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

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; 25: 1167–1177.