The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients

Paul Doody; Evans A. Asamane; Justin A. Aunger; Bridgitte Swales; Janet M. Lord; Carolyn A. Greig; Anna C. Whittaker

doi:10.1016/j.arr.2022.101666

The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients

Paul Doody^*, Evans A. Asamane, Justin A. Aunger, Bridgitte Swales, Janet M. Lord, Carolyn A. Greig, Anna C. Whittaker

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

6 Citations (Scopus)

17 Downloads (Pure)

Abstract

Background: Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators.

Methods: Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality.

Results: Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 8/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators.

Conclusions: Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.

Original language	English
Article number	101666
Number of pages	28
Journal	Ageing Research Reviews
Volume	80
Early online date	11 Jun 2022
DOIs	https://doi.org/10.1016/j.arr.2022.101666
Publication status	Published - Sept 2022

Bibliographical note

Funding Information:
The authors of this review would like to thank and acknowledge Ms. Lynne Harris (Subject advisor of the Main Library at the University of Birmingham, United Kingdom) for her assistance during the formulation of the search strategy utilised within this systematic review. The authors would also like to extend a sincere gratitude to all 256 authors who responded to our inquiries, and particularly those generous enough to provide additional data for various aspects of the analysis. Finally, the this review was supported by the European Commission Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement (675003); of which PD, EAA, and JAA are Marie Sklodowska-Curie Doctoral Research Fellow alumni, ACW, GAG, and JML their doctoral supervisors, and ACW the grants principal investigator. JML and CAG are further supported by the United Kingdom National Institute of Health Research Birmingham Biomedical Research Centre.

Publisher Copyright:
© 2022 The Authors

Keywords

Frailty
Health economics
Hospital
Inpatients
Older adults
Prevalence

ASJC Scopus subject areas

Biotechnology
Biochemistry
Ageing
Molecular Biology
Neurology

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H2020_ITN_PANINI (CO-ORDINATOR)
Thompson, J., Lord, J., Whittaker, A. & Greig, C.
European Commission, European Commission - Management Costs
1/01/16 → 31/12/19
Project: Research

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Doody, P., Asamane, E. A., Aunger, J. A., Swales, B., Lord, J. M., Greig, C. A., & Whittaker, A. C. (2022). The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients. Ageing Research Reviews, 80, Article 101666. https://doi.org/10.1016/j.arr.2022.101666

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title = "The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients",

abstract = "Background: Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators. Methods: Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality. Results: Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 8/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators. Conclusions: Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.",

keywords = "Frailty, Health economics, Hospital, Inpatients, Older adults, Prevalence",

author = "Paul Doody and Asamane, {Evans A.} and Aunger, {Justin A.} and Bridgitte Swales and Lord, {Janet M.} and Greig, {Carolyn A.} and Whittaker, {Anna C.}",

note = "Funding Information: The authors of this review would like to thank and acknowledge Ms. Lynne Harris (Subject advisor of the Main Library at the University of Birmingham, United Kingdom) for her assistance during the formulation of the search strategy utilised within this systematic review. The authors would also like to extend a sincere gratitude to all 256 authors who responded to our inquiries, and particularly those generous enough to provide additional data for various aspects of the analysis. Finally, the this review was supported by the European Commission Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement (675003); of which PD, EAA, and JAA are Marie Sklodowska-Curie Doctoral Research Fellow alumni, ACW, GAG, and JML their doctoral supervisors, and ACW the grants principal investigator. JML and CAG are further supported by the United Kingdom National Institute of Health Research Birmingham Biomedical Research Centre. Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

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doi = "10.1016/j.arr.2022.101666",

language = "English",

volume = "80",

journal = "Ageing Research Reviews",

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Doody, P, Asamane, EA , Aunger, JA, Swales, B, Lord, JM , Greig, CA & Whittaker, AC 2022, 'The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients', Ageing Research Reviews, vol. 80, 101666. https://doi.org/10.1016/j.arr.2022.101666

The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients. / Doody, Paul; Asamane, Evans A.; Aunger, Justin A. et al.
In: Ageing Research Reviews, Vol. 80, 101666, 09.2022.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure

T2 - A systematic review and meta-analysis of 467,779 geriatric hospital inpatients

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AU - Asamane, Evans A.

AU - Aunger, Justin A.

AU - Swales, Bridgitte

AU - Lord, Janet M.

AU - Greig, Carolyn A.

AU - Whittaker, Anna C.

N1 - Funding Information: The authors of this review would like to thank and acknowledge Ms. Lynne Harris (Subject advisor of the Main Library at the University of Birmingham, United Kingdom) for her assistance during the formulation of the search strategy utilised within this systematic review. The authors would also like to extend a sincere gratitude to all 256 authors who responded to our inquiries, and particularly those generous enough to provide additional data for various aspects of the analysis. Finally, the this review was supported by the European Commission Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement (675003); of which PD, EAA, and JAA are Marie Sklodowska-Curie Doctoral Research Fellow alumni, ACW, GAG, and JML their doctoral supervisors, and ACW the grants principal investigator. JML and CAG are further supported by the United Kingdom National Institute of Health Research Birmingham Biomedical Research Centre. Publisher Copyright: © 2022 The Authors

PY - 2022/9

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N2 - Background: Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators. Methods: Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality. Results: Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 8/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators. Conclusions: Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.

AB - Background: Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators. Methods: Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality. Results: Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 8/9 (range 7–9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7–51.1%), and 25.8% (95% CI 22.0–29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators. Conclusions: Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.

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KW - Older adults

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Doody P, Asamane EA , Aunger JA, Swales B, Lord JM , Greig CA et al. The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients. Ageing Research Reviews. 2022 Sept;80:101666. Epub 2022 Jun 11. doi: 10.1016/j.arr.2022.101666

The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

Fingerprint

Projects

H2020_ITN_PANINI (CO-ORDINATOR)

Cite this