sun Z, Yang L . Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study. Lancet Public Health. 2020; 5(12):e650-e660. PMC: 7708389. DOI: 10.1016/S2468-2667(20)30113-4. View

18.

Wuorela M, Lavonius S, Salminen M, Vahlberg T, Viitanen M, Viikari L . Self-rated health and objective health status as predictors of all-cause mortality among older people: a prospective study with a 5-, 10-, and 27-year follow-up. BMC Geriatr. 2020; 20(1):120. PMC: 7106830. DOI: 10.1186/s12877-020-01516-9. View

19.

Vermeiren S, Vella-Azzopardi R, Beckwee D, Habbig A, Scafoglieri A, Jansen B . Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc. 2016; 17(12):1163.e1-1163.e17. DOI: 10.1016/j.jamda.2016.09.010. View

20.

Weng S, Lin C, Tarng D, Lin S . Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study. BMC Geriatr. 2021; 21(1):92. PMC: 7849094. DOI: 10.1186/s12877-020-01971-4. View