Quick and Simple FRAIL Scale Predicts Incident Activities of Daily Living (ADL) and Instrumental ADL (IADL) Disabilities: A Systematic Review and Meta-analysis

Abstract

Objectives: To quantitatively examine frailty defined by FRAIL scale as a predictor of incident disability risks by conducting a systematic review and meta-analysis.

Design: Systematic review and meta-analysis.

Setting: A systematic review was conducted using 4 electronic databases (Embase, MEDLINE, CINAHL, and PsycINFO) in April 2018 for prospective cohort studies of middle-aged or older people examining associations between frailty and incident disability. Reference lists of the included studies were hand-searched for additional studies. Authors of potentially eligible studies were contacted for additional data if necessary. Methodological quality was assessed by the Newcastle-Ottawa scale.

Participants: Community-dwelling middle-aged and older people.

Measurements: Incident risks of activities of daily living (ADL) or instrumental activities of daily living (IADL) disability according the FRAIL scale-defined frailty.

Results: Seven studies provided odds ratios of incident disability risks according to frailty and were included in the meta-analysis. A random effects meta-analysis showed that frailty and prefrailty were significant predictors of ADL [pooled odds ratio (OR) = 9.82, 95% confidence interval (CI) = 4.71-20.46, P < .001 for frailty (FRAIL scale = 3-5) and pooled OR = 2.08, 95% CI = 1.77-2.45, P < .001 for prefrailty (FRAIL scale = 1-2) compared with robustness (FRAIL scale = 0); pooled OR = 4.44, 95% CI = 3.26-6.04, P < .001 for frailty compared with nonfrailty (FRAIL scale = 0-2)] and IADL (pooled OR = 2.50, 95% CI = 1.67-3.73, P < .001, for frailty and pooled OR = 1.74, 95% CI = 1.10-2.77, P = .02, for prefrailty compared with robustness). There was no evidence of publication bias.

Conclusions/implications: The current study demonstrated that frailty status defined by the FRAIL scale was a significant predictor of disability among community-dwelling middle-aged and older individuals. In light of feasibility of the FRAIL scale, especially in a clinical setting, it may be a promising tool to facilitate the translation of frailty research into clinical practice.

Keywords: ADL; FRAIL scale; Frailty; IADL; disability.