Frailty as a predictor of hospitalisation among community-dwelling older people: a systematic review and meta-analysis

G. Kojima

J Epidemiol Community Health. 2016;70(7):722-9

This study aims to identify studies on physical frailty as a predictor of hospitalization risks and to pool the risk estimates among community-dwelling older people.

A systematic literature search was performed in August 2015 using five databases: EMBASE, MEDLINE, CINAHL, PsycINFO and the Cochrane Library for prospective studies examining physical frailty as a predictor of hospitalization published in 2000 or later. OR and HR were combined to synthesize pooled effect measures using fixed-effects models. The included studies were assessed for heterogeneity, methodological quality and publication bias. Subgroup analysis and meta-regression analysis were conducted to examine study characteristics in relation to the hospitalization risks. The inclusion criteria were as follows:

  1. Prospective study design.
  2. Community-dwelling individuals.
  3. Mean age of 65 years or older.
  4. Frailty defined by original or modified versions of validated frailty criteria based on physical components.
  5. OR, risk ratio (RR) or HR provided as a risk measure or computable from available data.

Of the 4620 studies identified by the systematic review, 13 studies with average follow-up period of 3.1 years were selected. Frailty and prefrailty were significantly associated with higher hospitalization risks among 10 studies with OR (pooled OR=1.90, 95% CI 1.74–2.07, p<0.00001; pooled OR=1.26, 95% CI 1.18–1.33, p<0.00001, respectively) and 3 studies with HR (pooled HR=1.30, 95% CI 1.12–1.52, p=0.0007; pooled HR=1.13, 95% CI 1.04–1.24, p=0.005, respectively). Heterogeneity was low to moderate. No publication bias was detected. The studies with older populations and unadjusted outcome measures were associated with higher hospitalization risks in the subgroup analysis.

Comment: This systematic review and meta-analysis has demonstrated that physical frailty was a significant predictor of hospitalization among community-dwelling older people. The hospitalization risks according to frailty may be higher among those with advanced age. Interventions targeted at reducing frailty may potentially reduce hospitalization risks.