Review Article
Prevalence of Frailty in Nursing Homes: A Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.jamda.2015.06.025Get rights and content

Abstract

Background

Nursing home patients are expected to be very frail. However, evidence on frailty in a nursing home setting is scarce in the literature. Especially prevalence of frailty in this population is unknown.

Objective

To systematically search and analyze the prevalence of frailty among nursing home patients in the literature and synthesize pooled estimates of overall prevalence of frailty and prefrailty as well as prevalence of frailty stratified by age, gender, and frailty definitions.

Design

Systematic review using 5 databases: Embase, MEDLINE, CINAHL Plus, PsycINFO, and Cochrane library, and meta-analysis.

Setting

Cross-sectional studies or observational studies with baseline data in a nursing home setting.

Participants

Nursing home patients aged 60 years or older.

Measurements

Prevalence of frailty and prefrailty based on validated criteria or definitions of frailty was collected. In the included studies, meta-analysis was performed using random-effects models to calculate pooled estimates of prevalence of frailty and prefrailty. Methodological quality, heterogeneity, and publication bias were assessed.

Results

Nine studies with a total of 1373 nursing home patients were found to report prevalence of frailty. The included studies were highly heterogeneous and mean prevalence of frailty ranged widely from 19.0 to 75.6%. Pooled estimates of prevalence of frailty and prefrailty were 52.3% (95% confidence interval 37.9%–66.5%) (9 studies, n = 1373) and 40.2% (28.9%–52.1%) (7 studies, n = 1163), respectively.

Conclusions

As high as about one-half of the nursing home patients were frail. Approximately 40% were still prefrail and could be targeted by interventions for frailty prevention or treatment to avoid its negative health outcomes.

Section snippets

Data Sources and Search Strategy

The author systematically searched the literature in January 2015 in Embase, MEDLINE, CINAHL Plus, PsycINFO, and Cochrane library for studies published from 1990 to 2014 with the following search terms: (nursing home*) OR (nursing home patients) OR (long term care*) OR (long-term care*) OR (home* for the aged) OR (home* for the elderly) OR (institutionalized) OR (institutionalised) AND (frailty) OR (frailty syndrome), using Medical Subject Heading (MeSH) Terms when applicable. The reference

Results

Of a total of 1792 studies identified by the extensive and comprehensive systematic literature search, 9 studies17, 18, 19, 20, 21, 22, 23, 24, 25 reporting prevalence of frailty among nursing home patients aged 60 years or older were included for this systematic review and meta-analysis.

Discussion

This systematic review identified 9 studies with a total of 1373 nursing home patients aged 60 years or older reporting prevalence of frailty. These studies included relatively small numbers of participants and have been published from seven different countries only recently since 2011. The pooled estimate of prevalence of frailty was markedly high at 52.3%, making a striking contrast with about 10% of community-dwelling older people.4 Meanwhile, prevalence of prefrailty (7 studies, 1163

References (29)

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The author declares no conflicts of interest.

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