Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, BD9 6RJ, UK.
Qual Life Res. 2019 Aug;28(8):2041-2056. doi: 10.1007/s11136-019-02149-1. Epub 2019 Mar 14.
Frailty is an important predictor of adverse health events in older people, and improving quality of life (QOL) is increasingly recognised as a focus for services in this population. This systematic review synthesised evidence of the relationship between frailty and QOL in community-dwelling older people, with an emphasis on how this relationship varied across QOL domains.
We conducted a systematic review with meta-analysis. We searched five databases for reports of QOL in older people with frailty and included studies based on pre-defined criteria. We conducted meta-analyses comparing "frail" and "not frail" groups for each QOL scale where data were available. We compared pooled results to distribution-based and known-group differences to enhance interpretation. We summarised reported cross-sectional and longitudinal analyses.
Twenty-two studies (24,419 participants) were included. There were medium or larger standardised mean differences for 24 of 31 QOL scales between frail and not frail groups, with worse QOL for frail groups. These scales encompassed constructs of health-related quality of life as well as psychological and subjective well-being. There were similar findings from mean difference meta-analyses and within-study analyses.
The association between frailty and lower QOL across a range of constructs is clear and often substantial. Future research should establish whether causal mechanisms link the constructs, which aspects of QOL are most important to older people with frailty, and investigate their tractability. Services focused on measuring and improving QOL for older people with frailty should be introduced.
衰弱是老年人不良健康事件的重要预测因素，提高生活质量（QOL）越来越被认为是该人群服务的重点。本系统评价综合了社区居住老年人衰弱与 QOL 之间关系的证据，重点关注 QOL 领域的关系如何变化。
我们进行了系统评价和荟萃分析。我们在五个数据库中搜索了有关衰弱老年人 QOL 的报告，并根据预先确定的标准纳入了研究。我们对每个 QOL 量表进行了荟萃分析，比较了“衰弱”和“非衰弱”组的数据。我们将汇总结果与基于分布和已知组的差异进行比较，以增强解释。我们总结了报告的横断面和纵向分析。
纳入了 22 项研究（24,419 名参与者）。在 31 个 QOL 量表中，有 24 个量表在衰弱组和非衰弱组之间存在中等或更大的标准化均数差异，衰弱组的 QOL 更差。这些量表涵盖了健康相关生活质量的结构，以及心理和主观幸福感。均值差异荟萃分析和研究内分析得出了类似的结果。
衰弱与一系列结构的较低 QOL 之间的关联是明确的，而且通常是很大的。未来的研究应该确定因果机制是否将这些结构联系起来，了解对衰弱老年人最重要的是哪些方面的 QOL，并研究其可操作性。应该引入针对衰弱老年人测量和提高 QOL 的服务。
