Prevalence and Risk Factors for Frailty Among Community-Dwelling Older People in China: A Systematic Review and Meta-Analysis

• Published in: The Journal of nutrition, health & aging health & aging, 2019-05, Vol.23 (5), p.442-450
• Main Authors: He, B., Ma, Y., Wang, C., Jiang, M., Geng, C., Chang, X., Ma, B., Han, Lin
• Format: Article
• Language: English
• Subjects: Activities of daily living; Age; Aged; Aged, 80 and over; Aging; China; Chronic illnesses; Cross-Sectional Studies; Evidence-based medicine; Female; Females; Frail Elderly - statistics & numerical data; Frailty; Frailty - epidemiology; Geriatrics/Gerontology; Humans; Independent Living - trends; Male; Medicine; Medicine & Public Health; Meta-analysis; Neurosciences; Nutrition; Older people; Prevalence; Primary Care Medicine; Quality of Life Research; Risk Factors; Systematic review
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-019-1179-9

Objective To systematically assess the prevalence of frailty, including prefrailty, stratified prevalence according to frailty criteria, gender, age, and region, and the risk factors for frailty in China. Design We conducted a systematic literature review and meta-analysis using articles available in 8 databases including PubMed, Cochrane Library, Web of Science, CINAHL Plus, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP). Setting Crosssectional and cohort data from Chinese community. Participants Community-dwelling adults aged 65 and older. Measurements Two authors independently extracted data based upon predefined criteria. Where data were available we conducted a meta-analysis of frailty parameters using a random-effects model. Results We screened 915 different articles, and 14 studies (81258 participants) were ultimately included in this analysis. The prevalence of frailty and prefrailty in individual studies varied from 5.9% to 17.4% and from 26.8% to 62.8%, respectively. The pooled prevalence of frailty and prefrailty were 10% (95% CI: 8% to 12%, I2 = 97.4%, P = 0.000) and 43% (95% CI: 37% to 50%, I2 = 98.0%, P = 0.000), respectively. The pooled frailty prevalence was 8% for the Fried frailty phenotype, 12% for the frail index, and 15% for the FRAIL scale. Age-stratified meta-analyses showed the pooled prevalence of frailty to be 6%, 15%, and 25% for those aged 65–74, 75–84, and ≥85 years old, respectively. The pooled prevalence of frailty was 8% for males and 11% for females. The pooled prevalence of frailty in Mainland China, Taiwan, and Hong Kong was 12%, 8%, and 14%, respectively. The pooled frailty prevalence was 10% in urban areas and 7% in rural areas. After controlling for confounding variables, increasing age (OR = 1.28, 95% CI: 1.2 to 1.36, I 2 = 98.0%, P = 0.000), being female (OR = 1.29, 95% CI: 1.16 to 1.43, I 2 =92.7%, P=0.000), activities of daily living (ADL) disability (OR = 1.72, 95% CI: 1.57 to 1.90, I 2 = 99.7%, P = 0.000), and having three or more chronic diseases (OR = 1.97, 95% CI: 1.78 to 2.18, I 2 = 97.5%, P = 0.000) were associated with frailty. Conclusions These findings of this review indicate an overall pooled prevalence of frailty among Chinese community-dwelling older people of 10%. Increasing age, being female, ADL disability, and having three or more chronic diseases were all risk factors for frailty. Further research will be needed to