Prevalence of Frailty in Nursing Homes: A Systematic Review and Meta-Analysis

Background Nursing home patients are expected to be very frail. However, evidence on frailty in a nursing home setting is scarce in the literature. Especially prevalence of frailty in this population is unknown. Objective To systematically search and analyze the prevalence of frailty among nursing home patients in the literature and synthesize pooled estimates of overall prevalence of frailty and prefrailty as well as prevalence of frailty stratified by age, gender, and frailty definitions. Design Systematic review using 5 databases: Embase, MEDLINE, CINAHL Plus, PsycINFO, and Cochrane library, and meta-analysis. Setting Cross-sectional studies or observational studies with baseline data in a nursing home setting. Participants Nursing home patients aged 60 years or older. Measurements Prevalence of frailty and prefrailty based on validated criteria or definitions of frailty was collected. In the included studies, meta-analysis was performed using random-effects models to calculate pooled estimates of prevalence of frailty and prefrailty. Methodological quality, heterogeneity, and publication bias were assessed. Results Nine studies with a total of 1373 nursing home patients were found to report prevalence of frailty. The included studies were highly heterogeneous and mean prevalence of frailty ranged widely from 19.0 to 75.6%. Pooled estimates of prevalence of frailty and prefrailty were 52.3% (95% confidence interval 37.9%–66.5%) (9 studies, n = 1373) and 40.2% (28.9%–52.1%) (7 studies, n = 1163), respectively. Conclusions As high as about one-half of the nursing home patients were frail. Approximately 40% were still prefrail and could be targeted by interventions for frailty prevention or treatment to avoid its negative health outcomes.