Frailty as a predictor of hospitalisation among community-dwelling older people: a systematic review and meta-analysis

Background: Owing to detrimental hazards and substantial healthcare burden and costs, hospitalisation of older people has become a major focus. Frailty has increasingly been recognised as an important predictor of hospitalisation. This study aims to identify studies on physical frailty as a predictor of hospitalisation risks and to pool the risk estimates among community-dwelling older people.

Methods: A systematic literature search was performed in August 2015 using five databases: EMBASE, MEDLINE, CINAHL, PsycINFO and the Cochrane Library for prospective studies examining physical frailty as a predictor of hospitalisation published in 2000 or later. OR and HR were combined to synthesise pooled effect measures using fixed-effects models. The included studies were assessed for heterogeneity, methodological quality and publication bias. Subgroup analysis and meta-regression analysis were conducted to examine study characteristics in relation to the hospitalisation risks.

Results: Of the 4620 studies identified by the systematic review, 13 studies with average follow-up period of 3.1 years were selected. Frailty and prefrailty were significantly associated with higher hospitalisation risks among 10 studies with OR (pooled OR=1.90, 95% CI 1.74-2.07, p<0.00001; pooled OR=1.26, 95% CI 1.18-1.33, p<0.00001, respectively) and 3 studies with HR (pooled HR=1.30, 95% CI 1.12-1.52, p=0.0007; pooled HR=1.13, 95% CI 1.04-1.24, p=0.005, respectively). Heterogeneity was low to moderate. No publication bias was detected. The studies with older populations and unadjusted outcome measures were associated with higher hospitalisation risks in the subgroup analysis.

Conclusions: This systematic review and meta-analysis demonstrated physical frailty is a significant predictor of hospitalisation among community-dwelling older people. Hospitalisation can potentially be reduced by treating or preventing frailty.