Frailty as a predictor of mortality in the oldest old: A systematic review and meta-analysis

IF 2.4 4区医学 Q3 GERIATRICS & GERONTOLOGY

Geriatrics & Gerontology International Pub Date : 2024-11-24 DOI:10.1111/ggi.15025

Justina Angel Tan, Jin Hean Koh, Reshma Aziz Merchant, Li Feng Tan

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引用次数: 0

Abstract

Aim

Frailty is highly prevalent in old age and is associated with a high risk of mortality. Few studies have evaluated frailty as a predictor of mortality in the oldest old. This systematic review and meta-analysis aims to determine the mortality risk associated with frailty in this age group.

Methods

An electronic systemic literature search was performed in May 2023 on three databases (Medline/PubMed, Embase, and Cochrane Library) for studies investigating the risk of mortality with frailty. A meta-analysis was done to calculate pooled mortality estimates.

Results

Frail participants had significantly lower overall survival (OS) compared with non-frail participants (hazard ratio [HR]: 1.81; 95% confidence interval [CI]: 1.32 to 2.50; P < 0.01, I² = 100%; risk ratio [RR]: 4.15; 95% CI: 2.50 to 6.88; P < 0.01, I² = 97%). Among participants aged 90 and above, a higher percentage of male participants was associated with poorer OS in frail participants. While the pooled association of frailty with OS remained significant across studies in participants aged less than 90 years old (HR: 2.09; 95% CI: 1.55 to 2.82; I² = 75%), frailty was not significantly associated with OS in studies for participants aged 90 and above. The pooled association of frailty with OS was only significant for the Fried Frailty Phenotype (HR: 2.73; 95% CI: 1.05 to 7.12; I² = 93%) and not for the Frailty Index. The pooled association also remained significant among studies that adjusted for age (HR: 1.74; 95% CI: 1.50 to 2.02; I² = 0%) and sex (HR: 1.77; 95% CI: 1.48 to 2.11; I² = 94%) as a covariate.

Conclusions

Frailty was significantly associated with a poorer OS in participants below the age of 90. This association was not statistically significant in those older than 90 years, with sex-differentiated effects observed. Geriatr Gerontol Int 2025; 25: 102–107.

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作为高龄老人死亡率预测因素的虚弱：系统回顾和荟萃分析。

目的：虚弱是老年人的高发病，与高死亡风险相关。很少有研究将虚弱作为预测高龄老人死亡率的指标进行评估。本系统综述和荟萃分析旨在确定该年龄组与虚弱相关的死亡率风险：方法：2023 年 5 月，我们在三个数据库（Medline/PubMed、Embase 和 Cochrane Library）中进行了电子系统文献检索，以查找与虚弱相关的死亡风险研究。通过荟萃分析，计算出了汇总的死亡率估计值：结果：与非虚弱参与者相比，虚弱参与者的总生存率（OS）明显较低（危险比 [HR]：1.81；95% 置信区间 [CI]：1.32 至 2.50；P 2 = 100%；风险比 [RR]：4.15；95% 置信区间：2.50 至 6.88；P 2 = 97%）。在90岁及以上的参与者中，男性参与者比例越高，体弱参与者的OS越差。虽然在90岁以下的参与者中，虚弱与OS的总体相关性在各项研究中仍具有显著性（HR：2.09；95% CI：1.55至2.82；I2 = 75%），但在90岁及以上的参与者中，虚弱与OS的相关性并不显著。只有弗里德虚弱表型（HR：2.73；95% CI：1.05 至 7.12；I2 = 93%）和虚弱指数（Frailty Index）的汇总结果显示，虚弱与 OS 的关系显著。在对年龄（HR：1.74；95% CI：1.50 至 2.02；I2 = 0%）和性别（HR：1.77；95% CI：1.48 至 2.11；I2 = 94%）作为协变量进行调整的研究中，汇总的关联性仍然显著：在90岁以下的参与者中，体弱与较差的OS明显相关。结论：在90岁以下的参与者中，虚弱与较差的OS有明显相关性，而在90岁以上的参与者中，这种相关性在统计学上并不显著，而且观察到了性别差异效应。Geriatr Gerontol Int 2024; --：-----.

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来源期刊

Geriatrics & Gerontology International 医学-老年医学

CiteScore

5.50

自引率

6.10%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Geriatrics & Gerontology International is the official Journal of the Japan Geriatrics Society, reflecting the growing importance of the subject area in developed economies and their particular significance to a country like Japan with a large aging population. Geriatrics & Gerontology International is now an international publication with contributions from around the world and published four times per year.