Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis

PLoS One. 2020 Feb 7;15(2):e0228821. doi: 10.1371/journal.pone.0228821. eCollection 2020.


Introduction: The best interventions to address frailty among older adults have not yet been fully defined, and the diversity of interventions and outcome measures makes this process challenging. Consequently, there is a lack of guidance for clinicians and researchers regarding which interventions are most likely to help older persons remain robust and independent. This paper uses meta-analysis to assess effectiveness of primary care interventions for physical frailty among community-dwelling adults aged 60+ and provides an up-to-date synthesis of literature in this area.

Methods: PubMed, CINAHL, Cochrane Register of Controlled Trials, and PEDro databases were searched, and RCTs, controlled pilot studies, or trials with similar study designs addressing frailty in the primary care setting among persons aged 60+ were chosen. Study data was abstracted following PRISMA guidelines, then meta-analysis was performed using the random effects model.

Results: 31 studies with a total of 4794 participants were analysed. Interventions using predominantly resistance-based exercise and nutrition supplementation seemed to improve frailty status versus control (RR = 0.62 (CI 0.48-0.79), I2 = 0%). Exercise plus nutrition education also reduced frailty (RR = 0.69 (CI 0.58-0.82), I2 = 0%). Exercise alone seemed effective in reducing frailty (RR = 0.63 (CI 0.47-0.84), I2 = 0%) and improving physical performance (RR = 0.43 (CI 0.18-0.67), I2 = 0%). Exercise alone also appeared superior to control in improving gait speed (SMD = 0.36 (CI 0.10-0.61, I2 = 74%), leg strength (SMD = 0.61 (CI 0.09-1.13), I2 = 87%), and grip strength (Mean Difference = 1.08 (CI 0.02-2.15), I2 = 71%) though a high degree of heterogeneity was observed. Comprehensive geriatric assessment (RR = 0.77 (CI 0.64-0.93), I2 = 0%) also seemed superior to control in reducing frailty.

Conclusion: Exercise alone or with nutrition supplementation or education, and comprehensive geriatric assessment, may reduce physical frailty. Individual-level factors and health systems resource availability will likely determine configuration of future interventions.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Dietary Supplements*
  • Exercise*
  • Frailty / pathology
  • Gait
  • Geriatric Assessment
  • Hand Strength
  • Humans
  • Primary Health Care / methods*
  • Risk

Grants and funding

This study was funded by Ireland’s Health Research Board ( and St. Vincent’s University Hospital ( under the Applied Partnership Awards, grant number APA-2016-1857 held by Principal Investigator Dr. Marie Therese Cooney (MTC). Prof. Roman Romero-Ortuno (RRO) is funded by Science Foundation Ireland ( under the 2018 President of Ireland Future Research Leaders Programme, grant number 18/FRL/6188. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.