Table 2.
Frailty charactseristics of included articles
| All | Geriatrics | Emergency Department | General Medicine | Cardiology | Orthopedics | Intensive Care Unit | Oncology | Surgery | Prehospital | General Medicine & Surgery | General Medicine & Geriatrics | Geriatrics & Oncology | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Articles n (%) | 240 (100) | 29 (12.1) | 29 (12.1) | 22 (9.2) | 20 (8.3) | 11 (4.6) | 9 (3.8) | 6 (3) | 5 (2.1) | 2 (0.8) | 18 (7.5) | 7 (2.9) | 2 (0.8) |
| When was frailty measured n (%) | |||||||||||||
| At admission | 94 (46.1) | 15 (51.7) | 18 (62.1) | 12 (54.5) | 6 (30.0) | 3 (27.3) | 5 (55.6) | 3 (50.0) | 3 (60.0) | 0 | 3 (16.7) | 6 (85.7) | 1 (50.0) |
| During hospitalization | 34 (16.7) | 9 (31.0) | 3 (10.3) | 5 (22.7) | 4 (20.0) | 2 (18.2) | 1 (11.1) | 2 (33.3) | 0 | 1 (50.0) | 3 (16.7) | 0 | 0 |
| At discharge | 10 (4.9) | 1 (3.4) | 1 (3.4) | 0 | 3 (15.0) | 0 | 1 (11.1) | 0 | 0 | 0 | 0 | 0 | 0 |
| Mixeda | 13 (6.4) | 1 (3.4) | 3 (10.3) | 2 (9.0) | 0 | 1 (9.1) | 0 | 1 (16.7) | 0 | 0 | 0 | 1 (14.3) | 0 |
| Chart/Database review | 27 (13.2) | 3 (10.3) | 3 (10.3) | 2 (9.1) | 6 (30.0) | 3 (27.3) | 2 (22.2) | 0 | 1 (20.0) | 1 (50.0) | 1 (5.6) | 0 | 0 |
| Not reported | 26 (12.7) | 0 | 1 (3.4) | 1 (4.5) | 1 (5.0) | 2 (18.2) | 0 | 0 | 1 (20.0) | 0 | 11 (61.1) | 0 | 1 (50.0) |
| Number of frailty measures used n (%) | |||||||||||||
| 1 | 185 (90.7) | 25 (86.2) | 27 (93.1) | 21 (95.5) | 16 (80.0) | 8 (72.7) | 8 (88.9) | 6 (100.0) | 4 (80.0) | 2 (100.0) | 18 (100.0) | 7 (100.0) | 2 (100.0) |
| 2 | 9 (4.4) | 3 (10.3) | 0 | 0 | 4 (20.0) | 0 | 1 (11.1) | 0 | 0 | 0 | 0 | 0 | 0 |
| 3 | 5 (2.5) | 0 | 2 (6.9) | 1 (4.5) | 0 | 2 (18.2) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | 4 (2.0) | 1 (3.4) | 0 | 0 | 0 | 1 (9.1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 6 | 1 (0.5) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 (20.0) | 0 | 0 | 0 | 0 |
| Type of frailty measure n (%) | |||||||||||||
| Established frailty tools | 123 (51.3) | 17 (48.6) | 17 (51.5) | 17 (70.8) | 16 (66.7) | 6 (33.3) | 9 (90.0) | 3 (50.0) | 6 (60.0) | 1 (50.0) | 0 | 6 (85.7) | 1 (50.0) |
| Non-frailty toolsb | 57 (23.8) | 11 (31.4) | 13 (39.4) | 4 (16.7) | 3 (12.5) | 10 (55.6) | 0 | 1 (16.7) | 4 (40.0) | 0 | 1 (5.6) | 0 | 0 |
| Ad hoc measuresc | 56 (23.3) | 6 (17.1) | 3 (9.1) | 3 (12.5) | 4 (16.7) | 2 (11.1) | 1 (10.0) | 2 (33.3) | 0 | 1 (50.0) | 15 (83.3) | 1 (14.3) | 1 (50.0) |
| Clinical judgment | 4 (1.7) | 1 (2.9) | 0 | 0 | 1 (4.2) | 0 | 0 | 0 | 0 | 0 | 2 (11.1) | 0 | 0 |
| Frailty Measure used n (%) | |||||||||||||
| Established frailty tools | |||||||||||||
| Clinical Frailty Scale | 28 (11.7) | 6 (17.1) | 4 (12.1) | 4 (16.7) | 3 (12.5) | 0 | 6 (60.0) | 0 | 0 | 0 | 0 | 0 | 0 |
| Frailty Phenotype | 28 (11.7) | 2 (5.7) | 4 (12.1) | 4 (16.7) | 6 (25.0) | 1 (5.6) | 2 (20.0) | 0 | 2 (20.0) | 0 | 0 | 1 (14.3) | 0 |
| Frailty Index | 28 (11.7) | 3 (8.6) | 7 (21.2) | 4 (16.7) | 1 (4.2) | 4 (22.2) | 1 (10.0) | 0 | 1 (10.0) | 1 (50.0) | 0 | 1 (14.3) | 0 |
| Edmonton Frailty Scale | 10 (4.2) | 0 | 2 (6.1) | 2 (8.3) | 2 (8.3) | 1 (5.6) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Winodgrad Index | 7 (2.9) | 0 | 0 | 1 (4.2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4 (57.1) | 0 |
| Balducci criteria | 5 (2.1) | 0 | 0 | 0 | 0 | 0 | 0 | 3 (50.0) | 1 (10.0) | 0 | 0 | 0 | 1 (50.0) |
| Rockwood Geriatric Frailty Status | 5 (2.1) | 2 (5.7) | 0 | 0 | 1 (4.2) | 0 | 0 | 0 | 1 (10.0) | 0 | 0 | 0 | 0 |
| Study of Osteoporotic Fracture Index | 3 (1.3) | 2 (5.7) | 0 | 1 (4.2) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Tilburg Frailty Indicator | 3 (1.3) | 0 | 0 | 1 (4.2) | 2 (8.3) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| FRAIL scale | 2 (0.8) | 1 (2.9) | 0 | 0 | 1 (4.2) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Groningen Frailty Indicator | 2 (0.8) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 (10.0) | 0 | 0 | 0 | 0 |
| Other established toolsd | 2 (0.8) | 1 (2.9) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Non-frailty toolsb | |||||||||||||
| Identification of Seniors at Risk | 12 (5.0) | 4 (11.4) | 3 (9.1) | 2 (8.3) | 1 (4.2) | 1 (5.6) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Vulnerable Elders Survey | 5 (2.1) | 0 | 3 (9.1) | 0 | 0 | 0 | 0 | 0 | 1 (10.0) | 0 | 0 | 0 | 0 |
| Grip strength | 4 (1.7) | 2 (5.7) | 0 | 0 | 0 | 1 (5.6) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Barthel Index | 2 (0.8) | 0 | 2 (6.1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Life Space Assessment | 2 (0.8) | 0 | 2 (6.1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Multidimensional Prognosis Index | 2 (0.8) | 2 (5.7) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Short Physical Performance Battery | 2 (0.8) | 1 (2.9) | 0 | 0 | 0 | 0 | 0 | 1 (16.7) | 0 | 0 | 0 | 0 | 0 |
| Other non-frailty toolse | 28 (11.7) | 2 (5.7) | 3 (9.1) | 2 (9.1) | 2 (8.3) | 8 (44.4) | 0 | 0 | 3 (30.0) | 0 | 1 (5.6) | 0 | 0 |
| Ad hoc measuresc | |||||||||||||
| GEM criteriaf | 12 (5.0) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 12 (66.7) | 0 | 0 |
| Other ad hoc measures | 44 (18.3) | 6 (17.1) | 3 (9.1) | 3 (12.5) | 4 (16.7) | 2 (11.1) | 1 (10.0) | 2 (33.3) | 0 | 1 (50.0) | 3 (16.7) | 1 (14.3) | 1 (50.0) |
| Clinical judgment | 4 (1.7) | 1 (2.9) | 0 | 0 | 1 (4.2) | 0 | 0 | 0 | 0 | 0 | 2 (11.1) | 0 | 0 |
| Purpose of frailty use n (%) | |||||||||||||
| Risk stratificationg | 89 (43.6) | 12 (41.4) | 15 (51.7) | 10 (45.5) | 11 (55.0) | 8 (72.7) | 8 (88.9) | 2 (33.3) | 2 (40.0) | 1 (50.0) | 3 (16.7) | 2 (28.6) | 0 |
| Inclusion/Exclusion criterion | 41 (20.1) | 4 (13.8) | 3 (10.3) | 4 (18.2) | 1 (5.0) | 0 | 0 | 0 | 1 (20.0) | 1 (50.0) | 13 (72.2) | 5 (71.4) | 0 |
| Outcome measure | 4 (2.0) | 1 (3.4) | 1 (3.4) | 0 | 1 (5.0) | 1 (9.1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Mixedh | 3 (1.5) | 0 | 0 | 2 (9.0) | 0 | 0 | 0 | 1 (16.7) | 0 | 0 | 0 | 0 | 0 |
| Only descriptivei | 67 (32.8) | 12 (41.4) | 10 (34.5) | 6 (27.3) | 7 (35.0) | 2 (18.2) | 1 (11.1) | 3 (50.0) | 2 (40.0) | 0 | 2 (11.1) | 0 | 2 (100.0) |
| Prevalence of frailty (%) | |||||||||||||
| # of articles reporting | 122 | 17 | 13 | 12 | 17 | 5 | 8 | 5 | 7 | 0 | 4 | 2 | 1 |
| Range | 1.1–100 | 1.1–90.0 | 6.9–78.0 | 23.0–77.9 | 4.7–77.8 | 11.4–89.4 | 13.7–100 | 19.1–96.7 | 29.3–79.9 | N/A | 30.3–91.0 | 41.4–59.0 | 26.0 |
| Median (IQR) | 48.5 (32.0–69.5) | 43.3 (26.9–70.7) | 46.7 (34.2–70.2) | 51.3 (34.8–55.2) | 35.5 (28.7–69) | 68.5 (31.2–89.4) | 33.5 (25.3–47.0 | 41.4 (26.7–81.0) | 54.3 (50.0–70.7) | N/A | 45.3 (32.2–81.4) | N/A | N/A |
| Adverse outcomes predicted by frailty [n predicted/total measured (% predictive)]j | |||||||||||||
| All adverse outcomes | 169/228 (74.1) | 23/30 (69.7) | 25/32 (78.1) | 18/22 (81.8) | 15/19 (78.9) | 11/16 (68.8) | 22/33 (66.7) | 4/8 (50) | 11/14 (78.6) | 1/1 (100) | 4/4 (100) | 2/3 (66.7) | 0 |
| Mortality | 58/69 (84.1) | 13/14 (92.9) | 6/7 (85.7) | 4/4 (100.0) | 7/10 (70.0) | 4/5 (80.0) | 6/8 (75.0) | 1/2 (50.0) | 6/7 (85.7) | 1/1 (100.0) | 0 | 0 | 0 |
| Length of stay | 24/33 (72.7) | 3/5 (60.0) | 4/5 (80.0) | 4/7 (57.1) | 2/2 (100.0) | 3/3 (100.0) | 3/6 (50.0) | 0 | 0 | 0 | 1/1 (100.0) | 2/2 (100.0) | 0 |
| In-hospital complications | 20/29 (69.0) | 0 | 2/2 (100.0) | 0 | 2/2 (100.0) | 1/4 (25.0) | 1/3 (33.3) | 1/2 (50.0) | 5/7 (71.4) | 0 | 1/1 (100.0) | 0 | 0 |
| Institutionalization | 27/29 (93.1) | 1/1 (100.0) | 6/6 (100.0) | 7/7 (100.0) | 1/1 (100.0) | 1/1 (100.0) | 5/7 (71.4) | 1/1 (100.0) | 0 | 0 | 0 | 0 | 0 |
| Rehospitalization | 9/18 (50.0) | 3/4 (75.0) | 3/5 (60.0) | 0/1 (0) | 1/1 (100.0) | 0 | 0/1 (0) | 0 | 0 | 0 | 1/1 (100.0) | 0 | 0 |
| Functional decline | 8/8 (66.7) | 2/2 (100.0) | 2/4 (50.0) | 1/1 (100.0) | 0 | 0 | 3/3 (100.0) | 0 | 0 | 0 | 0 | 0/1 (0) | 0 |
| Treatment changek | 8/8 (66.7) | 1/1 (100.0) | 0/1 (0) | 0 | 2/3 (66.7) | 0 | 2/3 (66.7) | 0/1 (0) | 0 | 0 | 1/1 (100.0) | 0 | 0 |
| Falls | 3/7 (42.9) | 0/4 (0) | 1/1 (100.0) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Delirium | 1/4 (25.0) | 0/2 (0) | 0 | 1/1 (100.0) | 0 | 0/1 (0) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Treatment responsel | 4/4 (100.0) | 0 | 0 | 1/1 (100.0) | 0 | 0 | 0 | 1/1 (100.0) | 0 | 0 | 0 | 0 | 0 |
| Cognitive decline | 0/3 (0) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Quality of life | 2/2 (100.0) | 0 | 0 | 0 | 0 | 1/1 (100.0) | 1/1 (100.0) | 0 | 0 | 0 | 0 | 0 | 0 |
| Otherm | 5/6 (83.3) | 0 | 1/2 (50.0) | 0 | 0 | 1/1 (100.0) | 1/1 (100.0) | 0 | 0 | 0 | 0 | 0 | 0 |
We only stratified by disciplines that have been included in at least 2 articles
N/A not applicable, # number, IQR interquartile range
aMultiple testings for each patient or different testing times for subgroup of patients
bTools that were not developed specifically for measuring frailty
cOperationalized definitions of frailty (for example, ≥65 years of age plus 3 comorbidities)
dClinical Global Impression of Change in Physical Frailty; Geriatrician Clinical Impression of Frailty
eNon-frailty tools that were used only once
fThe Geriatric Evaluation and Management (GEM) drug study criterion was meeting at least 2 of the following 10 criteria: dependence in at least one activity of daily living, stroke within 3 months, previous falls, difficulty ambulating, malnutrition, dementia, depression, unplanned admission in the last 3 months, prolonged bed rest, or incontinence
gArticles that examined the association of a frailty measure with a longitudinal adverse outcome
hInclusion/Exclusions criterion and outcome measure; risk stratification and outcome measure
iArticles which only used frailty as a descriptive characteristic. For example, if an article used frailty both as an inclusion/exclusion criterion and a descriptive characteristic, it was only categorized as inclusion/exclusion criterion in our review
jMore than one outcome can be examined within each article
kFor example, change in anticoagulant use
lFor example, antibody levels
mAdverse outcomes that were examined only once