Natural Regression of Frailty among Community-Dwelling Older Adults aged 60 years and Older

A Systematic Review and Meta-Analysis

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background and Objectives: Frailty is a dynamic process with potential transitions over time. However, there is limited understanding of the patterns of frailty improvement. We conducted a systematic review and meta-analysis to estimate the natural rate of frailty regression among community-dwelling older adults aged at least 60 years. Research Design and Methods: Systematic searches for studies reporting frailty improvement were performed in 5 databases (Medline, Embase, CINAHL plus, Web of Science, and PsycINFO) from inception until January 2019. Results: Twenty-five studies from 26 countries were included. Among a baseline population of more than 50,000 individuals, the pooled prevalence of pre-frailty and frailty was 50.5% (95% confidence interval [CI] 47.8–53.3) and 12.8% (95% CI 9.1–17.0), respectively. During a median follow-up of 3.0 (range 1–10.0) years, 23.3% of surviving pre-frail individuals regressed to a robust state and 35.2% of surviving frail individuals reversed to a pre-frail or robust state. The pooled remission rates among people with pre-frailty and frailty were 80.4 (95% CI 61.7–104.6) and 135.3 (95% CI 98.1–186.5) per 1,000 person-years, respectively. Frailty and pre-frailty improvement rates varied by sex, diagnostic criteria, study region, and follow-up duration. The remission rates were significantly reduced when accounting for progressions to death. The heterogeneity of included studies was high which reflected considerable differences in methodological approach. Discussion and Implications: Although frailty is highly prevalent in older people, natural remission is possible and common. Improved understanding of the factors that confer increased likelihood of frailty regression may support the design of interventions to reduce the burden of frailty.
Original languageEnglish
Number of pages13
JournalThe Gerontologist
DOIs
Publication statusAccepted/In press - 22 May 2019

Cite this

@article{93b620df0d45405290fb3cd180a07c2e,
title = "Natural Regression of Frailty among Community-Dwelling Older Adults aged 60 years and Older: A Systematic Review and Meta-Analysis",
abstract = "Background and Objectives: Frailty is a dynamic process with potential transitions over time. However, there is limited understanding of the patterns of frailty improvement. We conducted a systematic review and meta-analysis to estimate the natural rate of frailty regression among community-dwelling older adults aged at least 60 years. Research Design and Methods: Systematic searches for studies reporting frailty improvement were performed in 5 databases (Medline, Embase, CINAHL plus, Web of Science, and PsycINFO) from inception until January 2019. Results: Twenty-five studies from 26 countries were included. Among a baseline population of more than 50,000 individuals, the pooled prevalence of pre-frailty and frailty was 50.5{\%} (95{\%} confidence interval [CI] 47.8–53.3) and 12.8{\%} (95{\%} CI 9.1–17.0), respectively. During a median follow-up of 3.0 (range 1–10.0) years, 23.3{\%} of surviving pre-frail individuals regressed to a robust state and 35.2{\%} of surviving frail individuals reversed to a pre-frail or robust state. The pooled remission rates among people with pre-frailty and frailty were 80.4 (95{\%} CI 61.7–104.6) and 135.3 (95{\%} CI 98.1–186.5) per 1,000 person-years, respectively. Frailty and pre-frailty improvement rates varied by sex, diagnostic criteria, study region, and follow-up duration. The remission rates were significantly reduced when accounting for progressions to death. The heterogeneity of included studies was high which reflected considerable differences in methodological approach. Discussion and Implications: Although frailty is highly prevalent in older people, natural remission is possible and common. Improved understanding of the factors that confer increased likelihood of frailty regression may support the design of interventions to reduce the burden of frailty.",
author = "Richard Ofori-Asenso and Chin, {Ken Lee} and Mohsen Mazidi and Ella Zomer and Jenni Ilomaki and Zanfina Ademi and Bell, {J. Simon} and Danny Liew",
year = "2019",
month = "5",
day = "22",
doi = "10.1093/geront/gnz064",
language = "English",
journal = "The Gerontologist",
issn = "0016-9013",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Natural Regression of Frailty among Community-Dwelling Older Adults aged 60 years and Older

T2 - A Systematic Review and Meta-Analysis

AU - Ofori-Asenso, Richard

AU - Chin, Ken Lee

AU - Mazidi, Mohsen

AU - Zomer, Ella

AU - Ilomaki, Jenni

AU - Ademi, Zanfina

AU - Bell, J. Simon

AU - Liew, Danny

PY - 2019/5/22

Y1 - 2019/5/22

N2 - Background and Objectives: Frailty is a dynamic process with potential transitions over time. However, there is limited understanding of the patterns of frailty improvement. We conducted a systematic review and meta-analysis to estimate the natural rate of frailty regression among community-dwelling older adults aged at least 60 years. Research Design and Methods: Systematic searches for studies reporting frailty improvement were performed in 5 databases (Medline, Embase, CINAHL plus, Web of Science, and PsycINFO) from inception until January 2019. Results: Twenty-five studies from 26 countries were included. Among a baseline population of more than 50,000 individuals, the pooled prevalence of pre-frailty and frailty was 50.5% (95% confidence interval [CI] 47.8–53.3) and 12.8% (95% CI 9.1–17.0), respectively. During a median follow-up of 3.0 (range 1–10.0) years, 23.3% of surviving pre-frail individuals regressed to a robust state and 35.2% of surviving frail individuals reversed to a pre-frail or robust state. The pooled remission rates among people with pre-frailty and frailty were 80.4 (95% CI 61.7–104.6) and 135.3 (95% CI 98.1–186.5) per 1,000 person-years, respectively. Frailty and pre-frailty improvement rates varied by sex, diagnostic criteria, study region, and follow-up duration. The remission rates were significantly reduced when accounting for progressions to death. The heterogeneity of included studies was high which reflected considerable differences in methodological approach. Discussion and Implications: Although frailty is highly prevalent in older people, natural remission is possible and common. Improved understanding of the factors that confer increased likelihood of frailty regression may support the design of interventions to reduce the burden of frailty.

AB - Background and Objectives: Frailty is a dynamic process with potential transitions over time. However, there is limited understanding of the patterns of frailty improvement. We conducted a systematic review and meta-analysis to estimate the natural rate of frailty regression among community-dwelling older adults aged at least 60 years. Research Design and Methods: Systematic searches for studies reporting frailty improvement were performed in 5 databases (Medline, Embase, CINAHL plus, Web of Science, and PsycINFO) from inception until January 2019. Results: Twenty-five studies from 26 countries were included. Among a baseline population of more than 50,000 individuals, the pooled prevalence of pre-frailty and frailty was 50.5% (95% confidence interval [CI] 47.8–53.3) and 12.8% (95% CI 9.1–17.0), respectively. During a median follow-up of 3.0 (range 1–10.0) years, 23.3% of surviving pre-frail individuals regressed to a robust state and 35.2% of surviving frail individuals reversed to a pre-frail or robust state. The pooled remission rates among people with pre-frailty and frailty were 80.4 (95% CI 61.7–104.6) and 135.3 (95% CI 98.1–186.5) per 1,000 person-years, respectively. Frailty and pre-frailty improvement rates varied by sex, diagnostic criteria, study region, and follow-up duration. The remission rates were significantly reduced when accounting for progressions to death. The heterogeneity of included studies was high which reflected considerable differences in methodological approach. Discussion and Implications: Although frailty is highly prevalent in older people, natural remission is possible and common. Improved understanding of the factors that confer increased likelihood of frailty regression may support the design of interventions to reduce the burden of frailty.

U2 - 10.1093/geront/gnz064

DO - 10.1093/geront/gnz064

M3 - Review Article

JO - The Gerontologist

JF - The Gerontologist

SN - 0016-9013

ER -