Frailty and multimorbidity

a systematic review and meta-analysis

Joint Action ADVANTAGE WP4 group

Research output: Contribution to journalArticle

Abstract

Background: Multimorbidity and frailty are complex syndromes characteristics of ageing. We reviewed the literature, and provided pooled estimations of any evidence regarding a) the coexistence of frailty and multimorbidity, and b) their association.

Methods: We searched PubMed and Web of Science for relevant articles up to September 2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity (I2), risk of bias and publication bias were assessed. PROSPERO registration: 57890.

Results: A total of 48 studies involving 78122 participants were selected, and 25 were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n=35). Forty-three studies presented a moderate risk of bias, and 5 a low risk. Most of the articles defined multimorbidity as having two or more diseases and frailty according to the Cardiovascular Health Study criteria. In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% Confidence Interval [95% CI] 63% to 81%; I2=91.3%) and the prevalence of frailty among multimorbid individuals was 16% (95% CI 12% to 21%; I2=96.5%). Multimorbidity was associated with frailty in pooled analyses (OR 2.27; 95% CI 1.97 to 2.62; I2 47.7%). The three longitudinal studies suggest a bidirectional association between multimorbidity and frailty.

Conclusions: Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid but fewer multimorbid ones present also frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.

Original languageEnglish
JournalThe journals of gerontology. Series A, Biological sciences and medical sciences
DOIs
Publication statusE-pub ahead of print - May 3 2018

Fingerprint

Meta-Analysis
Comorbidity
Confidence Intervals
Independent Living
Publication Bias
PubMed
Longitudinal Studies
Cross-Sectional Studies
Health

Cite this

Frailty and multimorbidity : a systematic review and meta-analysis. / Joint Action ADVANTAGE WP4 group.

In: The journals of gerontology. Series A, Biological sciences and medical sciences, 03.05.2018.

Research output: Contribution to journalArticle

@article{a64b1da4eb504299830cef2c7ec1c891,
title = "Frailty and multimorbidity: a systematic review and meta-analysis",
abstract = "Background: Multimorbidity and frailty are complex syndromes characteristics of ageing. We reviewed the literature, and provided pooled estimations of any evidence regarding a) the coexistence of frailty and multimorbidity, and b) their association.Methods: We searched PubMed and Web of Science for relevant articles up to September 2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity (I2), risk of bias and publication bias were assessed. PROSPERO registration: 57890.Results: A total of 48 studies involving 78122 participants were selected, and 25 were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n=35). Forty-three studies presented a moderate risk of bias, and 5 a low risk. Most of the articles defined multimorbidity as having two or more diseases and frailty according to the Cardiovascular Health Study criteria. In meta-analyses, the prevalence of multimorbidity in frail individual was 72{\%} (95{\%} Confidence Interval [95{\%} CI] 63{\%} to 81{\%}; I2=91.3{\%}) and the prevalence of frailty among multimorbid individuals was 16{\%} (95{\%} CI 12{\%} to 21{\%}; I2=96.5{\%}). Multimorbidity was associated with frailty in pooled analyses (OR 2.27; 95{\%} CI 1.97 to 2.62; I2 47.7{\%}). The three longitudinal studies suggest a bidirectional association between multimorbidity and frailty.Conclusions: Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid but fewer multimorbid ones present also frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.",
author = "{Joint Action ADVANTAGE WP4 group} and Vetrano, {Davide L} and Katie Palmer and Alessandra Marengoni and Emanuele Marzetti and Fabrizia Lattanzio and Regina Roller-Wirnsberger and {Lopez Samaniego}, Luz and Leocadio Rodr{\'i}guez-Ma{\~n}as and Roberto Bernabei and Graziano Onder",
year = "2018",
month = "5",
day = "3",
doi = "10.1093/gerona/gly110",
language = "English",
journal = "Journals of Gerontology - Series A Biological Sciences and Medical Sciences",
issn = "1079-5006",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Frailty and multimorbidity

T2 - a systematic review and meta-analysis

AU - Joint Action ADVANTAGE WP4 group

AU - Vetrano, Davide L

AU - Palmer, Katie

AU - Marengoni, Alessandra

AU - Marzetti, Emanuele

AU - Lattanzio, Fabrizia

AU - Roller-Wirnsberger, Regina

AU - Lopez Samaniego, Luz

AU - Rodríguez-Mañas, Leocadio

AU - Bernabei, Roberto

AU - Onder, Graziano

PY - 2018/5/3

Y1 - 2018/5/3

N2 - Background: Multimorbidity and frailty are complex syndromes characteristics of ageing. We reviewed the literature, and provided pooled estimations of any evidence regarding a) the coexistence of frailty and multimorbidity, and b) their association.Methods: We searched PubMed and Web of Science for relevant articles up to September 2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity (I2), risk of bias and publication bias were assessed. PROSPERO registration: 57890.Results: A total of 48 studies involving 78122 participants were selected, and 25 were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n=35). Forty-three studies presented a moderate risk of bias, and 5 a low risk. Most of the articles defined multimorbidity as having two or more diseases and frailty according to the Cardiovascular Health Study criteria. In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% Confidence Interval [95% CI] 63% to 81%; I2=91.3%) and the prevalence of frailty among multimorbid individuals was 16% (95% CI 12% to 21%; I2=96.5%). Multimorbidity was associated with frailty in pooled analyses (OR 2.27; 95% CI 1.97 to 2.62; I2 47.7%). The three longitudinal studies suggest a bidirectional association between multimorbidity and frailty.Conclusions: Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid but fewer multimorbid ones present also frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.

AB - Background: Multimorbidity and frailty are complex syndromes characteristics of ageing. We reviewed the literature, and provided pooled estimations of any evidence regarding a) the coexistence of frailty and multimorbidity, and b) their association.Methods: We searched PubMed and Web of Science for relevant articles up to September 2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity (I2), risk of bias and publication bias were assessed. PROSPERO registration: 57890.Results: A total of 48 studies involving 78122 participants were selected, and 25 were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n=35). Forty-three studies presented a moderate risk of bias, and 5 a low risk. Most of the articles defined multimorbidity as having two or more diseases and frailty according to the Cardiovascular Health Study criteria. In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% Confidence Interval [95% CI] 63% to 81%; I2=91.3%) and the prevalence of frailty among multimorbid individuals was 16% (95% CI 12% to 21%; I2=96.5%). Multimorbidity was associated with frailty in pooled analyses (OR 2.27; 95% CI 1.97 to 2.62; I2 47.7%). The three longitudinal studies suggest a bidirectional association between multimorbidity and frailty.Conclusions: Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid but fewer multimorbid ones present also frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.

U2 - 10.1093/gerona/gly110

DO - 10.1093/gerona/gly110

M3 - Article

JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences

JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences

SN - 1079-5006

ER -