Skip to main content

Frailty, Sarcopenia and Long Term Care Utilization in Older Populations: A Systematic Review

Abstract

This systematic literature review documents the link between frailty or sarcopenia, conceptualized as dimensions of physical health, and the use of long-term care services by older individuals. Long-term care services include formal and informal care provided at home as well as in institutions. A systematic review was performed according to PRISMA requirements using the following databases: PubMed-Medline, Embase, CINAHL, Web of Science, and Academic Search Premier. We included all quantitative studies published in English between January 2000 and December 2018 focusing on individuals aged 50 or more, using a relevant measurement of sarcopenia or physical frailty and a long-term care related outcome. A quality assessment was carried out using the questionnaire established by the Good Practice Task Force Report of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Five subsets of long-term care outcome were considered: 1/ nursing home placement (NHP), 2/ nursing home short stay (NHSS), 3/ formal personal care (FPC), 4/ formal home help (FHH), 5/ informal care (IC). Out of 1943 studies, 17 were finally included in the review. With some studies covering several LTC outcomes, frailty and / or sarcopenia were associated with increased LTC use in 17 out of 26 cases (NHP: 5/6, NHSS: 3/4, FPC: 5/7, FHH: 1/4, IC: 3/5) The association was not consistent in 5 cases (NHP: 1/6, NHSS: 1/4, FPC: 2/7, FHH: 0/4, IC: 1/5) and the association was either not significant or the results inconclusive in the remaining 9 cases. Overall, while results on sarcopenia are scarce, evidence support a positive association between frailty and LTC use. The evidence is stronger for the association of physical frailty with nursing home placement / short stay as well as on FPC. There is less (more heterogeneous) evidence regarding the correlation between physical frailty and FHH or IC use. Results need to be confirmed by more advanced statistical methods or design based on longitudinal data.

This is a preview of subscription content, access via your institution.

Figure 1

References

  1. Costa-Font, J., Courbage, C., Swartz, K.: Financing Long-Term Care: ex-ante, ex-post or both? Health Econ. 2015;24, 45–57. https://doi.org/10.1002/hec.3152

    Article  Google Scholar 

  2. OCDE: Health at a Glance 2019: OECD indicators.

  3. European Commission, Directorate-General for Economic and Financial Affairs, Economic Policy Committee of the European Communities: The 2018 ageing report: underlying assumptions and projection methodologies. 2017

  4. Marcell, T.J.: Sarcopenia: causes, consequences, and preventions. J. Gerontol. A. Biol. Sci. Med. Sci. 2003;58, M911–916

    Article  Google Scholar 

  5. Cesari, M., Landi, F., Vellas, B., Bernabei, R., Marzetti, E.: Sarcopenia and Physical Frailty: Two Sides of the Same Coin. Front. Aging Neurosci. 2014;6. https://doi.org/10.3389/fnagi.2014.00192

  6. Malmstrom, T.K., Morley, J.E.: SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J. Am. Med. Dir. Assoc. 2013;14, 531–532. https://doi.org/10.1016/j.jamda.2013.05.018

    Article  Google Scholar 

  7. Studenski, S.A., Peters, K.W., Alley, D.E., Cawthon, P.M., McLean, R.R., Harris, T.B., Ferrucci, L., Guralnik, J.M., Fragala, M.S., Kenny, A.M., Kiel, D.P., Kritchevsky, S.B., Shardell, M.D., Dam, T.-T.L., Vassileva, M.T.: The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J. Gerontol. A. Biol. Sci. Med. Sci. 2014;69, 547–558. https://doi.org/10.1093/gerona/glu010

    Article  Google Scholar 

  8. Cawthon, P.M., Peters, K.W., Shardell, M.D., McLean, R.R., Dam, T.-T.L., Kenny, A.M., Fragala, M.S., Harris, T.B., Kiel, D.P., Guralnik, J.M., Ferrucci, L., Kritchevsky, S.B., Vassileva, M.T., Studenski, S.A., Alley, D.E.: Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J. Gerontol. A. Biol. Sci. Med. Sci. 2014;69, 567–575. https://doi.org/10.1093/gerona/glu023

    Article  Google Scholar 

  9. Kojima, G.: Frailty as a predictor of hospitalisation among community-dwelling older people: a systematic review and meta-analysis. J. Epidemiol. Community Health. 2016;70, 722–729. https://doi.org/10.1136/jech-2015-206978

    Article  Google Scholar 

  10. Wang, S.-Y., Shamliyan, T.A., Talley, K.M.C., Ramakrishnan, R., Kane, R.L.: Not just specific diseases: systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Arch. Gerontol. Geriatr. 2013;57, 16–26. https://doi.org/10.1016/j.archger.2013.03.007

    Article  Google Scholar 

  11. Kojima, G.: Frailty as a Predictor of Nursing Home Placement Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. J. Geriatr. Phys. Ther. 2018;2001. 41, 42–48. https://doi.org/10.1519/JPT.0000000000000097

    Google Scholar 

  12. Cawthon, P.M., Fox, K.M., Gandra, S.R., Delmonico, M.J., Chiou, C.-F., Anthony, M.S., Sewall, A., Goodpaster, B., Satterfield, S., Cummings, S.R., Harris, T.B.: Do Muscle Mass, Muscle Density, Strength, and Physical Function Similarly Influence Risk of Hospitalization in Older Adults? J. Am. Geriatr. Soc. 2009;57, 1411–1419. https://doi.org/10.1111/j.1532-5415.2009.02366.x

    Article  Google Scholar 

  13. Centre for Reviews and Dissemination: Systematic Reviews. CRD’s guidance for undertaking reviews in health care. the Centre for Reviews and Dissemination, York 2009

  14. Berger, M.L., Martin, B.C., Husereau, D., Worley, K., Allen, J.D., Yang, W., Quon, N.C., Mullins, C.D., Kahler, K.H., Crown, W.: A Questionnaire to Assess the Relevance and Credibility of Observational Studies to Inform Health Care Decision Making: An ISPOR-AMCP-NPC Good Practice Task Force Report. Value Health. 2014;17, 143–156. https://doi.org/10.1016/j.jval.2013.12.011

    Article  Google Scholar 

  15. Rothman, M.D., Leo-Summers, L., Gill, T.M.: Prognostic Significance of Potential Frailty Criteria. J. Am. Geriatr. Soc. 2008;56, 2211–2216. https://doi.org/10.1111/j.1532-5415.2008.02008.x

    Article  Google Scholar 

  16. Rochat, S., Cumming, R.G., Blyth, F., Creasey, H., Handelsman, D., Le Couteur, D.G., Naganathan, V., Sambrook, P.N., Seibel, M.J., Waite, L.: Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project. AGE AGEING. 2010;39, 228–233. https://doi.org/10.1093/ageing/afp257

    Article  Google Scholar 

  17. Gobbens, R.J.J., van Assen, M.A.L.M., Luijkx, K.G., Schols, J.M.G.A.: The Predictive Validity of the Tilburg Frailty Indicator: Disability, Health Care Utilization, and Quality of Life in a Population at Risk. The Gerontologist. 2012;52, 619–631. https://doi.org/10.1093/geront/gnr135

    Article  Google Scholar 

  18. Hoeck, S., Francois, G., Geerts, J., Van der Heyden, J., Vandewoude, M., Van Hal, G.: Health-care and home-care utilization among frail elderly persons in Belgium. Eur. J. Public Health. 2012;22, 671–677. https://doi.org/10.1093/eurpub/ckr133

    Article  Google Scholar 

  19. Bentur N., Sternberg S.A., Shuldiner J.: Frailty transitions in community-dwelling older people. Isr. Med. Assoc. J. 2016;18, 449–453

    PubMed  Google Scholar 

  20. Hirani, V., Blyth, F., Naganathan, V., Le Couteur, D.G., Seibel, M.J., Waite, L.M., Handelsman, D.J., Cumming, R.G.: Sarcopenia Is Associated With Incident Disability, Institutionalization, and Mortality in Community-Dwelling Older Men: The Concord Health and Ageing in Men Project. J. Am. Med. Dir. Assoc. 2015;16, 607–613. https://doi.org/10.1016/j.jamda.2015.02.006

    Article  Google Scholar 

  21. Bock, J.-O., König, H.-H., Brenner, H., Haefeli, W.E., Quinzler, R., Matschinger, H., Saum, K.-U., Schöttker, B., Heider, D.: Associations of frailty with health care costs — results of the ESTHER cohort study. BMC Health Serv. Res. 2016;16, 128. https://doi.org/10.1186/s12913-016-1360-3

    Article  Google Scholar 

  22. Gonzalez-Colaço Harmand, M., Meillon, C., Bergua, V., Tabue Teguo, M., Dartigues, J.-F., Avila-Funes, J.A., Amieva, H.: Comparing the predictive value of three definitions of frailty: Results from the Three-City study. Arch. Gerontol. Geriatr. 2017;72, 153–163. https://doi.org/10.1016/j.archger.2017.06.005

    Article  Google Scholar 

  23. Ferrante, L.E., Pisani, M.A., Murphy, T.E., Gahbauer, E.A., Leo-Summers, L.S., Gill, T.M.: The Association of Frailty With Post-ICU Disability, Nursing Home Admission, and Mortality A Longitudinal Study. Chest. 2018;153, 1378–1386. https://doi.org/10.1016/j.chest.2018.03.007

    Article  Google Scholar 

  24. Hajek, A., Bock, J.-O., Saum, K.-U., Matschinger, H., Brenner, H., Holleczek, B., Haefeli, W.E., Heider, D., Koenig, H.-H.: Frailty and healthcare costs-longitudinal results of a prospective cohort study. Age Ageing. 2018;47, 233–241. https://doi.org/10.1093/ageing/afx157

    Article  Google Scholar 

  25. Lambotte, D., De Donder, L., Van Regenmortel, S., Fret, B., Dury, S., Smetcoren, A.-S., Dierckx, E., De Witte, N., Verte, D., Kardol, M.J.M., Consortium, D.-S.: Frailty differences in older adults’ use of informal and formal care. Arch. Gerontol. Geriatr. 2018;79, 69–77. https://doi.org/10.1016/j.archger.2018.05.018

    Article  Google Scholar 

  26. Verver, D., Merten, H., Robben, P., Wagner, C.: Care and support for older adults in The Netherlands living independently. Health Soc. Care Community. 2018;26, e404–e414. https://doi.org/10.1111/hsc.12539

    Article  Google Scholar 

  27. Hogan, D.B., Freiheit, E.A., Strain, L.A., Patten, S.B., Schmaltz, H.N., Rolfson, D., Maxwell, C.J.: Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living. BMC Geriatr. 2012;12. https://doi.org/10.1186/1471-2318-12-56

  28. Campitelli, M.A., Bronskill, S.E., Hogan, D.B., Diong, C., Amuah, J.E., Gill, S., Seitz, D., Thavorn, K., Wodchis, W.P., Maxwell, C.J.: The prevalence and health consequences of frailty in a population-based older home care cohort: a comparison of different measures. BMC Geriatr. 2016;16. https://doi.org/10.1186/s12877-016-0309-z

  29. Schoufour, J.D., Evenhuis, H.M., Echteld, M.A.: The impact of frailty on care intensity in older people with intellectual disabilities. Res. Dev. Disabil. 2014;35, 3455–3461. https://doi.org/10.1016/j.ridd.2014.08.006

    Article  Google Scholar 

  30. Butler, A., Gallagher, D., Gillespie, P., Crosby, L., Ryan, D., Lacey, L., Coen, R., O’Shea, E., Lawlor, B.: Frailty: a costly phenomenon in caring for elders with cognitive impairment. Int. J. Geriatr. Psychiatry. 2016;31, 161–168. https://doi.org/10.1002/gps.4306

    Article  Google Scholar 

  31. Kelaiditi, E., Andrieu, S., Cantet, C., Vellas, B., Cesari, M.: Frailty Index and Incident Mortality, Hospitalization, and Institutionalization in Alzheimer’s Disease: Data From the ICTUS Study. J. Gerontol. Ser. A. 2016;71, 543–548. https://doi.org/10.1093/gerona/glv137

    Article  Google Scholar 

  32. Sicsic, J., Ravesteijn, B., Rapp, T.: Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data. Health Policy. 2020;124, 865–872. https://doi.org/10.1016/j.healthpol.2020.05.009

    Article  Google Scholar 

  33. Berger, M.L., Martin, B.C., Husereau, D., Worley, K., Allen, J.D., Yang, W., Quon, N.C., Mullins, C.D., Kahler, K.H., Crown, W.: A Questionnaire to Assess the Relevance and Credibility of Observational Studies to Inform Health Care Decision Making: An ISPOR-AMCP-NPC Good Practice Task Force Report. Value Health. 2014;17, 143–156. https://doi.org/10.1016/j.jval.2013.12.011

    Article  Google Scholar 

Download references

Funding

Funding and acknowledgements: The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement no 115621, resources of which are composed of financial contribution from the European Union’ Seventh Framework Programme (FP7 / 2007–2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies’ in kind contribution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan Sicsic.

Ethics declarations

Conflicts of Interest: None of the authors report any conflict of interest whatsoever.

Supplementary Material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Roquebert, Q., Sicsic, J., Santos-Eggimann, B. et al. Frailty, Sarcopenia and Long Term Care Utilization in Older Populations: A Systematic Review. J Frailty Aging 10, 272–280 (2021). https://doi.org/10.14283/jfa.2021.7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.14283/jfa.2021.7

Key words

  • Frailty
  • sarcopenia
  • long-term care
  • systematic review
  • nursing home
  • informal care
  • formal care