Frailty and multimorbidity: a systematic review and meta-analysis

Joint Action ADVANTAGE WP4 group, Davide Liborio Vetrano, Katie Palmer, A. Marengoni, E. Marzetti, Fabrizia Lattanzio, R. E. Roller-Wirnsberger, Luz Lopez Samaniego, Luz Lopez Samaniego, L. Rodriguez-Manas, R. Bernabei, G. Onder

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
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Publication statusE-pub ahead of print - May 3 2018

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

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Joint Action ADVANTAGE WP4 group, Vetrano, D. L., Palmer, K., Marengoni, A., Marzetti, E., Lattanzio, F., ... Onder, G. (2018). Frailty and multimorbidity: a systematic review and meta-analysis. Journals of Gerontology - Series A Biological Sciences and Medical Sciences.

Frailty and multimorbidity: a systematic review and meta-analysis. / Joint Action ADVANTAGE WP4 group; Vetrano, Davide Liborio; Palmer, Katie; Marengoni, A.; Marzetti, E.; Lattanzio, Fabrizia; Roller-Wirnsberger, R. E.; Lopez Samaniego, Luz; Lopez Samaniego, Luz; Rodriguez-Manas, L.; Bernabei, R.; Onder, G.

In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 03.05.2018.

Research output: Contribution to journalArticle

Joint Action ADVANTAGE WP4 group, Vetrano, DL, Palmer, K, Marengoni, A, Marzetti, E, Lattanzio, F, Roller-Wirnsberger, RE, Lopez Samaniego, L, Lopez Samaniego, L, Rodriguez-Manas, L, Bernabei, R & Onder, G 2018, 'Frailty and multimorbidity: a systematic review and meta-analysis', Journals of Gerontology - Series A Biological Sciences and Medical Sciences.
Joint Action ADVANTAGE WP4 group, Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F et al. Frailty and multimorbidity: a systematic review and meta-analysis. Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2018 May 3.
Joint Action ADVANTAGE WP4 group ; Vetrano, Davide Liborio ; Palmer, Katie ; Marengoni, A. ; Marzetti, E. ; Lattanzio, Fabrizia ; Roller-Wirnsberger, R. E. ; Lopez Samaniego, Luz ; Lopez Samaniego, Luz ; Rodriguez-Manas, L. ; Bernabei, R. ; Onder, G. / Frailty and multimorbidity: a systematic review and meta-analysis. In: Journals of Gerontology - Series A Biological Sciences and Medical Sciences. 2018.
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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 Liborio} and Katie Palmer and A. Marengoni and E. Marzetti and Fabrizia Lattanzio and Roller-Wirnsberger, {R. E.} and {Lopez Samaniego}, Luz and {Lopez Samaniego}, Luz and L. Rodriguez-Manas and R. Bernabei and G. Onder",
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T1 - Frailty and multimorbidity: a systematic review and meta-analysis

AU - Joint Action ADVANTAGE WP4 group

AU - Vetrano, Davide Liborio

AU - Palmer, Katie

AU - Marengoni, A.

AU - Marzetti, E.

AU - Lattanzio, Fabrizia

AU - Roller-Wirnsberger, R. E.

AU - Lopez Samaniego, Luz

AU - Lopez Samaniego, Luz

AU - Rodriguez-Manas, L.

AU - Bernabei, R.

AU - Onder, G.

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.

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 -