Abstract
BackgroundOne of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological, physical, and social functioning. Hospitalization is one of the most stressful events for older people who are becoming frail. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults.MethodsA systematic review and meta-analysis of research was conducted using the Medline, Embase, Cochrane, ProQuest, CINAHL, SCOPUS and Web of Science electronic databases for papers published between 2000 and 2019. Randomized controlled studies were included that were aimed at the management of frailty in hospitalized older adults. The outcomes which were examined included frailty; physical, psychological, and social domains; length of stay in hospital; re-hospitalization; mortality; patient satisfaction; and the need for post discharge placement.ResultsAfter screening 7976 records and 243 full-text articles, seven studies (3 interventions) were included, involving 1009 hospitalized older patients. The quality of these studies was fair to poor and the risk of publication bias in the studies was low. Meta-analysis of the studies showed statistically significant differences between the intervention and control groups for the management of frailty in hospitalized older adults (ES = 0.35; 95% CI: 0. 067–0.632; z = 2.43; P < 0.015). However, none of the included studies evaluated social status, only a few of the studies evaluated other secondary outcomes. The analysis also showed that a Comprehensive Geriatric Assessment unit intervention was effective in addressing physical and psychological frailty, re-hospitalization, mortality, and patient satisfaction.ConclusionsInterventions for hospitalized frail older adults are effective in management of frailty. Multidimensional interventions conducted by a multidisciplinary specialist team in geriatric settings are likely to be effective in the care of hospitalized frail elderly. Due to the low number of RCTs carried out in a hospital setting and the low quality of existing studies, there is a need for new RCTs to be carried out to generate a protocol appropriate for frail older people.
Highlights
One of the most challenging issues for the elderly population is the clinical state of frailty
This systematic review and meta-analysis was conducted to evaluate the effectiveness of interventions for the care and management of frailty in hospitalized older adults
The present study aimed to determine the effectiveness of interventions on physical, psychological, social domains, and hospitalization status
Summary
One of the most challenging issues for the elderly population is the clinical state of frailty. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults. It is expected that the elderly population will reach 2 billion people in 2050 [1] which raises serious concerns for the management and planning of health systems [2]. Frailty is a new concept in medical sciences that is defined as “a clinically recognizable state of increased vulnerability that is the result of aging-related decline in function across multiple physiological organ systems such that the ability to cope with every day or acute stressors is compromised” [3]. There are two principal approaches to defining frailty, the frailty phenotype and the accumulation of deficits [4]. It is estimated that the incidence of frailty and pre-frailty in community-dwelling older adults are approximately 43 and 151 new cases per 1000 person-years, respectively [7]
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