Abstract
Objective
Sex-specific impact of frailty on all-cause mortality in older age population remains
controversial. This meta-analysis aimed to evaluate the association between frailty
and all-cause mortality in older age women vs men from the general population.
Design
Meta-analysis.
Setting and Participants
PubMed and Embase databases were searched until March 25, 2020 for studies reporting
sex-specific association of frailty phenotype or index with all-cause mortality among
the older general population (age ≥60 years) in the same study.
Measurements
All-cause mortality for the frail vs robust individuals.
Results
Eight studies enrolling a total of 87, 000 individuals were identified. Using the
frailty phenotype, the pooled risk ratio of all-cause mortality was 2.41 [95% confidence
interval (CI) 2.07–2.80] for frail women and 2.94 (95% CI 2.12–4.09) for frail men.
Using the frailty index, the pooled risk ratio of all-cause mortality was 3.23 (95%
CI 2.16–4.83) for frail women and 2.63 (95% CI 2.33–2.98) for frail men. The pooled
female-to-male ratio of relative risks was 0.93 (95% CI 0.76–1.13) for the frailty
phenotype and 1.22 (95% CI 0.79–1.88) for the frailty index.
Conclusions and Implications
Older men and women with frailty confer a higher risk of all-cause mortality in the
general population from the same source. However, there is no significant sex difference
in the association between phenotype or index and all-cause mortality.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frailty: An emerging research and clinical paradigm—Issues and controversies.J Gerontol Ser A Biol Sci Med Sci. 2007; 62: 731-737
- Frailty in elderly people.Lancet. 2013; 381: 752-762
- Prevalence of frailty in community-dwelling older persons: A systematic review.J Am Geriatr Soc. 2012; 60: 1487-1492
- Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70.J Am Geriatr Soc. 2006; 54: 975-979
- Frailty—A promising concept to evaluate disease vulnerability.Mech Ageing Dev. 2020; 187: 111217
- Association of frailty with survival: A systematic literature review.Ageing Res Rev. 2013; 12: 719-736
- Sex differences in the risk of frailty for mortality independent of disability and chronic diseases.J Am Geriatr Soc. 2005; 53: 401-447
- Sex differences in mortality among older frail Mexican Americans.J Womens Health (Larchmt). 2009; 18: 1647-1651
- Frailty as a predictor of all-cause mortality in older men and women.Geriatr Gerontol Int. 2014; 14: 899-905
- Frailty prevalence and 10-year survival in community-dwelling older adults: results from the ESTHER cohort study.Eur J Epidemiol. 2014; 29: 171-179
- Frailty and Mortality Outcomes in Cognitively Normal Older People: Sex Differences in a Population-Based Study.J Am Geriatr Soc. 2016; 64: 132-137
- Frailty index to predict all-cause mortality in Thai community-dwelling older population: A result from a National Health Examination Survey cohort.Arch Gerontol Geriatr. 2018; 77: 124-128
- Frail phenotype and mortality prediction: A systematic review and meta-analysis of prospective cohort studies.Int J Nurs Stud. 2015; 52: 1362-1374
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.J Clin Epidemiol. 2009; 62: e11-e34
- The Newcastle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses.(Available at:)http://www.ohri.ca/programs/clinical_epidemiology/oxford.aspDate accessed: May 16, 2020
- Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: A prospective analysis of 493 737 UK Biobank participants.Lancet Public Health. 2018; 3: e3231-e3320
- Frailty phenotype and its association with all-cause mortality in community-dwelling Norwegian women and men aged 70 years and older: The Tromso Study 2001‒2016.Geriatr Gerontol Int. 2018; 18: 1200-1205
- Frailty index and sex-specific 6-year mortality in community-dwelling older people: The ActiFE Study.J Gerontol A Biol Sci Med Sci. 2020; 75: 366-373
- Frailty for predicting all-cause mortality in elderly acute coronary syndrome patients: A meta-analysis.Ageing Res Rev. 2019; 52: 11-16
- Frailty in older adults: evidence for a phenotype.J Gerontol Ser A Biol Sci Med Sci. 2001; 56: M146-M156
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: Lessons from the Cardiovascular Health Study.J Am Geriatr Soc. 2008; 56: 898-903
- Frailty consensus: A call to action.J Am Med Dir Assoc. 2013; 14: 392-397
- The case of the misleading funnel plot.BMJ. 2006; 333: 597-600
Article info
Publication history
Published online: July 15, 2020
Footnotes
This work is supported by Jiangsu Provincial Key Research and Development Special Fund (BE2015666); Jiangsu Innovative Team Leading Talent Fund (CXTDC2016006); and Natural Science Foundation of Jiangsu Province (BK20171304).
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
