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:
- Prospective study design.
- Community-dwelling individuals.
- Mean age of 65 years or older.
- Frailty defined by original or modified versions of validated frailty criteria based on physical components.
- 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.