Sex differences in frailty: a systematic review and meta-analysis

Gordon, E. H., Peel, N. M., Samanta, M., Theou, O., Howlett, S. E. and Hubbard, R. E. (2017) Sex differences in frailty: a systematic review and meta-analysis. Experimental Gerontology, 89 30-40. doi:10.1016/j.exger.2016.12.021

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Author Gordon, E. H.
Peel, N. M.
Samanta, M.
Theou, O.
Howlett, S. E.
Hubbard, R. E.
Title Sex differences in frailty: a systematic review and meta-analysis
Journal name Experimental Gerontology   Check publisher's open access policy
ISSN 1873-6815
Publication date 2017-03-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.exger.2016.12.021
Open Access Status File (Author Post-print)
Volume 89
Start page 30
End page 40
Total pages 11
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Abstract It is a well-described clinical phenomenon that females live longer than males, yet tend to experience greater levels of co-morbidity and disability. Females can therefore be considered both more frail (because they have poorer health status) and less frail (because they have a lower risk of mortality). This systematic review aimed to determine whether this ageing paradox is demonstrated when the Frailty Index (FI) is used to measure frailty.

Medline, EMBASE and CINAHL databases were searched for observational studies that measured FI and mortality in community-dwellers over 65years of age. In five-year age groups, meta-analysis determined the sex differences in mean FI (MD=mean FIfemale-mean FImale) and mortality rate.

Of 6482 articles screened, seven articles were included. Meta-analysis of data from five studies (37,426 participants) found that MD values were positive (p<0.001; MD range=0.02-0.06) in all age groups, indicating that females had higher FI scores than males at all ages. This finding was consistent across individual studies. Heterogeneity was high (I2=72.7%), reflecting methodological differences. Meta-analysis of mortality data (13,127 participants) showed that male mortality rates exceeded female mortality rates up until the 90 to 94-years age group. Individual studies reported higher mortality for males at each level of FI, and higher risk of death for males when controlling for age and FI.

The pattern of sex differences in the FI and mortality of older adults was consistent across populations and confirmed a 'male-female health-survival paradox'.
Keyword Frailty
Frailty Index
Sex differences
Systematic review
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID U01 AG009740
P01 AG005842
P01 AG008291
P20 AG012815
R21 AG025169
Institutional Status UQ

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Created: Wed, 15 Nov 2017, 12:47:10 EST