Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults:a systematic review protocol

Apóstolo, João and Cooke, Richard and Bobrowicz-Campos, Elzbieta and Santana, Silvina and Marcucci, Maura and Cano, Antonio and Vollenbroek, Miriam and Holland, Carol (2016) Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults:a systematic review protocol. JBI database of systematic reviews and implementation reports, 14 (1). pp. 4-19. ISSN 2202-4433

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Review question/objective The objective of this review is to identify the effectiveness of the interventions in preventing progression of pre-frailty and frailty in older adults. More specifically, the review questions are: - What is the effectiveness of interventions in preventing or reducing frailty in older adults? - How does effectiveness vary with degree of frailty? - Are there factors that influence the effectiveness of interventions? - What is the economic feasibility of interventions for pre-frailty and frailty? Frailty is an age-related state of high vulnerability to adverse health outcomes after a stressor event1-6, predisposing the individuals to falls and fractures, disability, dependency, hospitalization and institutional placement, and ultimately death.1 It can be preceded by, but also occurs in the absence of, chronic disease.3,5,7 According to some authors, this clinical condition results from decrease in reserves across multiple physiological systems that are normally responsible for healthy adaptation to stress.1,8,9 Alternatively, it is considered that frailty is due to the critical accumulation of dysregulation in important signaling pathways and subsequent depletion of homeostatic reserve and resiliency.1,10,11 Other authors describe this state of increased vulnerability as associated with a reduced capacity to compensate aging-related molecular and cellular damage.2 Independently of pathophysiological conceptualization, it is assumed that frailty is a dynamic process that leads to a spiraling decline in various functional domains that exacerbates the risk of geriatric syndromes.1,3,5,6 The phenotypic markers of frailty include global weakness with low muscle strength (e.g. poor grip strength), overall slowness (particularly in gait), decreased balance and mobility, fatigability or exhaustion, low physical activity and involuntary weight loss.1,3,5,8 For diagnostic purposes, at least three of these components must be observed.8 The presence of only one or two of them is considered as an indicator of the state of pre-frailty. From a broader perspective, it is assumed that frailty can also manifest through cognitive impairment,12-16 although, according to evidence, the decline in cognition is very selective, being limited to executive functions, attention, verbal fluency and processing of speed. It is also well documented that frail elderlies manifest some impairment in activities of daily living and report significant reduction in quality of life.12,17 Furthermore, recent studies have shown that frailty may be related to mood change,16,18 although the nature of this association, as well as its relevance to the frailty construct, needs to be clarified.17 Regarding the prevalence of frailty, systematic comparison of numerous studies19 shows that frailty in community-dwelling adults aged 65 and over varies from 4% to 17%. In case of pre-frailty, the frequency varies between 19% and 53% in different studies.19 The differences in estimates due to differences in the operational definition of frailty (based on physical markers or incorporating a broader multidimensional approach) and study populations (e.g. the results of epidemiological studies can be affected by demographic variables, such as age and gender, as well as the presence of chronic disease or other comorbid conditions). Because of the frequency of its occurrence and the severity of its consequences, frailty is seen as a threatening condition for older adults, requiring attention from health care professionals, social care practitioners, researchers and policy-makers.3,6,19 The implications of the involvement of these agents can be observed at various levels, with issues related to improving prognosis and preventing the progression from pre-frail to frail being of the greatest interest and relevance. In relations to interventions, attempts to manage adverse consequences of frailty are often focused on minimization of risks of disability and dependency, or on the treatment of underlying conditions and symptoms. For complementary approaches, frailty management involves the development of coping strategies necessary to control potential stress factors or to minimize their impact.3,20 So far, various types of intervention have been proposed, among which are physical activity, psychosocial intervention, health and social care provision, cognitive stimulation, nutrition, medication/medical maintenance and adherence focused interventions, and multifactorial intervention. The results of studies conducted in this area have indicated that treating frailty in older adults is a realistic therapeutic goal.21-24 However, it is still hard to determine how effective these types of intervention are and how efficiency can be influenced by other factors, for example, severity of the clinical condition. Another issue requiring clarification is the effectiveness of interventions in terms of drug prescription and changes in analytical parameters.25,26 The focus of attention should also be directed to economic data, namely, costs relative to benefits and/or savings associated with implementing the interventions for pre-frailty and frailty.27 A preliminary search of the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, Prospero, CINAHL, and Medline has revealed that there are currently no systematic review (neither published nor in progress) on clinical/medical and economic effectiveness of interventions to prevent or reduce frailty in older adults. Therefore, it is necessary for a systematic review to be conducted to examine the effectiveness of the interventions to prevent the progression of pre-frailty and frailty in older adults, involving a critical analysis based on scientific evidence.

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Journal Article
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JBI database of systematic reviews and implementation reports
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Deposited On:
27 Jul 2018 08:24
Last Modified:
01 Sep 2020 04:32