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Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.

ABSTRACT: OBJECTIVE:To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs. DESIGN:Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083. DATA SOURCES:MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017. SETTING:Low-income and middle-income countries. PARTICIPANTS:Community-dwelling older adults aged ?60 years. RESULTS:We screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years. CONCLUSION:The prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries. PROSPERO REGISTRATION NUMBER:CRD42016036083.

SUBMITTER: Siriwardhana DD

PROVIDER: S-EPMC5855322 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.

Siriwardhana Dhammika D DD Hardoon Sarah S Rait Greta G Weerasinghe Manuj C MC Walters Kate R KR

BMJ open 20180301 3

<h4>Objective</h4>To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs.<h4>Design</h4>Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083.<h4>Data sources</h4>MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library we ...[more]

PMID: 29496895

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Project description:ImportanceFrailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level.ObjectiveTo estimate the global incidence of frailty and prefrailty among community-dwelling adults 60 years or older.Data sourcesMEDLINE, Embase, PsycINFO, Web of Science, CINAHL Plus, and AMED (Allied and Complementary Medicine Database) were searched from inception to January 2019 without language restrictions using combinations of the keywords frailty, older adults, and incidence. The reference lists of eligible studies were hand searched.Study selectionIn the systematic review, 2 authors undertook the search, article screening, and study selection. Cohort studies that reported or had sufficient data to compute incidence of frailty or prefrailty among community-dwelling adults 60 years or older at baseline were eligible.Data extraction and synthesisThe methodological quality of included studies was assessed using The Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence and Incidence Studies. Meta-analysis was conducted using a random-effects (DerSimonian and Laird) model.Main outcomes and measuresIncidence of frailty (defined as new cases of frailty among robust or prefrail individuals) and incidence of prefrailty (defined as new cases of prefrailty among robust individuals), both over a specified duration.ResultsOf 15 176 retrieved references, 46 observational studies involving 120 805 nonfrail (robust or prefrail) participants from 28 countries were included in this systematic review. Among the nonfrail individuals who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail, with the pooled incidence rate being 43.4 (95% CI, 37.3-50.4; I2 = 98.5%) cases per 1000 person-years. The incidence of frailty was significantly higher in prefrail individuals than robust individuals (pooled incidence rates, 62.7 [95% CI, 49.2-79.8; I2 = 97.8%] vs 12.0 [95% CI, 8.2-17.5; I2 = 94.9%] cases per 1000 person-years, respectively; P for difference < .001). Among robust individuals in 21 studies who survived a median follow-up of 2.5 (range, 1.0-10.0) years, 30.9% (9974 of 32 268) became prefrail, with the pooled incidence rate being 150.6 (95% CI, 123.3-184.1; I2 = 98.9%) cases per 1000 person-years. The frailty and prefrailty incidence rates were significantly higher in women than men (frailty: 44.8 [95% CI, 36.7-61.3; I2 = 97.9%] vs 24.3 [95% CI, 19.6-30.1; I2 = 8.94%] cases per 1000 person-years; prefrailty: 173.2 [95% CI, 87.9-341.2; I2 = 99.1%] vs 129.0 [95% CI, 73.8-225.0; I2 = 98.5%] cases per 1000 person-years). The incidence rates varied by diagnostic criteria and country income level. The frailty and prefrailty incidence rates were significantly reduced when accounting for the risk of death.Conclusions and relevanceResults of this study suggest that community-dwelling older adults are prone to developing frailty. Increased awareness of the factors that confer high risk of frailty in this population subgroup is vital to inform the design of interventions to prevent frailty and to minimize its consequences.

Project description:BackgroundThere is little evidence on the potential health benefits of active travel in low- and middle-income countries (LMICs). The aim of this study was to assess the association between levels of active travel and physical multi-morbidity (i.e., two or more chronic physical conditions) and individual physical conditions among community-dwelling adults aged 65 or older in six LMICs.MethodsData were analyzed from the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa). Active travel (minutes / week) was assessed with questions of the Global Physical Activity Questionnaire (GPAQ) and presented in tertiles. Eleven chronic conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed by self-report of diagnosis, symptoms, or blood pressure measurement. Multivariable logistic regression analysis was conducted to assess the association between levels of active travel, physical conditions and physical multi-morbidity.ResultsThe final sample consisted of 14,585 individuals aged ?65 years (mean age = 72.6±0.1 years; 54.9% female). In the fully adjusted model, compared to the highest tertile, those in the lowest tertile of active travel had a 1.28 (95%CI = 1.06-1.54) times higher odds for physical multi-morbidity. The association between active travel and physical multi-morbidity was significantly mediated by affect (14.4%) and cognition (9.7%). With regard to individual conditions, hearing problems, hypertension, stroke, and visual impairment were particularly strongly associated with less active travel.ConclusionThe current data suggest that lower levels of active travel are associated with the presence of physical health conditions and physical multi-morbidity. This multi-national study offers potentially valuable insight for a number of hypotheses which may influence this relationship, although testing with longitudinal studies is needed.

Dataset Information

Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.

Publications

Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis.

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