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Review
. 2018 Mar 1;8(3):e018195.
doi: 10.1136/bmjopen-2017-018195.

Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis

Dhammika D Siriwardhana  1   2 , Sarah Hardoon  1 , Greta Rait  1 , Manuj C Weerasinghe  3 , Kate R Walters  1
Affiliations
Free PMC article
Review

Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis

Dhammika D Siriwardhana et al. BMJ Open. .
Free PMC article

Abstract

Objective: To systematically review the research conducted on prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries (LMICs) and to estimate the pooled prevalence of frailty and prefrailty in community-dwelling older adults in LMICs.

Design: Systematic review and meta-analysis. PROSPERO registration number is CRD42016036083.

Data sources: MEDLINE, EMBASE, AMED, Web of Science, CINAHL and WHO Global Health Library were searched from their inception to 12 September 2017.

Setting: Low-income and middle-income countries.

Participants: Community-dwelling older adults aged ≥60 years.

Results: We screened 7057 citations and 56 studies were included. Forty-seven and 42 studies were included in the frailty and prefrailty meta-analysis, respectively. The majority of studies were from upper middle-income countries. One study was available from low-income countries. The prevalence of frailty varied from 3.9% (China) to 51.4% (Cuba) and prevalence of prefrailty ranged from 13.4% (Tanzania) to 71.6% (Brazil). The pooled prevalence of frailty was 17.4% (95% CI 14.4% to 20.7%, I2=99.2%) and prefrailty was 49.3% (95% CI 46.4% to 52.2%, I2=97.5%). The wide variation in prevalence rates across studies was largely explained by differences in frailty assessment method and the geographic region. These findings are for the studies with a minimum recruitment age 60, 65 and 70 years.

Conclusion: The prevalence of frailty and prefrailty appears higher in community-dwelling older adults in upper middle-income countries compared with high-income countries, which has important implications for healthcare planning. There is limited evidence on frailty prevalence in lower middle-income and low-income countries.

Prospero registration number: CRD42016036083.

Keywords: LMICs; ageing; epidemiology; frailty syndrome; meta-analysis; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study selection.
Figure 2
Figure 2
Random-effects pooled prevalence of frailty among community-dwelling older adults in LMICs. ES, effect size; LMICs, low-income and middle-income countries.
Figure 3
Figure 3
Funnel plot for assessing publication or other types of biases in meta-analysis of prevalence of frailty. ES, effect size.
Figure 4
Figure 4
Random-effects pooled prevalence of prefrailty among community-dwelling older adults in LMICs. ES, effect size; LMICs, low-income and middle-income countries.
Figure 5
Figure 5
Funnel plot for assessing publication or other types of biases in meta-analysis of prevalence of prefrailty. ES, effect size.
See this image and copyright information in PMC

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