Impact of frailty on pneumonia outcomes in older patients: a systematic review and meta-analysis

The ideal method for identifying frailty remains unclear, but the condition is associated with poor prognoses in many illnesses. Despite the availability of studies, the prognostic implications of frailty on older patients with pneumonia remains unexplored. To determine the burden and effect of frailty on selected clinical outcomes among older patients with pneumonia.

We searched Medline, Google Scholar, and Science Direct databases for articles published in English following the PRISMA framework to guide our review. We included studies conducted on patients (> 60 years) with frailty and pneumonia, and reporting the effect of frailty on mortality, hospital stay, length readmission, and ICU admission. We performed a meta-analysis using STATA 14.2, calculating pooled odds ratios and 95% confidence intervals.

We analysed data from 16 studies and calculated a pooled frailty prevalence of 49% (95% CI 37–60%) in older patients with pneumonia. Unadjusted analyses revealed an odds ratio (OR) of 2.50 (95% CI 1.88–3.32) for the intermediate risk group, and an OR of 3.51 (95% CI 3.05–4.05) for the high risk group regarding mortality. The high risk frailty group also exhibited significant elevations in the risk of readmissions and extended hospital stay lengths. Substantial heterogeneity was observed in both adjusted and unadjusted analyses.

Our systematic review and meta-analysis results show that one in every two older individuals with pneumonia present frailty, a condition that significantly influences their rates of mortality and readmission, and their hospital stay length.