Effectiveness of interventions to improve frailty among community-dwelled older adults: A systematic review

Frailty, a geriatric syndrome linked to adverse outcomes, is a significant public health concern in aging populations. This systematic review synthesizes evidence on the effectiveness of interventions, grouped by their components, to reduce frailty in community-dwelling older adults.

Major biomedical databases were searched for relevant intervention studies from inception to 24 October 2024. Dual screening, data extraction, risk assessment, and synthetic analysis were conducted. Interventions were classified into discrete characteristic components based on the key intervention features identified in the included studies. Findings on effectiveness of interventions were narratively synthesized owing to heterogeneity.

This review included 62 studies (32,364 participants; 76 interventions). Most interventions were multidimensional, and multimodal interventions were found to be effective in improving frailty. The standalone approach of multicomponent or two-component exercise showed potential benefits, while single-component exercise was less likely to be effective. Studies on single-component interventions other than exercise were limited, with mixed results: Nutritional supplements, nutrition guides, art-based activities, and pharmacological agents showed limited efficacy as standalone strategies. Comprehensive educational programs, medical-related care, and cognitive training were scarcely studied but suggested favorable effects on frailty indicators. Limited economic evidence supported cost-effectiveness or cost-saving of interventions addressing frailty.

Current frailty interventions for older residents in the community predominantly relied on exercise or physical activity. Future research should prioritize exploring optimal intervention components or combinations and developing comprehensive intervention strategies, to achieve precise and sustainable improvements in frailty among the broader community-based older populations.