A Systematic Review of Frailty Trajectories: Their Shape and Influencing Factors

Abstract

Background and Objectives Frailty describes an increased vulnerability to adverse events such as disease or injury. Combatting this state remains a major challenge for geriatric research. By exploring how and why frailty changes throughout later life we will be better positioned to improve ways of identifying and treating those at high risk. Research Design and Methods We systematically reviewed publications that captured rate of frailty progression over time and established any associated risk or protective factors that affected this progression. We included longitudinal observational studies which quantified frailty trajectories in adults aged 50+ using any validated continuous frailty measurement tool. Results After screening 8,318 publications, 25 met our criteria. Findings show that despite a great degree of heterogeneity in the literature, progression of frailty is unquestionably affected by numerous risk and protective factors, with particular influence exhibited by social demographics, brain pathology, and physical co-morbidities. Discussion and Implications Findings that the gradient of frailty progression is affected by various influencing factors are valuable to clinicians and policymakers as will help identify those at highest frailty risk and inform prevention strategies. However, the heterogeneous methodological approaches of the publications included in this review highlights the need for consensus within the field to promote more coordinated research. Improved consistency of methods will enable further data synthesis and facilitate a greater understanding of the shape of frailty over time and the influencing factors contributing to change, the results of which could have crucial implications for frailty risk reduction.

Trajectories of frailty in aging: Prospective cohort study

“…Emerging evidence supports heterogeneity in frailty progression in aging with variations in individual rates of change [3,8]. Previous studies using different definitions of frailty as well as methodological approaches have reported both stable and declining trajectories in older adults [8][9][10][11][12]. But these findings regarding different frailty courses were not cross-validated in independent samples, and none have explored the underlying biology of latent subpopulations of frailty trajectories [8,12].…”

“…Previous studies using different definitions of frailty as well as methodological approaches have reported both stable and declining trajectories in older adults [8][9][10][11][12]. But these findings regarding different frailty courses were not cross-validated in independent samples, and none have explored the underlying biology of latent subpopulations of frailty trajectories [8,12]. Identifying trends and trajectories is acknowledged as a high priority for frailty research [3,8].…”

Inflammation as a risk factor for the development of frailty in the Lothian Birth Cohort 1936

“…This could have important implications for public health intervention strategies for the care of elderly people. A recent systematic review ( Welstead et al, 2020 ), concluded that, in lieu of a gold standard frailty measurement tool, it may be beneficial to utilise multiple measures. Subsequently, we used both the FI and the Fried phenotype to assess associations with inflammation and evaluate any potential differences in findings according to the measure used.…”

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“…Although the concept of frailty is based on reversibility, many previous studies have focused on risk factors and protective factors for frailty [28]. Many studies have identified risk factors for frailty, including age, sex (female), cognitive ability (executive function, etc.…”

“…socioeconomic factors (financial stress, etc.) [28]. Conversely, the rate of recovery from frailty has not been investigated sufficiently, and the manifestation of frailty has been limited to physical frailty [29][30][31].…”