Global incidence of frailty in community-dwelling adults

By Melanie Hinze
A new Australian-led, global study suggests that 4.3% of community-dwelling adults aged 60 years and over will develop frailty each year.

In their systematic review and meta-analysis, published in the JAMA Network Open, researchers assessed the incidence of frailty and prefrailty in 46 observational studies involving more than 120,000 community-dwelling individuals aged 60 years or over in 28 countries.

They found that in the community-dwelling adults (robust or prefrail) who survived a median follow up of three years, 13.6% became frail (pooled incidence rate, 43 new cases per 1000 person-years). Among robust individuals who survived a median follow up of 2.5 years, 30.9% became prefrail (pooled incidence rate, 151 new cases per 1000 person-years).

The researchers also found the incidence of frailty was significantly higher in women than men, and the incidence of frailty and prefrailty varied by frailty measurement method used and country income level.

The researchers noted that epidemiological evidence on frailty had been dominated by a focus on prevalence, while its incidence remained poorly understood.

Professor Leon Flicker, Professor of Geriatric Medicine and Director of the Western Australian Centre for Health & Ageing at the University of Western Australia, said that overall this was an interesting study; however, it had many, mostly technical, limitations.

‘One of the things that we found a few years ago is that frailty is extremely prone to nonresponse bias,’ he said.

This means that epidemiological surveys may substantially underestimate frailty levels among older people. Additionally, for analyses hoping to bring individual studies together, there are problems with heterogeneity, which the authors found.

‘What we can say from this meta-analysis is that frailty is relatively common and both prevalence and incidence increase with age,’ he said.‘It seems less common in men and may be more common relatively among middle- and low-income countries,’ Professor Flicker said, noting that these findings were already known.

Professor Flicker said interventions were important to better identify frailty and improve the quality of care and outcomes for people with frailty. These included using a validated measurement tool to identify frailty; prescribing physical activity with a resistance training component; and addressing polypharmacy by reducing or deprescribing inappropriate or superfluous medications. Looking for common geriatric problems, by screening for and addressing fatigue, reversible causes of weight loss and vitamin D deficiency were also beneficial.
JAMA Netw Open 2019; 2: e198398; doi:10.1001/jamanetworkopen.2019.8398.