The Impact of Multidimensional Frailty on Adverse Outcomes in Older Adults: A Systematic Review and Meta-Analysis

Frailty is a recognized syndrome in aging populations, predicting adverse outcomes. The link between its evaluation and adverse effects, particularly under Gobben's framework, is unclear. This study reviews how multidimensional frailty affects older adults' health risks.

We searched the PubMed, EMBASE, Web of Science, Cochrane Library, CIHNAL, and Chinese databases (WANFANG, CNKI, VIP, and CBM) for relevant studies published from the establishment of the library to January 9, 2026. Statistical synthesis was performed using R software. Employing either fixed-effects or random-effects models based on heterogeneity assessments to evaluate the association between multidimensionally frail older adults and adverse outcomes. Methodological quality, sensitivity analyses, and publication bias were systematically conducted.

A review of 26 studies with 11 186 older adults found that 20.5%-80% exhibited multidimensional frailty, which was associated with increased risks of adverse outcomes, including mortality (HR = 1.61, 95% CI: 1.37-1.89, OR = 2.40, 95% CI: 1.82-3.17), falls (OR = 2.45, 95% CI: 1.29-4.64), and hospitalization (OR = 1.80, 95% CI: 1.29-2.52). However, significant small-study effects were detected for mortality (Egger's test p < 0.001). After trim-and-fill adjustment, the HR attenuated to 1.27 (95% CI: 1.02-1.59), indicating a weaker but still statistically significant association. The association with readmission was of borderline significance (HR = 1.40, 95% CI: 1.00-1.96, p = 0.05).

The research indicates that multidimensional frailty affects older adults, increasing their risk of mortality, falls, hospitalization, and readmission. These results underscore the crucial need for early screening and preventative measures.