Prefrailty prevalence and all-cause mortality risk in older adults from the general population: A meta-analysis of prospective cohort studies.

Abstract

Aim: Prefrailty represents an intermediate stage between robust health and frailty. This meta-analysis aimed to estimate the global prevalence of prefrailty and evaluate its association with all-cause mortality in older adults from the general population.

Methods: Two independent reviewers systematically searched PubMed, Web of Science, and Embase for relevant studies published through to December 10, 2024. Eligible studies reported either prefrailty prevalence or all-cause mortality risk in older adults from the general population aged 65 years and older.

Results: The analysis included 26 studies (25 articles; N = 222 473). The included studies utilized the Fried frailty phenotype and frailty index to define prefrailty. The pooled prefrailty prevalence was 45% (95% confidence interval [CI] 42-48%), with similar rates across assessment methods. Prefrailty significantly increased all-cause mortality risk (hazard ratio [HR] 1.38; 95% CI 1.32-1.45). Sex-specific analyses showed a marginally higher risk in men (HR 1.39; 95% CI 1.30-1.49) than in women (HR 1.33; 95% CI 1.25-1.41). Mortality associations were stronger when prefrailty was defined by the frailty index (HR 1.47; 95% CI 1.35-1.61) than by phenotype (HR 1.37; 95% CI 1.32-1.42).

Conclusions: Nearly half of older adults exhibit prefrailty, which confers a 38% increased mortality risk in older adults from the general population. These findings underscore the need for early identification and intervention in this high-risk subgroup. Geriatr Gerontol Int 2025; ••: ••-••.