Department of Primary Care and Population Health, University College London, London, UK.
Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
Ageing Res Rev. 2019 Mar;50:81-88. doi: 10.1016/j.arr.2019.01.010. Epub 2019 Jan 16.
Frailty is a well-established risk factor for adverse health outcomes. However, comparatively little is known about the dynamic nature of frailty and the extent to which it can improve. The purposes of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age>60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1-10 years), 13.7% (95%CI = 11.7-15.8%) improved, 29.1% (95%CI = 25.9-32.5%) worsened and 56.5% (95%CI = 54.2-58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI = 48.8-59.1%), 40.6% (95%CI = 36.7-44.7%) and 4.5% (95%CI = 3.2-6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI = 18.8-27.6%), 58.2% (95%CI = 55.6-60.7%) and 18.2% (95%CI = 14.9-21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI = 1.6-5.5%), 40.3% (95%CI = 34.6-46.1%) and 54.5% (95%CI = 47.6-61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered.
衰弱是不良健康结局的一个既定风险因素。然而，人们对衰弱的动态性质及其改善程度知之甚少。本研究的目的是系统地搜索关于社区居住的老年人随时间推移的衰弱转变的研究，并综合衰弱转变率。2018 年 7 月，在四个电子数据库（Medline、Embase、PsycINFO 和 CINAHL）中进行了搜索。纳入标准为：前瞻性设计，平均年龄>60 岁的社区居住老年人，使用 5 项衰弱表型标准定义三种状态：健壮、衰弱前期和衰弱，以及基于基线和随访时的衰弱状态，参与者有 9 种衰弱转变模式的数量。排除标准为：选择人群，使用少于 5 项衰弱表型标准。两名调查员独立筛选了 504 篇研究论文以确定入选标准，并确定了 16 项研究纳入本综述。两名调查员独立提取数据。通过随机效应荟萃分析计算衰弱转变模式的汇总率。在来自 16 项研究的 42775 名社区居住老年人中，平均随访时间为 3.9 年（范围：1-10 年），13.7%（95%CI=11.7-15.8%）改善，29.1%（95%CI=25.9-32.5%）恶化，56.5%（95%CI=54.2-58.8%）保持相同的衰弱状态。在基线时健壮的人群中，保持健壮或转变为衰弱前期和衰弱的汇总率分别为 54.0%（95%CI=48.8-59.1%）、40.6%（95%CI=36.7-44.7%）和 4.5%（95%CI=3.2-6.1%）。在基线时衰弱前期的人群中，相应的健壮、衰弱前期和衰弱的比率分别为 23.1%（95%CI=18.8-27.6%）、58.2%（95%CI=55.6-60.7%）和 18.2%（95%CI=14.9-21.7%）。在基线时衰弱的人群中，汇总的向健壮、衰弱前期和衰弱转变的比率分别为 3.3%（95%CI=1.6-5.5%）、40.3%（95%CI=34.6-46.1%）和 54.5%（95%CI=47.6-61.3%）。分层和荟萃回归分析表明，年龄、性别和随访时间与衰弱转变模式相关。老年人的衰弱状况会发生动态变化。鉴于只有四分之一的衰弱前期老年人改善为健壮，而只有 3%的衰弱老年人改善为健壮，因此应考虑早期干预。
