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. 中高齡老年人衰弱程度與老年性骨質疏松癥的相關性探討. 中國骨質疏松雜志, 2018, 24(3): 376-379, 384.
8.	侯曉琳, 高靜, 吳晨曦, 等. 養老機構老年人衰弱現狀及分析. 中華護理雜志, 2018, 53(1): 88-93.
9.	李陽, 張立萍, 羅洋. 哈爾濱市社區老年人衰弱現狀及其影響因素調查. 護理研究, 2018, 32(2): 224-228.
10.	李曉凱, 陳長香, 張敏, 等. 唐山市高齡空巢老年人健康狀況及生活方式與衰弱相關性. 中國公共衛生, 2018, 34(2): 162-166.
11.	李秋萍, 韓斌如. 外科住院老年病人衰弱現狀及影響因素的調查分析. 護理研究, 2017, 31(33): 4307-4311.
12.	任青卓, 周靜靜, 鄭雅婧, 等. 廣州市老年人衰弱現狀及其影響因素. 2019, 35(4): 413-417.
13.	張治香, 侯惠如. 海南部分地區百歲老人衰弱現狀及影響因素分析. 解放軍醫學院學報, 2018, 39(4): 286-290, 307.
14.	田曉宇, 喬曉霞, 董莉娟, 等. 社區老年人衰弱與衛生服務利用的關系研究. 中國衛生事業管理, 2017, 34(7): 494-497.
15.	喬曉霞, 楊華, 苗紅, 等. 社區老年人衰弱與機構養老需求的關系. 中國老年學雜志, 2018, 38(2): 450-452.
16.	奚興, 郭桂芳, 孫靜. 社區老年人衰弱狀況與抑郁癥狀關系的研究. 護理學雜志, 2014, 29(15): 87-89, 92.
17.	陶曉春, 胡安梅, 魏書俠, 等. 社區老年人的臨床研究. 實用老年醫學, 2015, 29(1): 63-66.
18.	孫凱旋, 劉永兵, 薛謹, 等. 老年住院患者衰弱狀況及其影響因素分析. 中華老年病研究電子雜志, 2017, 4(1): 30-35.
19.	衛尹, 曹艷佩, 楊曉莉, 等. 老年住院患者衰弱綜合征現狀及影響因素. 復旦學報(醫學版), 2018, 45(4): 496-502.
20.	徐秀萍, 吳凌云, 王秀麗, 等. 衢州市老年住院患者衰弱綜合征評估及照護依賴狀況研究. 醫學與社會, 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, 馬紅梅, 徐旭, 等. 中國社區老年人衰弱發生率的Meta分析. 職業與健康, 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. 中高齡老年人衰弱程度與老年性骨質疏松癥的相關性探討. 中國骨質疏松雜志, 2018, 24(3): 376-379, 384.
8. 侯曉琳, 高靜, 吳晨曦, 等. 養老機構老年人衰弱現狀及分析. 中華護理雜志, 2018, 53(1): 88-93.
9. 李陽, 張立萍, 羅洋. 哈爾濱市社區老年人衰弱現狀及其影響因素調查. 護理研究, 2018, 32(2): 224-228.
10. 李曉凱, 陳長香, 張敏, 等. 唐山市高齡空巢老年人健康狀況及生活方式與衰弱相關性. 中國公共衛生, 2018, 34(2): 162-166.
11. 李秋萍, 韓斌如. 外科住院老年病人衰弱現狀及影響因素的調查分析. 護理研究, 2017, 31(33): 4307-4311.
12. 任青卓, 周靜靜, 鄭雅婧, 等. 廣州市老年人衰弱現狀及其影響因素. 2019, 35(4): 413-417.
13. 張治香, 侯惠如. 海南部分地區百歲老人衰弱現狀及影響因素分析. 解放軍醫學院學報, 2018, 39(4): 286-290, 307.
14. 田曉宇, 喬曉霞, 董莉娟, 等. 社區老年人衰弱與衛生服務利用的關系研究. 中國衛生事業管理, 2017, 34(7): 494-497.
15. 喬曉霞, 楊華, 苗紅, 等. 社區老年人衰弱與機構養老需求的關系. 中國老年學雜志, 2018, 38(2): 450-452.
16. 奚興, 郭桂芳, 孫靜. 社區老年人衰弱狀況與抑郁癥狀關系的研究. 護理學雜志, 2014, 29(15): 87-89, 92.
17. 陶曉春, 胡安梅, 魏書俠, 等. 社區老年人的臨床研究. 實用老年醫學, 2015, 29(1): 63-66.
18. 孫凱旋, 劉永兵, 薛謹, 等. 老年住院患者衰弱狀況及其影響因素分析. 中華老年病研究電子雜志, 2017, 4(1): 30-35.
19. 衛尹, 曹艷佩, 楊曉莉, 等. 老年住院患者衰弱綜合征現狀及影響因素. 復旦學報(醫學版), 2018, 45(4): 496-502.
20. 徐秀萍, 吳凌云, 王秀麗, 等. 衢州市老年住院患者衰弱綜合征評估及照護依賴狀況研究. 醫學與社會, 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, 馬紅梅, 徐旭, 等. 中國社區老年人衰弱發生率的Meta分析. 職業與健康, 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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