Prevalence of cognitive frailty, reversible and potentially reversible cognitive frailty among older adults without dementia: a systematic review and meta-analysis

Abstract Objectives Cognitive frailty (CF) is characterized by the coexistence of physical frailty and cognitive impairment, while potentially reversible cognitive frailty (PRCF) and reversible cognitive frailty (RCF) refer to two related conditions that may be modifiable or responsive to interventions. This study aimed to estimate the pooled prevalence of CF, PRCF, and RCF among older adults without dementia. Methods A search of six literature databases was conducted from inception to August 15, 2024. Cohort and cross-sectional studies reporting CF, PRCF, or RCF prevalence in older adults aged 60+ without dementia were included. Random-effects meta-analyses with logit-transformed prevalence were performed, along with subgroup analyses and meta-regression. Results Of the 13,100 articles identified, 90 studies from 17 countries were eligible, with 63 studies on CF, 50 studies on PRCF, and 10 studies on RCF. In community settings, the pooled prevalence of CF and PRCF was 5% (95% CI: 4%-6%) and 17% (95% CI: 13%-21%), respectively; in hospitals, 13% (95% CI: 8%-20%) and 32% (95% CI: 23%-42%); and in nursing homes, 22% (95% CI: 17%-29%) and 32% (95% CI: 1%-99%). The pooled prevalence of RCF in community settings was 21% (95% CI: 15%-29%). Studies with older participants showed higher CF prevalence. Moreover, studies with suboptimal sample sizes reported higher PRCF prevalence. Discussion The prevalence of CF, PRCF, and RCF among older adults varies across settings, with PRCF and RCF showing notable rates. Further studies in underrepresented regions, along with age-stratified analyses, prior sample size calculations, and appropriate assessment tool selection, are needed.