The prognostic value of frailty criteria in older adults: a systematic review and meta-analysis

Abstract Introduction Frailty, a prevalent geriatric syndrome, increases susceptibility to adverse outcomes like mortality, cardiovascular disease, and hospitalization. This study evaluated the Fried frailty phenotype and its components’ association with clinical outcomes, focusing on mortality. Methods We conducted a systematic review and meta-analysis of studies on individuals aged 50 or more from databases searched up to October 2024. Included studies assessed at least one frailty criterion (weakness, slowness, exhaustion, physical inactivity, weight loss) and reported hazard ratios (HRs) for mortality or other outcomes. Random-effects models and subgroup analyses (e.g., heart failure, chronic kidney disease) were employed. Results From 3445 articles, 36 studies were included. All frailty components are significantly associated with all-cause mortality: weakness (HR: 1.44, 95%CI: 1.30–1.59, p < 0.01), slowness (HR: 1.75, 95%CI: 1.56–1.95, p < 0.01), exhaustion (HR: 1.47, 95%CI: 1.29–1.68, p < 0.01), physical inactivity (HR: 1.72, 95%CI: 1.55–1.92, p < 0.01), and weight loss (HR: 1.56, 95%CI: 1.31–1.84, p < 0.01). Slowness, weakness, and physical inactivity were linked to cardiovascular mortality (HRs: 1.97, 1.45, 1.26, respectively, p < 0.01), while slowness and exhaustion were also linked to an increased risk of hospitalization (HRs: 1.46, 1.25, p < 0.01). Slowness was associated with a two-fold higher mortality risk (I2 = 57%, HR: 1.99, 95%CI: 1.73–2.30, p < 0.01). Subgroup analyses confirmed these links in heart failure and chronic kidney disease patients. Conclusion Frailty components, especially weakness and slowness, are significantly associated with mortality and related outcomes, highlighting the urgency of early frailty detection to improve patient prognosis. Graphical abstract This systematic review and meta-analysis of 36 studies demonstrates that the components of frailty, when considered individually, are significantly associated with an increased mortality risk; weakness (HR: 1.44), slowness (HR: 1.75), exhaustion (HR: 1.47), physical inactivity (HR: 1.72), and unintentional weight loss (HR: 1.56). Slowness and weakness are also associated with cardiovascular mortality and hospitalization, with slowness associated with a two-fold higher mortality risk in community-dwelling older adults (HR: 1.99). These robust associations, confirmed in heart failure and chronic kidney disease subgroups, highlight frailty's critical role in adverse outcomes, urging early identification and intervention to enhance patient care and reduce clinical burden.