INSTRUMENTS USED IN THE ASSESSMENT OF FUNCTIONAL CAPACITY, FRAILTY AND SARCOPENIA IN THE ELDERLY: INTEGRATIVE REVIEW

Santos, Maria Eduarda dos; Fernandes, Daiane de Souza; Silva, Mauriely Paiva de Alcântara e; Matiello, Fernanda de Brito; Braga, Pollyanna Guimarães; Cervantes, Elisa Rosas; Rodrigues, Rosalina Aparecida Partezani

doi:10.1590/ce.v28i0.92112

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REVIEW • Cogit. Enferm. 28 • 2023 • https://doi.org/10.1590/ce.v28i0.92112 copy

INSTRUMENTS USED IN THE ASSESSMENT OF FUNCTIONAL CAPACITY, FRAILTY AND SARCOPENIA IN THE ELDERLY: INTEGRATIVE REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

Identification of the main instruments for the assessment of the elderly person.
Most used instruments: Lawton and Brody, and frailty phenotype.
Screening clinical conditions by instruments provides comprehensive care.
Instruments strengthen interprofessional practice in the health of older adults.

ABSTRACT

Objective:

to analyze the knowledge produced in the scientific literature on the instruments used to assess functional capacity, frailty, and sarcopenia in older adults.

Method:

integrative literature review, in the Cinahl, MEDLINE/PubMed, Embase, Web of Science and Scopus databases, from 2012-2021. Data were extracted: authors, year, country of publication, type of study, sample characteristics, objective, results, and instruments. In addition, the methodological quality and level of evidence were assessed.

Results:

The final sample included 13 articles. The most used instruments were Lawton and Brody Index for functional capacity assessment; conceptual model of the frailty phenotype; and the conceptualization and diagnosis of the European Working Group on Sarcopenia.

Conclusion:

The scientific evidence demonstrated the importance of using instruments to screen for these conditions that can interfere with the health of the elderly population, reinforcing the need to strengthen interprofessional care practices.

DESCRITORES:
Aged; Activities of Daily Living; Frailty; Sarcopenia; Health of the Elderly

Author/ Year of publication	Objective	Study type and sample characteristics	Main results	Conclusion	Level of Evidence
A⁶6 Park H, Jang IY, Lee HY, Jung HW, Lee E, Kim DH. Screening value of social frailty and its Association with Physical Frailty and Disability in community-dDwelling older koreans: aging study of pyeong chang rural area. Int J Environ Res Public Health. [Internet]. 2019 [cited in 2022 Jan.12]; 16(16):2809. Available in: https://doi.org/10.3390/ijerph16162809. https://doi.org/10.3390/ijerph16162809...	To assess the prevalence of social frailty and its association with physical frailty, geriatric syndromes and BADL disability in community-dwelling older adults.	Cross-sectional Sample: 408 participants Mean age: 74.9 years	Physical frailty increased the risk of BADL disability and sarcopenia.	Social frailty screening can identify frail older people not recognized by demographic characteristics and physical frailty.	VI (Clinical Question: diagnosis)
A¹⁸18 Bahat OG, Kılıç C, Bozkurt ME, Karan MA. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J Nutr Health Aging. [Internet]. 2021 [cited in 2022 Jan.13]; 25(4):433-39. Available in: https://doi.org/doi:10.1007/s12603-020-1535-9. https://doi.org/doi:10.1007/s12603-020-1...	To study the prevalence of fear of falling and its association with physical performance, functionality, frailty, sarcopenia, and a variety of geriatric syndromes.	Cross-sectional Sample: 1021 participants Mean age: 74.9 years.	The prevalence of sarcopenia was 11.6%, pre-frail or frail phenotype 61.3%. Screening was positive for the presence of sarcopenia.	Functionality is impaired due to decreased physical activity and fear of falls.	VI (Clinical Question: diagnosis)
A¹⁹19 Thompson MQ, Solomon Y, Tucker GR, Adams RJ, Cesari M, Theou O, et al. Frailty and sarcopenia in combination are more predictive of mortality than either condition alone. Maturitas. [Internet]. 2021 [cited in 2022 Jan. 14 Jan.]; 144:102-7. Available in: https://doi.org/10.1016/j.maturitas.2020.11.009. https://doi.org/10.1016/j.maturitas.2020...	To examine the predictive ability of combined frailty and sarcopenia classification on mortality.	Longitudinal Sample: 716 participants Mean age: 74.1 years	2.8% were identified as frail and sarcopenic, 15.5% frail and 3.5% sarcopenic. Classification as frail and sarcopenic resulted in significantly elevated mortality risk.	Frail individuals have benefited from sarcopenia screening and assessment.	VI (Clinical Question: diagnosis)
aA²⁰20 Rasheedy D, EL-Kawaly WH. The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly. Electron J Gen Med. [Internet]. 2021 [cited in 2022 Feb. 20]; 18(2):277. Available in: https://doi.org/10.29333/ejgm/9695. https://doi.org/10.29333/ejgm/9695...	To quantify the cumulative impact of sarcopenia, frailty, malnutrition, and other geriatric giants in hospitalized older people.	Cross-sectional Sample: 206 participants Mean age: 69.4 years	In the sample, 20.9% were pre-frail and 31.1% frail. Regarding sarcopenia, 20.4% had pre-sarcopenia status, 13.1% had probable sarcopenia, 16.5% had positive sarcopenia and 18.4% had severe sarcopenia. Regarding functional capacity, 23.8% presented moderate dependence, 18.9% severe dependence and 7.3% total dependence.	Sarcopenia and frailty were common among elderly inpatients, occurring concomitantly.	VI (Clinical Question: diagnosis)
A²¹21 Caliskan H, Igdir V, Ozsurekci C, Emrah Caliskan E, Halil M. Frailty and sarcopenia in patients with distal radius fracture: a geriatric perspective. Geriatr Orthop Surg Rehabil. [Internet]. 2020 [cited in 2022 Feb. 20]. Available in: https://doi.org/doi:10.1177/2151459320906361. https://doi.org/doi:10.1177/215145932090...	To assess the sarcopenia and frailty status of older people with distal radius fracture and compare with age- and sex-matched controls without distal radius fracture.	Cross-sectional Sample: 55 participants Mean age: not informed	The prevalence of sarcopenia was similar between groups. Pre-fracture -fragile (non-robust) phenotype was higher in patients with distal radius fracture.	Assessment of frailty and detection of patients with non-robust phenotype may help in fracture prevention strategies.	VI (Clinical Question: diagnosis)
A²²22 Soysal P, Ates BE, Yavuz I, Isik AT. Decreased basal metabolic rate can be an objective marker for sarcopenia and frailty in older males. J Am Med Dir Assoc. [Internet]. 2019 [cited in 2022 Fev. 22]; 20(1):58-63. Available in: https://doi.org/doi:10.1016/j.jamda.2018.07.001. https://doi.org/doi:10.1016/j.jamda.2018...	To demonstrate the ability of basal metabolic rate (BMR) to detect frailty and sarcopenia in older men.	Cross-sectional Sample: 305 participants Mean age: 74.5 years	In the sample, 31.1% had sarcopenia and 18% frailty. Participants with a low BMR had a higher frequency of frailty and sarcopenia.	Older male patients with sarcopenia and frailty had a greater reduction in BMR.	VI (Clinical Question: diagnosis)
A²³23 Mori H, Tokuda Y. Differences and overlap between sarcopenia and physical frailty in older community-dwelling Japanese. Asia Pac J Clin Nutr. [Internet]. 2019 [cited in 2022 Feb. 23]; 28(1):157-65. Available in: https://doi.org/doi:10.6133/apjcn.201903_28(1).0021. https://doi.org/doi:10.6133/apjcn.201903...	To investigate the clinical characteristics and factors relevant to sarcopenia with frailty in community-dwelling older Japanese men.	Cross-sectional Sample: 331 participants Mean age: 71.5 years	The prevalence of sarcopenia with frailty was 3.6% and there was a higher risk of recurrent falls and lower scores on physical and mental assessments.	Sarcopenia with frailty had a higher incidence of falls and poor quality of life.	VI (Clinical Question: diagnosis)
A²⁴24 Ates BE, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging. [Internet]. 2018 [cited in 2022 Feb. 23]; 13:1899-1905. Available in: https://doi.org/10.2147/CIA.S180281. https://doi.org/10.2147/CIA.S180281...	To determine the frequency of geriatric syndromes in community-dwelling older adults.	Cross-sectional Sample: 1017 participants Mean age: 76 years	In the sample, 218 were frail, 313 sarcopenic and 53% of the frail patients were also sarcopenic.	The frequency and coincidence of geriatric syndromes increased with age.	VI (Clinical Question: diagnosis)
A²⁵25 Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, et al. Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: the concord health and ageing in men project. Age Ageing. [Internet]. 2017 [cited in 2022 Feb. 25]; 46(3):413-20. Available in: https://doi.org/10.1093/ageing/afw214. https://doi.org/10.1093/ageing/afw214...	To explore the longitudinal associations between body composition measures, sarcopenic obesity and outcomes of frailty, BADL, IADL, institutionalization and mortality.	Longitudinal Sample: 1705 participants Mean age: 81.4 years	Men with low muscle mass were at increased risk of frailty and IADL disability.	Low muscle mass and sarcopenic obesity were associated with poor functional outcomes.	VI (Clinical Question: diagnosis)
A²⁶26 Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. [Internet]. 2017 [cited in 2022 Feb. 25]; 29(2):265-72. Available in: https://doi.org/10.1007/s40520-016-0561-2. https://doi.org/10.1007/s40520-016-0561-...	To estimate the prevalence of frailty and sarcopenia in a representative sample of older adults in Bogotá.	Cross-sectional Sample: 1442 participants Mean age: 70.7 years	Mean BADL scores of 98.1% indicated high levels of functional independence. The percentage of adults with only zero or one IADL affected was 84.6%. The prevalence of frailty was 9.4% and the prevalence of sarcopenia was 11.5%.	Frailty, sarcopenia, and multi-morbidity are overlapping but distinct conditions in the sample.	VI (Clinical Question: diagnosis)
A²⁷27 Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. [Internet]. 2013 [cited in 2022 Feb. 26]; 42(2):203-209. Available in: https://doi.org/10.1093/ageing/afs194. https://doi.org/10.1093/ageing/afs194...	To assess the impact of sarcopenia on the risk of all-cause death in a population of frail older adults living in the community.	Cross-sectional Sample: 364 participants Mean age: 82.2 years	In the sample, 21.8% had sarcopenia. During the 7-year follow-up, 67.4% died among subjects with sarcopenia compared to subjects without sarcopenia.	There was an association with mortality, independent of age and other clinical and functional variables.	VI (Clinical Question: diagnosis)
A²⁸28 González ED de L, Pérez HET, Hermosillo HG, Rodríguez JAC, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Medicina clinica. [Internet]. 2012 [cited in 2022 Feb. 26]; 138(11):468-74. Available in: https://doi.org/10.1016/j.medcli.2011.03.024. https://doi.org/10.1016/j.medcli.2011.03...	To determine the association between frailty and mortality, functional dependence, falls and hospitalizations in the National Health and Aging Study in Mexico.	Cross-sectional Sample: 4774 participants Mean age: 69.4 years	In the sample, 33% of the elderly had frailty and 43% pre-frailty. Dependence in at least one BADL was 11.4% for the frail group and 5.9% for the pre-frail group.	The state of frailty has a silent and economic impact on the risk of dependence in BADL, hospitalization and mortality.	VI (Clinical Question: diagnosis)
A²⁹29 Viana JU, Silva SL, Torres JL, Dias JM, Pereira LS, Dias RC. Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study. Braz J Phys Ther. [Internet]. 2013 [cited in 2022 Feb. 26]; 17(4):373-81. Available in: https://doi.org/10.1590/S1413-35552013005000102. https://doi.org/10.1590/S1413-3555201300...	To assess whether indirect indicators of sarcopenia and functionality influence the frailty profile in older adults.	Cross-sectional Sample: 53 participants Mean age: 76.7 years	In the sample, 54.7% of the elderly were pre-frail and 15.1% frail. The indicators of sarcopenia, level of physical activity and gait speed were the most prevalent.	The association between sarcopenia, frailty, physical inactivity and gait speed as the most important factors in frailty screening is confirmed.	VI (Clinical Question: diagnosis)

Type of Evaluation	Instruments used
Functional capacity	Katz Index¹⁸18 Bahat OG, Kılıç C, Bozkurt ME, Karan MA. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J Nutr Health Aging. [Internet]. 2021 [cited in 2022 Jan.13]; 25(4):433-39. Available in: https://doi.org/doi:10.1007/s12603-020-1535-9. https://doi.org/doi:10.1007/s12603-020-1... ^,²⁰20 Rasheedy D, EL-Kawaly WH. The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly. Electron J Gen Med. [Internet]. 2021 [cited in 2022 Feb. 20]; 18(2):277. Available in: https://doi.org/10.29333/ejgm/9695. https://doi.org/10.29333/ejgm/9695... ^-²¹21 Caliskan H, Igdir V, Ozsurekci C, Emrah Caliskan E, Halil M. Frailty and sarcopenia in patients with distal radius fracture: a geriatric perspective. Geriatr Orthop Surg Rehabil. [Internet]. 2020 [cited in 2022 Feb. 20]. Available in: https://doi.org/doi:10.1177/2151459320906361. https://doi.org/doi:10.1177/215145932090... ^,²⁵25 Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, et al. Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: the concord health and ageing in men project. Age Ageing. [Internet]. 2017 [cited in 2022 Feb. 25]; 46(3):413-20. Available in: https://doi.org/10.1093/ageing/afw214. https://doi.org/10.1093/ageing/afw214... ^,²⁷27 Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. [Internet]. 2013 [cited in 2022 Feb. 26]; 42(2):203-209. Available in: https://doi.org/10.1093/ageing/afs194. https://doi.org/10.1093/ageing/afs194... Lawton and Brody Index¹⁸18 Bahat OG, Kılıç C, Bozkurt ME, Karan MA. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J Nutr Health Aging. [Internet]. 2021 [cited in 2022 Jan.13]; 25(4):433-39. Available in: https://doi.org/doi:10.1007/s12603-020-1535-9. https://doi.org/doi:10.1007/s12603-020-1... ^,²⁰20 Rasheedy D, EL-Kawaly WH. The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly. Electron J Gen Med. [Internet]. 2021 [cited in 2022 Feb. 20]; 18(2):277. Available in: https://doi.org/10.29333/ejgm/9695. https://doi.org/10.29333/ejgm/9695... 21 Caliskan H, Igdir V, Ozsurekci C, Emrah Caliskan E, Halil M. Frailty and sarcopenia in patients with distal radius fracture: a geriatric perspective. Geriatr Orthop Surg Rehabil. [Internet]. 2020 [cited in 2022 Feb. 20]. Available in: https://doi.org/doi:10.1177/2151459320906361. https://doi.org/doi:10.1177/215145932090... ^-²²22 Soysal P, Ates BE, Yavuz I, Isik AT. Decreased basal metabolic rate can be an objective marker for sarcopenia and frailty in older males. J Am Med Dir Assoc. [Internet]. 2019 [cited in 2022 Fev. 22]; 20(1):58-63. Available in: https://doi.org/doi:10.1016/j.jamda.2018.07.001. https://doi.org/doi:10.1016/j.jamda.2018... ^,²⁶26 Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. [Internet]. 2017 [cited in 2022 Feb. 25]; 29(2):265-72. Available in: https://doi.org/10.1007/s40520-016-0561-2. https://doi.org/10.1007/s40520-016-0561-... ^,²⁸28 González ED de L, Pérez HET, Hermosillo HG, Rodríguez JAC, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Medicina clinica. [Internet]. 2012 [cited in 2022 Feb. 26]; 138(11):468-74. Available in: https://doi.org/10.1016/j.medcli.2011.03.024. https://doi.org/10.1016/j.medcli.2011.03... Barthel Index²⁶26 Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. [Internet]. 2017 [cited in 2022 Feb. 25]; 29(2):265-72. Available in: https://doi.org/10.1007/s40520-016-0561-2. https://doi.org/10.1007/s40520-016-0561-...
Frailty	Criteria proposed by Fried et al.⁶6 Park H, Jang IY, Lee HY, Jung HW, Lee E, Kim DH. Screening value of social frailty and its Association with Physical Frailty and Disability in community-dDwelling older koreans: aging study of pyeong chang rural area. Int J Environ Res Public Health. [Internet]. 2019 [cited in 2022 Jan.12]; 16(16):2809. Available in: https://doi.org/10.3390/ijerph16162809. https://doi.org/10.3390/ijerph16162809... ^,¹⁸18 Bahat OG, Kılıç C, Bozkurt ME, Karan MA. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J Nutr Health Aging. [Internet]. 2021 [cited in 2022 Jan.13]; 25(4):433-39. Available in: https://doi.org/doi:10.1007/s12603-020-1535-9. https://doi.org/doi:10.1007/s12603-020-1... 19 Thompson MQ, Solomon Y, Tucker GR, Adams RJ, Cesari M, Theou O, et al. Frailty and sarcopenia in combination are more predictive of mortality than either condition alone. Maturitas. [Internet]. 2021 [cited in 2022 Jan. 14 Jan.]; 144:102-7. Available in: https://doi.org/10.1016/j.maturitas.2020.11.009. https://doi.org/10.1016/j.maturitas.2020... ^-²⁰20 Rasheedy D, EL-Kawaly WH. The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly. Electron J Gen Med. [Internet]. 2021 [cited in 2022 Feb. 20]; 18(2):277. Available in: https://doi.org/10.29333/ejgm/9695. https://doi.org/10.29333/ejgm/9695... ^,²²22 Soysal P, Ates BE, Yavuz I, Isik AT. Decreased basal metabolic rate can be an objective marker for sarcopenia and frailty in older males. J Am Med Dir Assoc. [Internet]. 2019 [cited in 2022 Fev. 22]; 20(1):58-63. Available in: https://doi.org/doi:10.1016/j.jamda.2018.07.001. https://doi.org/doi:10.1016/j.jamda.2018... 23 Mori H, Tokuda Y. Differences and overlap between sarcopenia and physical frailty in older community-dwelling Japanese. Asia Pac J Clin Nutr. [Internet]. 2019 [cited in 2022 Feb. 23]; 28(1):157-65. Available in: https://doi.org/doi:10.6133/apjcn.201903_28(1).0021. https://doi.org/doi:10.6133/apjcn.201903... 24 Ates BE, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging. [Internet]. 2018 [cited in 2022 Feb. 23]; 13:1899-1905. Available in: https://doi.org/10.2147/CIA.S180281. https://doi.org/10.2147/CIA.S180281... 25 Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, et al. Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: the concord health and ageing in men project. Age Ageing. [Internet]. 2017 [cited in 2022 Feb. 25]; 46(3):413-20. Available in: https://doi.org/10.1093/ageing/afw214. https://doi.org/10.1093/ageing/afw214... ^-²⁶26 Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. [Internet]. 2017 [cited in 2022 Feb. 25]; 29(2):265-72. Available in: https://doi.org/10.1007/s40520-016-0561-2. https://doi.org/10.1007/s40520-016-0561-... ^,²⁸28 González ED de L, Pérez HET, Hermosillo HG, Rodríguez JAC, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Medicina clinica. [Internet]. 2012 [cited in 2022 Feb. 26]; 138(11):468-74. Available in: https://doi.org/10.1016/j.medcli.2011.03.024. https://doi.org/10.1016/j.medcli.2011.03... ^-²⁹29 Viana JU, Silva SL, Torres JL, Dias JM, Pereira LS, Dias RC. Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study. Braz J Phys Ther. [Internet]. 2013 [cited in 2022 Feb. 26]; 17(4):373-81. Available in: https://doi.org/10.1590/S1413-35552013005000102. https://doi.org/10.1590/S1413-3555201300...
Sarcopenia	European Working Group on Sarcopenia in the Elderly People ⁶6 Park H, Jang IY, Lee HY, Jung HW, Lee E, Kim DH. Screening value of social frailty and its Association with Physical Frailty and Disability in community-dDwelling older koreans: aging study of pyeong chang rural area. Int J Environ Res Public Health. [Internet]. 2019 [cited in 2022 Jan.12]; 16(16):2809. Available in: https://doi.org/10.3390/ijerph16162809. https://doi.org/10.3390/ijerph16162809... ^,¹⁹19 Thompson MQ, Solomon Y, Tucker GR, Adams RJ, Cesari M, Theou O, et al. Frailty and sarcopenia in combination are more predictive of mortality than either condition alone. Maturitas. [Internet]. 2021 [cited in 2022 Jan. 14 Jan.]; 144:102-7. Available in: https://doi.org/10.1016/j.maturitas.2020.11.009. https://doi.org/10.1016/j.maturitas.2020... 20 Rasheedy D, EL-Kawaly WH. The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly. Electron J Gen Med. [Internet]. 2021 [cited in 2022 Feb. 20]; 18(2):277. Available in: https://doi.org/10.29333/ejgm/9695. https://doi.org/10.29333/ejgm/9695... 21 Caliskan H, Igdir V, Ozsurekci C, Emrah Caliskan E, Halil M. Frailty and sarcopenia in patients with distal radius fracture: a geriatric perspective. Geriatr Orthop Surg Rehabil. [Internet]. 2020 [cited in 2022 Feb. 20]. Available in: https://doi.org/doi:10.1177/2151459320906361. https://doi.org/doi:10.1177/215145932090... ^-²²22 Soysal P, Ates BE, Yavuz I, Isik AT. Decreased basal metabolic rate can be an objective marker for sarcopenia and frailty in older males. J Am Med Dir Assoc. [Internet]. 2019 [cited in 2022 Fev. 22]; 20(1):58-63. Available in: https://doi.org/doi:10.1016/j.jamda.2018.07.001. https://doi.org/doi:10.1016/j.jamda.2018... ^,²⁴24 Ates BE, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging. [Internet]. 2018 [cited in 2022 Feb. 23]; 13:1899-1905. Available in: https://doi.org/10.2147/CIA.S180281. https://doi.org/10.2147/CIA.S180281... ^,²⁶26 Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. [Internet]. 2017 [cited in 2022 Feb. 25]; 29(2):265-72. Available in: https://doi.org/10.1007/s40520-016-0561-2. https://doi.org/10.1007/s40520-016-0561-... ^-²⁷27 Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. [Internet]. 2013 [cited in 2022 Feb. 26]; 42(2):203-209. Available in: https://doi.org/10.1093/ageing/afs194. https://doi.org/10.1093/ageing/afs194... ^,²⁹29 Viana JU, Silva SL, Torres JL, Dias JM, Pereira LS, Dias RC. Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study. Braz J Phys Ther. [Internet]. 2013 [cited in 2022 Feb. 26]; 17(4):373-81. Available in: https://doi.org/10.1590/S1413-35552013005000102. https://doi.org/10.1590/S1413-3555201300... Asian Working Group for Sarcopenia²³23 Mori H, Tokuda Y. Differences and overlap between sarcopenia and physical frailty in older community-dwelling Japanese. Asia Pac J Clin Nutr. [Internet]. 2019 [cited in 2022 Feb. 23]; 28(1):157-65. Available in: https://doi.org/doi:10.6133/apjcn.201903_28(1).0021. https://doi.org/doi:10.6133/apjcn.201903... SARC-F¹⁸18 Bahat OG, Kılıç C, Bozkurt ME, Karan MA. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J Nutr Health Aging. [Internet]. 2021 [cited in 2022 Jan.13]; 25(4):433-39. Available in: https://doi.org/doi:10.1007/s12603-020-1535-9. https://doi.org/doi:10.1007/s12603-020-1... Questionnaire

Critical review of quantitative studies	A⁶6 Park H, Jang IY, Lee HY, Jung HW, Lee E, Kim DH. Screening value of social frailty and its Association with Physical Frailty and Disability in community-dDwelling older koreans: aging study of pyeong chang rural area. Int J Environ Res Public Health. [Internet]. 2019 [cited in 2022 Jan.12]; 16(16):2809. Available in: https://doi.org/10.3390/ijerph16162809. https://doi.org/10.3390/ijerph16162809...	A¹⁸18 Bahat OG, Kılıç C, Bozkurt ME, Karan MA. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J Nutr Health Aging. [Internet]. 2021 [cited in 2022 Jan.13]; 25(4):433-39. Available in: https://doi.org/doi:10.1007/s12603-020-1535-9. https://doi.org/doi:10.1007/s12603-020-1...	A¹⁹19 Thompson MQ, Solomon Y, Tucker GR, Adams RJ, Cesari M, Theou O, et al. Frailty and sarcopenia in combination are more predictive of mortality than either condition alone. Maturitas. [Internet]. 2021 [cited in 2022 Jan. 14 Jan.]; 144:102-7. Available in: https://doi.org/10.1016/j.maturitas.2020.11.009. https://doi.org/10.1016/j.maturitas.2020...	A²⁰20 Rasheedy D, EL-Kawaly WH. The Cumulative Impact of Sarcopenia, Frailty, Malnutrition, and Cachexia on Other Geriatric Syndromes in Hospitalized Elderly. Electron J Gen Med. [Internet]. 2021 [cited in 2022 Feb. 20]; 18(2):277. Available in: https://doi.org/10.29333/ejgm/9695. https://doi.org/10.29333/ejgm/9695...	A²¹21 Caliskan H, Igdir V, Ozsurekci C, Emrah Caliskan E, Halil M. Frailty and sarcopenia in patients with distal radius fracture: a geriatric perspective. Geriatr Orthop Surg Rehabil. [Internet]. 2020 [cited in 2022 Feb. 20]. Available in: https://doi.org/doi:10.1177/2151459320906361. https://doi.org/doi:10.1177/215145932090...	A²²22 Soysal P, Ates BE, Yavuz I, Isik AT. Decreased basal metabolic rate can be an objective marker for sarcopenia and frailty in older males. J Am Med Dir Assoc. [Internet]. 2019 [cited in 2022 Fev. 22]; 20(1):58-63. Available in: https://doi.org/doi:10.1016/j.jamda.2018.07.001. https://doi.org/doi:10.1016/j.jamda.2018...	A²³23 Mori H, Tokuda Y. Differences and overlap between sarcopenia and physical frailty in older community-dwelling Japanese. Asia Pac J Clin Nutr. [Internet]. 2019 [cited in 2022 Feb. 23]; 28(1):157-65. Available in: https://doi.org/doi:10.6133/apjcn.201903_28(1).0021. https://doi.org/doi:10.6133/apjcn.201903...	A²⁴24 Ates BE, Soysal P, Isik AT. Frequency and coincidence of geriatric syndromes according to age groups: single-center experience in Turkey between 2013 and 2017. Clin Interv Aging. [Internet]. 2018 [cited in 2022 Feb. 23]; 13:1899-1905. Available in: https://doi.org/10.2147/CIA.S180281. https://doi.org/10.2147/CIA.S180281...	A²⁵25 Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, et al. Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: the concord health and ageing in men project. Age Ageing. [Internet]. 2017 [cited in 2022 Feb. 25]; 46(3):413-20. Available in: https://doi.org/10.1093/ageing/afw214. https://doi.org/10.1093/ageing/afw214...	A²⁶26 Samper-Ternent R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in Bogotá: results from the SABE Bogotá Study. Aging Clin Exp Res. [Internet]. 2017 [cited in 2022 Feb. 25]; 29(2):265-72. Available in: https://doi.org/10.1007/s40520-016-0561-2. https://doi.org/10.1007/s40520-016-0561-...	A²⁷27 Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. [Internet]. 2013 [cited in 2022 Feb. 26]; 42(2):203-209. Available in: https://doi.org/10.1093/ageing/afs194. https://doi.org/10.1093/ageing/afs194...	A²⁸28 González ED de L, Pérez HET, Hermosillo HG, Rodríguez JAC, Torres G. Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más. Medicina clinica. [Internet]. 2012 [cited in 2022 Feb. 26]; 138(11):468-74. Available in: https://doi.org/10.1016/j.medcli.2011.03.024. https://doi.org/10.1016/j.medcli.2011.03...	A²⁹29 Viana JU, Silva SL, Torres JL, Dias JM, Pereira LS, Dias RC. Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study. Braz J Phys Ther. [Internet]. 2013 [cited in 2022 Feb. 26]; 17(4):373-81. Available in: https://doi.org/10.1590/S1413-35552013005000102. https://doi.org/10.1590/S1413-3555201300...
Was the objective clear?	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Review of relevant literature on this topic conducted?	Y	Y	N	Y	N	Y	Y	Y	Y	N	Y	Y	Y
Describe the design	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Sample described in detail	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Provided justification for sample size	Y	Y	N	Y	Y	Y	N	Y	Y	Y	Y	Y	Y
Reliable outcome measures	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Valid outcome measures of Intervention described in detail	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Contamination was avoided	NI	NI	NI	NI	NI	NI	NI	NI	NI	NI	NI	NI	NI
Concurrent intervention was avoided	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
Results reported in terms of statistical significance	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Appropriate methods of analysis	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Clinical importance was reported	N	Y	Y	N	N	Y	N	N	N	N	Y	N	N
Reporting of participants who dropped out of the study	N	N	N	N	N	N	N	N	N	N	N	N	N
Conclusions consistent with methods and results obtained	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y

Universidade Federal do Paraná Av. Prefeito Lothário Meissner, 632, Cep: 80210-170, Brasil - Paraná / Curitiba, Tel: +55 (41) 3361-3755 - Curitiba - PR - Brazil
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[1] Corresponding author: Daiane de Souza Fernandes Universidade de São Paulo - USP Av. Bandeirantes, 3900 Ribeirão Preto, SP Cep 14040-902 E-mail: daissf@usp.br