Background
Methods
Search strategy
Study selection
Quality assessment & Data extraction
Nr. | Criteria | Yes = 1 | No = 0 |
---|---|---|---|
1 | Was the rationale of the research described? | ||
2 | Were the objectives of the research clearly stated? | ||
3 | Was the study a prospective cohort study? | ||
4 | Was the follow-up of the cohort study 5 years or longer? | ||
5 | Were the key-elements of the study design described? | ||
6 | Were the setting, relevant dates and timeframe of the research described? | ||
7 | Were the eligibility criteria for participants described? | ||
8 | Were the participants free of disability at baseline? | ||
9 | Were the predictors and dependent variables described? | ||
10 | Were the measurement methods for the predictors and dependent variables described? | ||
11 | Were standardized or valid measurements used for the predictors? | ||
12 | Were standardized or valid measurements used for the outcome? | ||
13 | Were potential types of bias addressed? | ||
14 | Was it clear how the quantitative data were handled in the analyses? | ||
15 | Were appropriate multivariate analysis techniques used? | ||
16 | Did the statistical methods control for confounding and examine subgroups or interactions? | ||
17 | Was there a description on how the final number of participants was established? | ||
18 | Was the (loss to) follow-up of the participants described? | ||
19 | Was the attrition less than 20%? | ||
20 | Was information provided regarding the baseline characteristics of participants? | ||
21 | Was the number of outcome events or summary measures over time reported? | ||
22 | Were the results expressed in an Odds Ratio (OR), Risk Ratio (RR) or Hazard Ratio (HR) with the corresponding 95% confidence interval? | ||
23 | If sub-group analyses were performed, were these clearly described? | ||
24 | Were the key-results described in the discussion? | ||
25 | Were the limitations of the study reported? | ||
26 | Were previous research and the limitations of the study taken into account when an overall interpretation of the study results was provided? | ||
27 | Was the generalisability of the study results described? |
Results
Selection process
Characteristics of included studies
1st Author (year) | Follow Up | Sample size & Participant characteristics | Physical frailty indicators measured in study* | Quality (0-27) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
W | E | G | M | P | B | O | ||||
Gill et al. (1995) [35] | 1 year | 563 participants (74% women) with a mean age of 79.1 (SD 4.7) | X | X | X | 22 | ||||
Guralnik et al. (1995) [20] | 4 years | 1122 men and women aged 71 years and older | X | 25 | ||||||
Sonn et al. (1995) [37] | 6 years | 371 men and women aged 70 | X | X | 21 | |||||
Tinetti et al. (1995) [44] | 1 year | 927 participants (73% women) with a mean age of 79.9 (SD 5.2) | X | X | 22 | |||||
Gill et al. (1996) [36] | 3 years | 775 participants (74% women) with a mean age of 79.1 (SD 5.0) | X | 24 | ||||||
Ostir et al. (1998) [18] | 2 years | 1365 participants (53% women) with a mean age of 73.3 | X | X | X | 22 | ||||
Giampaoli et al. (1999) [33] | 4 years | 140 men aged 71 to 91 | X | 20 | ||||||
Wu et al. (1999) [40] | 3 years | 1321 participants (49% women) 44.4% aged 65-69 and 10.9% aged 80 or older | X | 22 | ||||||
Guralnik et al. (2000) [19] | 6 years | 6534 participants aged 65 years and older | X | X | 22 | |||||
Ishizaki et al. (2000) [30] | 3 years | 583 participants (56% women) with a mean age of 70.9 (SD 4.9) | X | 23 | ||||||
Lee (2000) [38] | 7 years | 7527 men and women aged 70 years and older | X | 20 | ||||||
Sarkisian et al. (2000) [39] | 4 years | 6632 women with a mean age of 73.0 (4.9) | X | X | X | 21 | ||||
Shinkai et al. (2000) [29] | 6 years | 736 men and women aged 65 and older | X | X | X | 24 | ||||
Stessman et al. (2002) [27] | 7 years | 287 participants (51% women) aged 70 years at baseline. | X | 20 | ||||||
Wang et al. (2002) [45] | 3.4 years | 2578 participants (59% women) aged 65 years and older | X | 21 | ||||||
Shinkai et al. (2003) [28] | 6 years | 601 participants (56.1% women) with a mean age of 70.9 (SD 4.9) | X | X | X | 22 | ||||
Al Snih et al. (2004) [22] | 7 years | 2493 participants (58% women) with a mean age of 72 | X | 24 | ||||||
Gill et al. (2004) [25] | 3 years | 754 participants (65% women) aged 70 years or older | X | 24 | ||||||
Al Snih et al. (2005) [21] | 7 years | 1737 Mexican- American participants (58% women) aged 65 and older | X | 23 | ||||||
van den Brink et al. (2005) [34] | 10 years | 560 men aged 70 to 89 years | X | 26 | ||||||
Onder et al. (2005) [42] | 3 years | 884 women (72% white) with a mean age of 78.7 (SD 8.0) | X | X | X | X | 23 | |||
Jacobs et al. (2008) [26] | 7 years | 343 men and women aged 70 years. | X | 22 | ||||||
Ritchie et al. (2008) [43] | 4 years | 983 men and women with a mean age of 75.30 (SD 6.72) | X | 22 | ||||||
Rosano et al. (2008) [31] | 8.4 years | 3156 participants (57% women, 71% white) with a mean age of 74.0 (SD 4.6) | X | 23 | ||||||
Rothman et al. (2008) [23] | 8 years | 754 men and women with a mean age of 78.4 (SD 5.3) | X | X | X | X | X | 22 | ||
Gill et al. (2009) [24] | 9 years | 722 participants (65.2% women) with a mean age of 78.4 (SD 5.2) | X | X | 25 | |||||
Arnold et al. (2010) [32] | 14 years | 3278 participants (61% women, 83% white) with a mean age of 80 | X | 23 | ||||||
Balzi et al. (2010) [41] | 3 years | 897 Italian men and women, aged 65 to 102 | X | X | 21 | |||||
Total number of studies per indicator
|
4
|
1
|
12
|
10
|
9
|
6
|
8
|
1st Author (year) | Study Results |
---|---|
Gill et al. (1995) [35] | Each performance test (chair stand, rapid gait, 360° turn, bending over, foot taps, and hand signature) is significantly associated with the onset of functional dependence in ADL disability. Adjusted Risk Ratios (RR) vary from 1.2 (.7-2.0) for foot taps to 2.4 (1.4-4.2) for rapid gait. |
Guralnik et al. (1995) [20] | Elderly people with lowest lower extremity function have a higher risk of ADL disability compared to elderly people in higher lower extremity function groups. RR 4.2 (2.3-7.7). Elderly people in the moderate group have a higher risk of ADL disability compared to elderly people in the high group. RR 1.6 (1.0-2.6). |
Sonn et al. (1995) [37] | Walking speed and grip strength at age 70 are significantly associated with incident ADL disability at age 76. |
Tinetti et al. (1995) [44] | Elderly people with lower usual gait speed, lower rapid gait speed, or lower balance have a higher risk of functional dependence in ADL. OR 2.0 (1.5-2.7), 2.3 (1.7-3.2), and 2.0 (1.5-2.7) respectively. |
Gill et al. (1996) [36] | Elderly people in the lowest quartile of physical function (measured by walking, turning, chair stands) have a higher risk of functional dependence in ADL. RR 2.1 (1.4-3.0). |
Ostir et al. (1998) [18] | Elderly people in the lowest quartile of walking speed, balance, and chair stands have a higher risk of ADL disability after a 2-year follow-up compared to elderly people in the highest quartile. OR 5.4 (1.2-23.6), OR 2.4 (1.0-5.4), and OR 2.8 (1.2-6.4) respectively. |
Giampaoli et al. (1999) [33] | Elderly men with higher hand grip strength have a lower risk of disability compared to men with lower hand grip strength. OR .97 (.96-.99). |
Wu et al. (1999) [40] | Elderly people who participated regularly in exercise had a lower risk of becoming chronically ADL disabled after a 3-year follow-up. RR .52 (.39-.68). |
Guralnik et al. (2000) [19] | Elderly people with low lower extremity function have a higher risk of ADL disability compared to elderly people with high lower extremity function. RR ranging from 3.4 (1.7-7.1) to 7.4 (1.8-30.5). Elderly people with moderate lower extremity function have a higher risk of ADL disability compared to elderly people with high lower extremity function. RR ranging from 1.2 (.7-2.2) to 2.0 (.7-5.3). Gait speed alone performed almost as well as total lower extremity function in predicting incident disability. |
Ishizaki et al. (2000) [30] | Elderly people with higher hand grip strength (1kg) have a lower risk of developing disability in basic ADL within the next 3 years. OR .91 (.84-.97). |
Lee (2000) [38] | Elderly people who think that they are less active than other people their age have a higher risk of ADL disability compared to people who think that they are a lot more active than other people their age. OR 1.65 (1.14-2.39). |
Sarkisian et al. (2000) [39] | Elderly people in the lowest quintile of gait speed have a higher risk of decline in basic ADL. OR 2.29 (1.66-3.17). Elderly people in the lowest quintile of exercise level also have a higher risk of basic ADL decline. OR 1.47 (1.06-2.05). |
Shinkai et al. (2000) [29] | Maximum walking speed, usual walking speed, balance, and grip strength are significant predictors of the onset of functional ADL dependence after a 6-year follow-up in elderly people who are aged 65-74 and 75 or older. For elderly people in the lowest quartile the HR ranged from 2.21 (1.23-3.97) to 6.18 (3.16-12.1). |
Stessman et al. (2002) [27] | Elderly people who are not physically active or who do not exercise at least four days a week at age 70 have a higher risk of ADL disability after a 7-year follow- up compared to elderly people who are physically active at age 70. OR for men 4.3 (1.1-17.1), OR for women 8.5 (2.0-36.2). |
Wang et al. (2002) [45] | Elderly persons who exercise regularly have a decreased age-adjusted risk of functional decline in ADL. |
Shinkai et al. (2003) [28] | Elderly people in the lowest quartile of hand grip strength, balance, usual walking speed or maximal walking speed have a higher risk of disability in basic ADL. HR 1.22 (1.07-1.39), 1.41 (1.22-1.62), 1.31 (1.14-1.50), and 1.40 (1.22-1.61) respectively. |
Al Snih et al. (2004) [22] | Men and women in the lowest quartile of hand grip strength have a higher risk of ADL limitations in the next 7 years. HR for men 1.9 (1.14-3.17) and HR for women 2.28 (1.59-3.27). |
Gill et al. (2004) [25] | Slow gait speed is associated significantly with the development of insidious disability. OR 2.4 (1.4-4.1). |
Al Snih et al. (2005) [21] | Elderly people with weight loss of 5% or more within a 2-year follow-up after baseline have a higher risk of lower body ADL disability compared to elderly people with stable weight. Adjusted OR 1.43 (1.06-1.95). |
van den Brink et al. (2005) [34] | Compared to the lowest tertile of total physical activity men from the middle and highest tertile have a lower risk of disability. OR .56 (.32-.99) and OR .50 (.29- .88) respectively. |
Onder et al. (2005) [42] | Balance, chair stands, and walking speed were significant predictors of progressive incident ADL disability. Walking speed was also a significant predictor of catastrophic incident disability. |
Jacobs et al. (2008) [26] | Elderly people who go out less then daily at age 70 have a higher risk of incident dependence in ADL compared to elderly people who go out daily at age 70. RR 6.9 (1.4-34.0). |
Ritchie et al. (2008) [43] | A history of unintentional weight loss at baseline predicts more rapid decline in ADL. |
Rosano et al. (2008) [31] | Gait speed is a significant predictor of disability. HR .88 (.80-.96). This HR remains when controlling for age, sex, race, education, and possible confounders. |
Rothman et al. (2008) [23] | Slow gait speed, low physical activity and weight loss are significant predictors of chronic incident disability. HR 3.0 (2.3-3.8), HR 2.1 (1.7-2.6), and HR 1.7 (1.4-2.1) respectively. Exhaustion and grip strength do not predict chronic incident disability |
Gill et al. (2009) [24] | Poor grip strength was associated with 3 subtypes of disability. OR ranging from 1.42 (1.03-1.95) to 1.80 (1.04-3.12). Lower extremity performance score was significantly associated with 5 subtypes of ADL disability. OR ranging from 1.10 (1.04-1.17) to 1.35 (1.24-1.47). |
Arnold et al. (2010) [32] | Elderly people with weight loss of 5% or more between consecutive annual visits have a higher risk of incident ADL disability compared to elderly people with stable weight. Adjusted OR 1.27 (1.10-1.46). |
Balzi et al. (2010) [41] | High level of physical activity compared to sedentary state is associated with a lower incidence of ADL disability after a 3-year follow-up. OR .30 (.12-.76). Lower extremity performance score is a significant predictor of disability. |
Predictive value of physical frailty indicators on ADL disability
Physical frailty indicator | Total number of studies | Number of studies, only including participants free of disability at baseline, that reported a significant increased risk of ADL disability (Number of cohorts) ++ | Number of studies, including both participants free and not free of ADL disability at baseline, that reported a significant increased risk of ADL disability (Number of cohorts) + | Number of studies reporting no significant increased risk of ADL disability (Number of cohorts) - |
---|---|---|---|---|
Weight loss | 4 | 4 (4) | 0 (0) | 0 (0) |
Exhaustion | 1 | 0 (0) | 0 (0) | 1 (1) |
Gait speed | 12 | 9 (6) | 3 (3) | 0 (0) |
Muscle strength | 10 | 4 (2) | 3 (3) | 3 (3) |
Physical activity | 9 | 5 (5) | 4 (4) | 0 (0) |
Balance | 6 | 4 (3) | 1 (1) | 1 (1) |
Others: | ||||
- Lower extremity function | 5 | 4 (4) | 1 (1) | 0 (0) |
- Chair stands | 3 | 2 (2) | 1 (1) | 0 (0) |
- 360° turn, bending over, foot taps, hand signature | 1 | 1 (1) | 0 (0) | 0 (0) |