Epidemiological characteristics of frailty in Chinese elderly population: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

TIAN Peng ¹ , YANG Ning ² , HAO Qiukui ³ ,  PENG Chaoming ¹

1. Department of Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, P.R.China;
2. Department of Respiration, The Affiliated Hospital of Yan'an Medical College, Yan'an, 716000, P.R.China;
3. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

PENG Chaoming, Email: 99542305@qq.com

Keywords：

Frailty; China; Epidemiology; Systematic review

DOI：

10.7507/1672-2531.201901056

Video：

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Objectives To systematically review the epidemiological characteristics of frailty in Chinese elderly population.Methods PubMed, EMbase, Web of Science, CNKI, VIP and WanFang Data databases were electronically searched to collect studies on the epidemiological characteristics of frailty in China from January, 1978 to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using OpenMetaanalyst software.Results A total of 29 studies, involving 64 306 patients were included. The results of meta-analysis showed that: the prevalence of frailty in Chinese community was 12.8% (95%CI 0.105 to 0.152), in Chinese hospital was 22.6% (95%CI 0.130 to 0.270), and in nursing home was 44.3% (95% CI 0.222 to 0.664). In the subgroup analysis by gender: male prevalence in community was 9.2% (95%CI 0.074 to 0.110), female was 12.9% (95%CI 0.100 to 0.157). Prevalence of male in hospital was 23.3% (95%CI 0.124 to 0.342), Prevalence of female was 17.9% (95%CI 0.122 to 0.237). In the subgroup analysis by region: the prevalence of frailty in north China was 13.4% (95%CI 0.093 to 0.175), in east China was 13.6% (95%CI 0.083 to 0.189), and in Taiwan province and HongKong was 9.8% (95% CI 0.078 to 0.199). In the subgroup analysis by age: the prevalence of frailty among the elderly aged 65 to 74 was 12.2% (95%CI 0.037 to 0.206), and 33.2% (95%CI 0.136 to 0.527) among the elderly aged 75 to 84, and 46.8% (95%CI 0.117 to 0.820) among the elderly aged above 85. For investigation based on time periods, the prevalence of frailty was 9.1% (95%CI 0.078 to 0.104) from 2003 to 2010, and 14.4% (95%CI 0.111 to 0.177) from 2011 to 2018.Conclusions The prevalence of frailty in China is high. Economic underdevelopment is higher in more developed regions. The prevalence in hospital population is higher than that in community population. The prevalence of female in community and rural is higher than male. The higher ages has higher prevalence. The prevalence of frailty from 2011 to 2018 is higher than from 2003 to 2010. As no uniform screening tools exist, the results of this study requires further validations by high quality research.

Citation： TIAN Peng, YANG Ning, HAO Qiukui, PENG Chaoming. Epidemiological characteristics of frailty in Chinese elderly population: a systematic review. Chinese Journal of Evidence-Based Medicine, 2019, 19(6): 656-664. doi: 10.7507/1672-2531.201901056 Copy

1.	United Nations Department of Economic and Social Affairs, Population Division, World Population Prospects. The 2015 Revision, United Nations Department of Economic and Social Affairs, Population Division. New York: United Nations, 2015.
2.	Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc, 2006, 54(6): 991-1001.
3.	Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: characterization in the women's health and aging studies. J Gerontol A Biol Sci Med Sci, 2006, 61(3): 262-266.
4.	Ensrud KE, Ewing SK, Cawthon PM, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc, 2009, 57(3): 492-498.
5.	Theou O, Brothers TD, Mitnitski A, et al. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc, 2013, 61(9): 1537-1551.
6.	Siriwardhana DD, Hardoon S, Rait G, et al. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open, 2018, 8(3): e018195.
7.	焦桂梅, 李建民. 中高龄老年人衰弱程度与老年性骨质疏松症的相关性探讨. 中国骨质疏松杂志, 2018, 24(3): 376-379, 384.
8.	侯晓琳, 高静, 吴晨曦, 等. 养老机构老年人衰弱现状及分析. 中华护理杂志, 2018, 53(1): 88-93.
9.	李阳, 张立萍, 罗洋. 哈尔滨市社区老年人衰弱现状及其影响因素调查. 护理研究, 2018, 32(2): 224-228.
10.	李晓凯, 陈长香, 张敏, 等. 唐山市高龄空巢老年人健康状况及生活方式与衰弱相关性. 中国公共卫生, 2018, 34(2): 162-166.
11.	李秋萍, 韩斌如. 外科住院老年病人衰弱现状及影响因素的调查分析. 护理研究, 2017, 31(33): 4307-4311.
12.	任青卓, 周静静, 郑雅婧, 等. 广州市老年人衰弱现状及其影响因素. 2019, 35(4): 413-417.
13.	张治香, 侯惠如. 海南部分地区百岁老人衰弱现状及影响因素分析. 解放军医学院学报, 2018, 39(4): 286-290, 307.
14.	田晓宇, 乔晓霞, 董莉娟, 等. 社区老年人衰弱与卫生服务利用的关系研究. 中国卫生事业管理, 2017, 34(7): 494-497.
15.	乔晓霞, 杨华, 苗红, 等. 社区老年人衰弱与机构养老需求的关系. 中国老年学杂志, 2018, 38(2): 450-452.
16.	奚兴, 郭桂芳, 孙静. 社区老年人衰弱状况与抑郁症状关系的研究. 护理学杂志, 2014, 29(15): 87-89, 92.
17.	陶晓春, 胡安梅, 魏书侠, 等. 社区老年人的临床研究. 实用老年医学, 2015, 29(1): 63-66.
18.	孙凯旋, 刘永兵, 薛谨, 等. 老年住院患者衰弱状况及其影响因素分析. 中华老年病研究电子杂志, 2017, 4(1): 30-35.
19.	卫尹, 曹艳佩, 杨晓莉, 等. 老年住院患者衰弱综合征现状及影响因素. 复旦学报(医学版), 2018, 45(4): 496-502.
20.	徐秀萍, 吴凌云, 王秀丽, 等. 衢州市老年住院患者衰弱综合征评估及照护依赖状况研究. 医学与社会, 2017, 30(8): 64-66.
21.	Chen LJ, Chen CY, Lue H, et al. Prevalence and Associated Factors of Frailty Among Elderly People in Taiwan. Inter J Geron, 2014, 8: 114-119.
22.	Chen CY, Wu SC, Chen LJ, et al. The prevalence of subjective frailty and factors associated with frailty in Taiwan. Arch Gerontol Geriatr, 2010, 50 Suppl 1: S43-S47.
23.	Chang CI, Chan DC, Kuo KN, et al. Prevalence and correlates of geriatric frailty in a northern Taiwan community. J Formos Med Assoc, 2011, 110(4): 247-257.
24.	Biritwum RB, Minicuci N, Yawson AE, et al. Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas, 2016, 91: 8-18.
25.	Hao Q, Dong B, Yang M, et al. Frailty and cognitive impairment in predicting mortality among oldest-old people. Front Aging Neurosci, 2018, 10: 295.
26.	Hoogendijk EO, Rijnhart JJM, Kowal P, et al. Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE). Maturitas, 2018, 115: 56-63.
27.	Lai HY, Chang HT, Lee YL, et al. Association between inflammatory markers and frailty in institutionalized older men. Maturitas, 2014, 79(3): 329-333.
28.	Li J, Zhao D, Dong B, et al. Frailty index and its associations with self-neglect, social support and sociodemographic characteristics among older adults in rural China. Geriatr Gerontol Int, 2018, 18(7): 987-996.
29.	Lin CH, Chou CY, Liu CS, et al. Association between frailty and subclinical peripheral vascular disease in a community-dwelling geriatric population: Taichung Community Health Study for Elders. Geriatr Gerontol Int, 2015, 15(3): 261-267.
30.	Liu ZY, Shen YY, Ji LJ, et al. Association between serum β2-microglobulin levels and frailty in an elderly Chinese population: results from RuLAS. Clin Interv Aging, 2017, 12: 1725-1729.
31.	Yang F, Chen QW. Evaluation of frailty and influencing factors in old people in hospital institution: Evidence for a phenotype of frailty. Medicine (Baltimore), 2018, 97(3): e9634.
32.	Lee JS, Auyeung TW, Leung J, et al. Transitions in frailty states among community-living older adults and their associated factors. J Am Med Dir Assoc, 2014, 15(4): 281-286.
33.	Chen S, Hao Q, Yang M, et al. Association between Angiotensin-converting enzyme insertion/deletion polymorphisms and frailty among chinese older people. J Am Med Dir Assoc, 2015, 16(5): 438. e1-e6.
34.	Woo J, Zheng Z, Leung J, et al. Prevalence of frailty and contributory factors in three Chinese populations with different socioeconomic and healthcare characteristics. BMC Geriatr, 2015, 15: 163.
35.	Yang L, Jiang Y, Xu S, et al. Evaluation of frailty status among older people living in urban communities by Edmonton Frail Scale in Wuhu, China: a cross-sectional study. Contemp Nurse, 2018, 54(6): 630-639.
36.	廖春霞, 马红梅, 徐旭, 等. 中国社区老年人衰弱发生率的Meta分析. 职业与健康, 2017, 33(20): 2767-2770.
37.	Collard RM, Boter H, Schoevers RA, et al. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc, 2012, 60(8): 1487-1492.
38.	Kiely DK, Cupples LA, Lipsitz LA. Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Geriatr Soc, 2009, 57(9): 1532-1539.
39.	Cawthon PM, Marshall LM, Michael Y, et al. Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc, 2007, 55(8): 1216-1223.
40.	Evenhuis HM, Hermans H, Hilgenkamp TI, et al. Frailty and disability in older adults with intellectual disabilities: results from the healthy ageing and intellectual disability study. J Am Geriatr Soc, 2012, 60(5): 934-938.
41.	Gill TM, Gahbauer EA, Allore HG, et al. Transitions between frailty states among community-living older persons. Arch Intern Med, 2006, 166(4): 418-423.
42.	Wong CH, Weiss D, Sourial N, et al. Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study. Aging Clin Exp Res, 2010, 22(1): 54-62.
43.	Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA, 1995, 273(17): 1341-1347.
44.	Ahmed N, Mandel R, Fain MJ. Frailty: an emerging geriatric syndrome. Am J Med, 2007, 120(9): 748-753.
45.	Metzelthin SF, van Rossum E, de Witte LP, et al. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. BMJ, 2013, 347: f5264.
46.	Ensrud KE, Blackwell TL, Cauley JA, et al. Circulating 25-hydroxyvitamin D levels and frailty in older men: the osteoporotic fractures in men study. J Am Geriatr Soc, 2011, 59(1): 101-106.

1. United Nations Department of Economic and Social Affairs, Population Division, World Population Prospects. The 2015 Revision, United Nations Department of Economic and Social Affairs, Population Division. New York: United Nations, 2015.
2. Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc, 2006, 54(6): 991-1001.
3. Bandeen-Roche K, Xue QL, Ferrucci L, et al. Phenotype of frailty: characterization in the women's health and aging studies. J Gerontol A Biol Sci Med Sci, 2006, 61(3): 262-266.
4. Ensrud KE, Ewing SK, Cawthon PM, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc, 2009, 57(3): 492-498.
5. Theou O, Brothers TD, Mitnitski A, et al. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc, 2013, 61(9): 1537-1551.
6. Siriwardhana DD, Hardoon S, Rait G, et al. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open, 2018, 8(3): e018195.
7. 焦桂梅, 李建民. 中高龄老年人衰弱程度与老年性骨质疏松症的相关性探讨. 中国骨质疏松杂志, 2018, 24(3): 376-379, 384.
8. 侯晓琳, 高静, 吴晨曦, 等. 养老机构老年人衰弱现状及分析. 中华护理杂志, 2018, 53(1): 88-93.
9. 李阳, 张立萍, 罗洋. 哈尔滨市社区老年人衰弱现状及其影响因素调查. 护理研究, 2018, 32(2): 224-228.
10. 李晓凯, 陈长香, 张敏, 等. 唐山市高龄空巢老年人健康状况及生活方式与衰弱相关性. 中国公共卫生, 2018, 34(2): 162-166.
11. 李秋萍, 韩斌如. 外科住院老年病人衰弱现状及影响因素的调查分析. 护理研究, 2017, 31(33): 4307-4311.
12. 任青卓, 周静静, 郑雅婧, 等. 广州市老年人衰弱现状及其影响因素. 2019, 35(4): 413-417.
13. 张治香, 侯惠如. 海南部分地区百岁老人衰弱现状及影响因素分析. 解放军医学院学报, 2018, 39(4): 286-290, 307.
14. 田晓宇, 乔晓霞, 董莉娟, 等. 社区老年人衰弱与卫生服务利用的关系研究. 中国卫生事业管理, 2017, 34(7): 494-497.
15. 乔晓霞, 杨华, 苗红, 等. 社区老年人衰弱与机构养老需求的关系. 中国老年学杂志, 2018, 38(2): 450-452.
16. 奚兴, 郭桂芳, 孙静. 社区老年人衰弱状况与抑郁症状关系的研究. 护理学杂志, 2014, 29(15): 87-89, 92.
17. 陶晓春, 胡安梅, 魏书侠, 等. 社区老年人的临床研究. 实用老年医学, 2015, 29(1): 63-66.
18. 孙凯旋, 刘永兵, 薛谨, 等. 老年住院患者衰弱状况及其影响因素分析. 中华老年病研究电子杂志, 2017, 4(1): 30-35.
19. 卫尹, 曹艳佩, 杨晓莉, 等. 老年住院患者衰弱综合征现状及影响因素. 复旦学报(医学版), 2018, 45(4): 496-502.
20. 徐秀萍, 吴凌云, 王秀丽, 等. 衢州市老年住院患者衰弱综合征评估及照护依赖状况研究. 医学与社会, 2017, 30(8): 64-66.
21. Chen LJ, Chen CY, Lue H, et al. Prevalence and Associated Factors of Frailty Among Elderly People in Taiwan. Inter J Geron, 2014, 8: 114-119.
22. Chen CY, Wu SC, Chen LJ, et al. The prevalence of subjective frailty and factors associated with frailty in Taiwan. Arch Gerontol Geriatr, 2010, 50 Suppl 1: S43-S47.
23. Chang CI, Chan DC, Kuo KN, et al. Prevalence and correlates of geriatric frailty in a northern Taiwan community. J Formos Med Assoc, 2011, 110(4): 247-257.
24. Biritwum RB, Minicuci N, Yawson AE, et al. Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas, 2016, 91: 8-18.
25. Hao Q, Dong B, Yang M, et al. Frailty and cognitive impairment in predicting mortality among oldest-old people. Front Aging Neurosci, 2018, 10: 295.
26. Hoogendijk EO, Rijnhart JJM, Kowal P, et al. Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE). Maturitas, 2018, 115: 56-63.
27. Lai HY, Chang HT, Lee YL, et al. Association between inflammatory markers and frailty in institutionalized older men. Maturitas, 2014, 79(3): 329-333.
28. Li J, Zhao D, Dong B, et al. Frailty index and its associations with self-neglect, social support and sociodemographic characteristics among older adults in rural China. Geriatr Gerontol Int, 2018, 18(7): 987-996.
29. Lin CH, Chou CY, Liu CS, et al. Association between frailty and subclinical peripheral vascular disease in a community-dwelling geriatric population: Taichung Community Health Study for Elders. Geriatr Gerontol Int, 2015, 15(3): 261-267.
30. Liu ZY, Shen YY, Ji LJ, et al. Association between serum β2-microglobulin levels and frailty in an elderly Chinese population: results from RuLAS. Clin Interv Aging, 2017, 12: 1725-1729.
31. Yang F, Chen QW. Evaluation of frailty and influencing factors in old people in hospital institution: Evidence for a phenotype of frailty. Medicine (Baltimore), 2018, 97(3): e9634.
32. Lee JS, Auyeung TW, Leung J, et al. Transitions in frailty states among community-living older adults and their associated factors. J Am Med Dir Assoc, 2014, 15(4): 281-286.
33. Chen S, Hao Q, Yang M, et al. Association between Angiotensin-converting enzyme insertion/deletion polymorphisms and frailty among chinese older people. J Am Med Dir Assoc, 2015, 16(5): 438. e1-e6.
34. Woo J, Zheng Z, Leung J, et al. Prevalence of frailty and contributory factors in three Chinese populations with different socioeconomic and healthcare characteristics. BMC Geriatr, 2015, 15: 163.
35. Yang L, Jiang Y, Xu S, et al. Evaluation of frailty status among older people living in urban communities by Edmonton Frail Scale in Wuhu, China: a cross-sectional study. Contemp Nurse, 2018, 54(6): 630-639.
36. 廖春霞, 马红梅, 徐旭, 等. 中国社区老年人衰弱发生率的Meta分析. 职业与健康, 2017, 33(20): 2767-2770.
37. Collard RM, Boter H, Schoevers RA, et al. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc, 2012, 60(8): 1487-1492.
38. Kiely DK, Cupples LA, Lipsitz LA. Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Geriatr Soc, 2009, 57(9): 1532-1539.
39. Cawthon PM, Marshall LM, Michael Y, et al. Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc, 2007, 55(8): 1216-1223.
40. Evenhuis HM, Hermans H, Hilgenkamp TI, et al. Frailty and disability in older adults with intellectual disabilities: results from the healthy ageing and intellectual disability study. J Am Geriatr Soc, 2012, 60(5): 934-938.
41. Gill TM, Gahbauer EA, Allore HG, et al. Transitions between frailty states among community-living older persons. Arch Intern Med, 2006, 166(4): 418-423.
42. Wong CH, Weiss D, Sourial N, et al. Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study. Aging Clin Exp Res, 2010, 22(1): 54-62.
43. Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA, 1995, 273(17): 1341-1347.
44. Ahmed N, Mandel R, Fain MJ. Frailty: an emerging geriatric syndrome. Am J Med, 2007, 120(9): 748-753.
45. Metzelthin SF, van Rossum E, de Witte LP, et al. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. BMJ, 2013, 347: f5264.
46. Ensrud KE, Blackwell TL, Cauley JA, et al. Circulating 25-hydroxyvitamin D levels and frailty in older men: the osteoporotic fractures in men study. J Am Geriatr Soc, 2011, 59(1): 101-106.

Chinese Journal of Evidence-Based Medicine

Epidemiological characteristics of frailty in Chinese elderly population: a systematic review

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