Frailty and <i>delirium</i> in hospitalized older adults: A systematic review with meta-analysis

Authors’ contribution

Study concept and design: Clovis Cechinel, Maria Helena Lenardt, João Alberto Martins Rodrigues. Obtaining data: Clovis Cechinel, João Alberto Martins Rodrigues, Maria Angélica Binotto, Márcia Marrocos Aristides, Rosane Kraus. Data analysis and interpretation: Clovis Cechinel, Maria Helena Lenardt, João Alberto Martins Rodrigues, Maria Angélica Binotto, Márcia Marrocos Aristides, Rosane Kraus. Statistical analysis: Clovis Cechinel. Drafting the manuscript: Clovis Cechinel, Maria Helena Lenardt, João Alberto Martins Rodrigues, Maria Angélica Binotto, Márcia Marrocos Aristides, Rosane Kraus. Critical review of the manuscript as to its relevant intellectual content: Clovis Cechinel, Maria Helena Lenardt, Maria Angélica Binotto, Márcia Marrocos Aristides, Rosane Kraus. All authors approved the final version of the text.

Conflict of interest

The authors have declared that there is no conflict of interest.

AUTHOR (DATA)	1. Is the sample clipping appropriate to adress the target population?	2. Were the study participants properly sampled?	3. Was the sample size adequate?	4. Were the study participantes and design described in detail?	5.Was data analysis performed with sufficient sample coverage?	6. Were valid methods used to identify the condition?	7. Was the condition assessed in a standardized and reliable way?	8. Was na appropriate statistical analysis performed?	9. Was the response rate adequate and, if not, was the low response rate properly managed?	Total
Leung; Tsai; Sands, 2011 ¹⁷17. Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Delineando pesquisa clínica. 4. ed. Apêndice 12A. Porto Alegre: Artmed; 2015.	(-)	(+)	(-)	(+)	(+)	(+)	(+)	(+)	(+)	7
Eeles et al., 2012 ¹⁸18. R Core Team. R: A language and environment for statistical computing [Homepage]. Vienna: R Foundation for Statistical Computing; 2021 [cited 2022 Mar 21]. Available from: https://www.R-project.org/ https://www.R-project.org/...	(+)	(+)	(-)	(-)	(+)	(+)	(+)	(-)	(+)	6
Joosten et al., 2014 ¹⁹19. Leung JM, Tsai TL, Sands LP. Brief report: preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg. 2011;112(5):1199-201. Doi: 10.1213/ANE.0b013e31820c7c06 https://doi.org/10.1213/ANE.0b013e31820c...	(+)	(I)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	8
Hempenius et al., 2014 ²⁰20. Eeles EMP, White SV, O'Mahony SM, Bayer AJ, Hubbard RE. The impact of frailty and delirium on mortality in older inpatients. Age Ageing. 2012;41(3);412-6. Doi: 10.1093/ageing/afs021 https://doi.org/10.1093/ageing/afs021...	(-)	(+)	(+)	(+)	(+)	(+)	(U)	(+)	(+)	7
Eide et al., 2015 ²¹21. Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. Doi: 10.1186/1471-2318-14-1 https://doi.org/10.1186/1471-2318-14-1...	(+)	(+)	(-)	(+)	(+)	(+)	(U)	(+)	(+)	7
Partridge et al., 2015 ²²22. Hempenius L, Slaets JP, van Asselt DZ, Schukking J, de Bock GH, Wiggers T, et al. Interventions to prevent postoperative delirium in elderly cancer patients should be targeted at those undergoing nonsuperficial surgery with special attention to the cognitive impaired patients. Eur J Surg Oncol. 2015;41(1):28-33. Doi: 10.1016/j.ejso.2014.04.006 https://doi.org/10.1016/j.ejso.2014.04.0...	(+)	(+)	(+)	(+)	(+)	(+)	(U)	(+)	(+)	8
Nguyen; Cumming; Hilmer, 2016 ²³23. Eide LSP, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, et al. Comparison of frequency, risk factors, and time course of postoperative delirium in octogenarians after transcatheter aortic valve implantation versus surgical aortic valve replacement. Am J Cardiol. 2015;115(6):802-9. Doi: 10.1016/j.amjcard.2014.12.043 https://doi.org/10.1016/j.amjcard.2014.1...	(-)	(+)	(+)	(+)	(+)	(+)	(U)	(+)	(+)	7
Assmann et al., 2016 ²⁴24. Partridge JS, Fuller M, Harari D, Taylor PR, Martin FC, Dhesi JK. Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg. 2015;18:57-63. Doi: 10.1016/j.ijsu.2015.04.037 https://doi.org/10.1016/j.ijsu.2015.04.0...	(-)	(+)	(-)	(+)	(+)	(+)	(+)	(+)	(+)	7
Chew et al., 2017 ²⁵25. Nguyen TN, Cumming RG, Hilmer SN. The Impact of Frailty on Mortality, Length of Stay and Re-hospitalisation in Older Patients with Atrial Fibrillation. Heart Lung Circ. 2016;25(6):551-7. Doi: 10.1016/j.hlc.2015.12.002 https://doi.org/10.1016/j.hlc.2015.12.00...	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
Ogawa et al., 2017 ²⁶26. Assmann P, Kievit P, van der Wulp K, Verkroost M, Noyez L, Bor H, et al. Frailty is associated with delirium and mortality after transcatheter aortic valve implantation. Open Heart. 2016;3(2):e000478. Doi: 10.1136/openhrt-2016-000478 https://doi.org/10.1136/openhrt-2016-000...	(+)	(+)	(+)	(+)	(+)	(-)	(-)	(+)	(+)	7
Gleason et al., 2017 ²⁷27. Chew J, Lim WS, Chong MS, Ding YY, Tay L. Impact of frailty and residual subsyndromal delirium on 1-year functional recovery: A prospective cohort study. Geriatr Gerontol Int. 2017;17(12):2472-8. Doi: 10.1111/ggi.13108 https://doi.org/10.1111/ggi.13108...	(-)	(+)	(+)	(+)	(+)	(+)	(-)	(+)	(+)	7
Dani et al., 2018 ²⁸28. Ogawa M, Izawa KP, Satomi-Kobayashi S, Tsuboi Y, Komaki K, Gotake Y, et al. Impact of delirium on postoperative frailty and long term cardiovascular events after cardiac surgery. PLoS One. 2017;12(12):e0190359. Doi: 10.1371/journal.pone.0190359 https://doi.org/10.1371/journal.pone.019...	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
Tanaka et al., 2018 ²⁹29. Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL Questionnaire Screening Tool and Short-Term Outcomes in Geriatric Fracture Patients. J Am Med Dir Assoc. 2017 Dec 1;18(12):1082-6. Doi: 10.1016/j.jamda.2017.07.005 https://doi.org/10.1016/j.jamda.2017.07....	(+)	(+)	(+)	(+)	(+)	(+)	(U)	(+)	(+)	8
Giroux et al., 2018 ⁹9. Giroux M, Sirois MJ, Boucher V, Daoust R, Gouin É, Pelletier M, et al. Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department. J Emerg Med. 2018;55(2):157-64. Doi: 10.1016/j.jemermed.2018.02.032 https://doi.org/10.1016/j.jemermed.2018....	(+)	(+)	(-)	(+)	(+)	(+)	(+)	(+)	(-)	7
Alabaf Sabbaghi et al., 2018 ³⁰30. Tanaka S, Ueno M, Iida H, Kaibori M, Nomi T, Hirokawa F, et al. Preoperative assessment of frailty predicts age-related events after hepatic resection: a prospective multicenter study. J Hepatobiliary Pancreat Sci. 2018;25(8):377-87. Doi: 10.1002/jhbp.568 https://doi.org/10.1002/jhbp.568...	(+)	(+)	(+)	(+)	(+)	(-)	(U)	(+)	(-)	6
Nomura et al., 2018 ³¹31. Alabaf Sabbaghi S, De Souza D, Sarikonda P, Keevil VL, Wallis SJ, Romero-Ortuno R. Allocating patients to geriatric medicine wards in a tertiary university hospital in England: A service evaluation of the Specialist Advice for the Frail Elderly (SAFE) team. Aging Med (Milton). 2018;1(2):120-4. Doi: 10.1002/agm2.12029 https://doi.org/10.1002/agm2.12029...	(-)	(+)	(-)	(+)	(+)	(+)	(U)	(+)	(+)	6
Goudzwaard et al., 2018 ³²32. Nomura Y, Nakano M, Bush B, Tian J, Yamaguchi A, Walston J, et al. Observational Study Examining the Association of Baseline Frailty and Postcardiac Surgery Delirium and Cognitive Change. Anesth Analg. 2019;129(2):507-14. Doi: 10.1213/ANE.0000000000003967 https://doi.org/10.1213/ANE.000000000000...	(-)	(+)	(-)	(+)	(+)	(+)	(U)	(+)	(+)	6
Geriatric Medicine Research Collaborative, 2019 ³³33. Goudzwaard JA, de Ronde-Tillmans MJAG, El Faquir N, Acar F, Van Mieghem NM, Lenzen MJ, et al. The Erasmus Frailty Score is associated with delirium and 1-year mortality after Transcatheter Aortic Valve Implantation in older patients. The TAVI Care & Cure program. Int J Cardiol. 2019;276:48-52. Doi: 10.1016/j.ijcard.2018.10.093 https://doi.org/10.1016/j.ijcard.2018.10...	(+)	(+)	(+)	(-)	(+)	(+)	(+)	(+)	(+)	8
Saravana-Bawan et al., 2019 ³⁴34. Geriatric Medicine Research Collaborative. Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day. BMC Med. 2019;17(1):229. Doi: 10.1186/s12916-019-1458-7 https://doi.org/10.1186/s12916-019-1458-...	(+)	(+)	(+)	(+)	(+)	(+)	(U)	(+)	(+)	8
Bellelli et al., 2019 ¹⁰10. Bellelli PG, Biotto M, Morandi A, Meagher D, Cesari M, Mazzola P, et al. The relationship among frailty, delirium and attentional tests to detect delirium: a cohort study. Eur J Intern Med. 2019;70:33-8. Doi: 10.1016/j.ejim.2019.09.008 https://doi.org/10.1016/j.ejim.2019.09.0...	(-)	(+)	(-)	(+)	(+)	(+)	(U)	(+)	(+)	6
Goudzwaard et al., 2020 ³⁵35. Saravana-Bawan B, Warkentin LM, Rucker D, Carr F, Churchill TA, Khadaroo RG. Incidence and predictors of postoperative delirium in the older acute care surgery population: a prospective study. Can J Surg. 2019;62(1):33-8. Doi: 10.1503/cjs.016817 https://doi.org/10.1503/cjs.016817...	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
Itagaki et al., 2020 ³⁶36. Goudzwaard JA, de Ronde-Tillmans MJAG, de Jager TAJ, Lenzen MJ, Nuis RJ, van Mieghem NM, et al. Incidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation. Age Ageing. 2020;49(3):389-94. Doi: 10.1093/ageing/afaa001 https://doi.org/10.1093/ageing/afaa001...	(+)	(+)	(-)	(+)	(+)	(+)	(U)	(+)	(-)	6
Saljuqi et al., 2020 ³⁷37. Itagaki A, Sakurada K, Matsuhama M, Yajima J, Yamashita T, Kohzuki M. Impact of frailty and mild cognitive impairment on delirium after cardiac surgery in older patients. J Cardiol. 2020;76(2):147-53. Doi: 10.1016/j.jjcc.2020.02.007 https://doi.org/10.1016/j.jjcc.2020.02.0...	(+)	(+)	(+)	(-)	(+)	(+)	(U)	(+)	(+)	7
Susano et al., 2020 ³⁸38. Saljuqi AT, Hanna K, Asmar S, Tang A, Zeeshan M, Gries L, et al. Prospective Evaluation of Delirium in Geriatric Patients Undergoing Emergency General Surgery. J Am Coll Surg. 2020;230(5):758-65. Doi: 10.1016/j.jamcollsurg.2020.01.029 https://doi.org/10.1016/j.jamcollsurg.20...	(+)	(+)	(+)	(+)	(+)	(+)	(-)	(+)	(+)	8
Mahanna-Gabrielli et al., 2020 ³⁹39. Susano MJ, Grasfield RH, Friese M, Rosner B, Crosby G, Bader AM, et al. Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery. Anesthesiology. 2020;133(6):1184-91. Doi: 10.1097/ALN.0000000000003523 https://doi.org/10.1097/ALN.000000000000...	(+)	(+)	(+)	(+)	(+)	(+)	(U)	(+)	(+)	8
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Authors	Origin	Type of patients	Objective	Sample size	Type of study	Age	Instrument for frailty	Instrument for delirium	Results (95% CI^*)
Leung; Tsai; Sands, 2011¹⁹19. Leung JM, Tsai TL, Sands LP. Brief report: preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg. 2011;112(5):1199-201. Doi: 10.1213/ANE.0b013e31820c7c06 https://doi.org/10.1213/ANE.0b013e31820c...	USA	Surgical, non-cardiac.	To investigate if preoperative frailty in surgical non-cardiac patients favors onset of postoperative delirium.	63	Prospective cohort study	>65 years old	Modified Fried Criteria	CAM^†	Prevalence of frailty HR^‡ 0.33 (0.23 - 0.45) Prevalence of delirium HR^‡ 0.25 (0.16 - 0.37) Risk of delirium in frail patients RR^§ 2.57 (1.11 - 5.94)
Eeles, et al., 2012²⁰20. Eeles EMP, White SV, O'Mahony SM, Bayer AJ, Hubbard RE. The impact of frailty and delirium on mortality in older inpatients. Age Ageing. 2012;41(3);412-6. Doi: 10.1093/ageing/afs021 https://doi.org/10.1093/ageing/afs021...	Australia	Acute care, general hospital	To explore the relationship between delirium and frailty in aged patients and to determine their impact on survival.	273	Prospective cohort study	82.3±7.5	FI^\|\| (33 items) (Frail>0.25)	DSM-5^¶	Prevalence of frailty HR^‡ 0.41 (0.35 - 0.47) Prevalence of delirium HR^‡ 0.37 (0.31 - 0.43) Risk of delirium in frail patients RR^§ 3.62 (2.54 - 5.18)
Joosten, et al., 2014²¹21. Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1. Doi: 10.1186/1471-2318-14-1 https://doi.org/10.1186/1471-2318-14-1...	Belgium	Geriatric ward	To evaluate the prevalence of frailty and to determine to which extent it predicts delirium, falls and mortality in hospitalized aged patients.	220	Prospective cohort study	CHS^**: Frail 83.3±5.4 SOF^††: 83.1±5.2	CHS^** and SOF^††	CAM^†	Prevalence of frailty HR^‡ 0.40 (0.34 - 0.47) Prevalence of delirium HR^‡ 0.11 (0.08 - 0.16) Risk of delirium in frail patients RR^§ 1.07 (0.50 - 2.30)
Hempenius, et al., 2014²²22. Hempenius L, Slaets JP, van Asselt DZ, Schukking J, de Bock GH, Wiggers T, et al. Interventions to prevent postoperative delirium in elderly cancer patients should be targeted at those undergoing nonsuperficial surgery with special attention to the cognitive impaired patients. Eur J Surg Oncol. 2015;41(1):28-33. Doi: 10.1016/j.ejso.2014.04.006 https://doi.org/10.1016/j.ejso.2014.04.0...	Netherlands	Surgery, solid tumors	To determine the risk factors for postoperative delirium (POD) in aged patients with cancer.	251	Multicenter and retrospective cohort study	74.2±6.4 (65 - 92)	Groningen Frailty Indicator	CAM^†	Prevalence of frailty HR^‡ 0.34 (0.23 - 0.34) Prevalence of delirium HR^‡ 0.18 (0.14 - 0.24) Risk of delirium in frail patients RR^§ 2.01 (1.20 - 2.37)
Eide, et al., 2015²³23. Eide LSP, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, et al. Comparison of frequency, risk factors, and time course of postoperative delirium in octogenarians after transcatheter aortic valve implantation versus surgical aortic valve replacement. Am J Cardiol. 2015;115(6):802-9. Doi: 10.1016/j.amjcard.2014.12.043 https://doi.org/10.1016/j.amjcard.2014.1...	Norway	Cardiac Surgery	To determine the incidence of postoperative delirium in people aged 80-89 years old subjected to TAVI^‡‡ or to aortic valve surgical replacement; to identify risk factors and describe possible differences at onset and progression of postoperative delirium between the groups.	143	Prospective cohort study	> 80 83.5±2.7	SOF^††	CAM^†	Prevalence of frailty HR^‡ 0.39 (0.31 - 0.47) Prevalence of delirium HR^‡ 0.42 (0.34 - 0.50) Risk of delirium in frail patients RR^§ 1.14 (0.85 - 1.53)
Partridge, et al., 2015²⁴24. Partridge JS, Fuller M, Harari D, Taylor PR, Martin FC, Dhesi JK. Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg. 2015;18:57-63. Doi: 10.1016/j.ijsu.2015.04.037 https://doi.org/10.1016/j.ijsu.2015.04.0...	United Kingdom	Elective and emergency arterial-vascular surgeries	To evaluate the prevalence of frailty, clinical conditions and functional status in preoperative among older adults undergoing arterial vascular surgery and to evaluate postoperative outcomes.	125	Prospective cohort study	76.3±7.27	EFS^§§ (Frail≥6.5)	Not reported	Prevalence of frailty HR^‡ 0.52 (0.43 - 0.61) Prevalence of delirium HR^‡ 0.15 (0.10 - 0.22) Risk of delirium in frail patients RR^§ 0.27 (0.17 - 0.43)
Nguyen; Cumming; Hilmer, 2016²⁵25. Nguyen TN, Cumming RG, Hilmer SN. The Impact of Frailty on Mortality, Length of Stay and Re-hospitalisation in Older Patients with Atrial Fibrillation. Heart Lung Circ. 2016;25(6):551-7. Doi: 10.1016/j.hlc.2015.12.002 https://doi.org/10.1016/j.hlc.2015.12.00...	Australia	Clinical	To investigate the impact of frailty on mortality, hospitalization time and readmission in hospitalized aged patients with arterial fibrillation.	302	Prospective cohort study	84.7±7.1	EFS^§§	Not reported	Prevalence of frailty HR^‡ 0.53 (0.48 - 0.59) Prevalence of delirium HR^‡ 0.10 (0.07 - 0.14) Risk of delirium in frail patients RR^§ 1.00 (0.51 - 1.98)
Assmann, et al., 2016²⁶26. Assmann P, Kievit P, van der Wulp K, Verkroost M, Noyez L, Bor H, et al. Frailty is associated with delirium and mortality after transcatheter aortic valve implantation. Open Heart. 2016;3(2):e000478. Doi: 10.1136/openhrt-2016-000478 https://doi.org/10.1136/openhrt-2016-000...	Netherlands	Cardiac surgery (TAVI^‡‡)	To evaluate frailty as an indicator to predict delirium and mortality after TAVI^‡‡.	89	Prospective cohort study	80.4	FI^\|\| and Clinical judgment	DSM-4^\|\|\|\|	Prevalence of frailty HR^‡ 0.53 (0.43 - 0.63) Prevalence of delirium HR^‡ 0.28 (0.20 - 0.38)
Chew, et al., 2017²⁷27. Chew J, Lim WS, Chong MS, Ding YY, Tay L. Impact of frailty and residual subsyndromal delirium on 1-year functional recovery: A prospective cohort study. Geriatr Gerontol Int. 2017;17(12):2472-8. Doi: 10.1111/ggi.13108 https://doi.org/10.1111/ggi.13108...	Singapore	Surgical	To investigate the association between frailty and incomplete recovery from delirium at discharge and to examine the mediating role of incomplete recovery in the relationship between frailty and functional recovery 12 months after delirium.	234	Prospective cohort study	84.1±7.1	FI^\|\| (20 items) (Frail>0.25)	DRS-R-98^¶¶	Prevalence of frailty HR^‡ 0.68 (0.62 - 0.74) Prevalence of delirium HR^‡ 0.23 (0.18 - 0.28) Risk of delirium in frail patients RR^§ 0.90 (0.84 - 0.98)
Ogawa, et al., 2017²⁸28. Ogawa M, Izawa KP, Satomi-Kobayashi S, Tsuboi Y, Komaki K, Gotake Y, et al. Impact of delirium on postoperative frailty and long term cardiovascular events after cardiac surgery. PLoS One. 2017;12(12):e0190359. Doi: 10.1371/journal.pone.0190359 https://doi.org/10.1371/journal.pone.019...	Japan	Cardiac surgery	To examine the associations between delirium and postoperative frailty and mayor cardiac adverse events.	326	Prospective cohort study	68.6±14.8	Handgrip strength and gait speed	ICDSC^***	Prevalence of frailty HR^‡ 0.07 (0.04 - 0.10) Prevalence of delirium HR^‡ 0.13 (0.10 - 0.17) Risk of delirium in frail patients RR^§ 3.16 (1.67 - 5.96)
Gleason, et al., 2017²⁹29. Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL Questionnaire Screening Tool and Short-Term Outcomes in Geriatric Fracture Patients. J Am Med Dir Assoc. 2017 Dec 1;18(12):1082-6. Doi: 10.1016/j.jamda.2017.07.005 https://doi.org/10.1016/j.jamda.2017.07....	USA	Orthopedic surgery and Geriatrics service	To stratify frailty in older adults admitted with fractures to determine its association with the postoperative results.	175	Retrospective cohort study	82.3±7.4	FRAIL	Not performed	Prevalence of frailty HR^‡ 0.42 (0.35 - 0.49) Prevalence of delirium HR^‡ 0.20 (0.15 - 0.27) Risk of delirium in frail patients RR^§ 0.48 (0.26 - 0.87)
Dani, et al., 2018¹³13. Dani M, Owen LH, Jackson TA, Rockwood K, Sampson EL, Davis D. Delirium, Frailty, and Mortality: Interactions in a Prospective Study of Hospitalized Older People. J Gerontol A Biol Sci Med Sci. 2018;73(3):415-8. Doi: 10.1093/gerona/glx214 https://doi.org/10.1093/gerona/glx214...	United Kingdom	Emergency Sector	To evaluate the impact of delirium on mortality in a cohort evaluated for frailty.	710	Prospective cohort study	83.1±7.41	FI^\|\| (31 items)	CAM^†	Prevalence of delirium HR^‡ 0.10 (0.08 - 0.13)
Tanaka, et al., 2018³⁰30. Tanaka S, Ueno M, Iida H, Kaibori M, Nomi T, Hirokawa F, et al. Preoperative assessment of frailty predicts age-related events after hepatic resection: a prospective multicenter study. J Hepatobiliary Pancreat Sci. 2018;25(8):377-87. Doi: 10.1002/jhbp.568 https://doi.org/10.1002/jhbp.568...	Japan	Liver resection surgery	To apply the Kihon Checklist to evaluate preoperative frailty in older adults to predict outcomes after liver resection.	217	Multicenter and prospective cohort study	75 frail and age 72 non-frail people	KC^††† (Frail≥8)	ICDSC^***	Prevalence of frailty HR^‡ 0.29 (0.23 - 0.35) Prevalence of delirium HR^‡ 0.12 (0.09 - 0.17) Risk of delirium in frail patients RR^§ 6.52 (1.79 - 23.78)
Giroux, et al., 2018⁹9. Giroux M, Sirois MJ, Boucher V, Daoust R, Gouin É, Pelletier M, et al. Frailty Assessment to Help Predict Patients at Risk of Delirium When Consulting the Emergency Department. J Emerg Med. 2018;55(2):157-64. Doi: 10.1016/j.jemermed.2018.02.032 https://doi.org/10.1016/j.jemermed.2018....	Canada	Emergency Sector	To evaluate if frailty screening in older adults in the Emergency Department can help identify the risk of delirium.	335	Prospective cohort study	76.8±8.1	CFS^‡‡‡ (Frail>5/7)	CAM^†	Prevalence of frailty HR^‡ 0.21 (0.17 - 0.26) Prevalence of delirium HR^‡ 0.12 (0.09 - 0.16) Risk of delirium in frail patients RR^§ 3.79 (2.16 - 6.63)
Alabaf Sabbaghi, et al., 2018³¹31. Alabaf Sabbaghi S, De Souza D, Sarikonda P, Keevil VL, Wallis SJ, Romero-Ortuno R. Allocating patients to geriatric medicine wards in a tertiary university hospital in England: A service evaluation of the Specialist Advice for the Frail Elderly (SAFE) team. Aging Med (Milton). 2018;1(2):120-4. Doi: 10.1002/agm2.12029 https://doi.org/10.1002/agm2.12029...	United Kingdom	Emergency Sector	To compare the clinical characteristics, frailty, dementia and delirium in a hospital with a specialized counseling team for frail older adults versus usual treatment.	6,191	Retrospective and documentary	84.6±6.3	CFS^‡‡‡	4-ATM^§§§	Prevalence of frailty HR^‡ 0.05 (0.04 - 0.06) Prevalence of delirium HR^‡ 0.12 (0.11 - 0.13)
Nomura, et al., 2018³²32. Nomura Y, Nakano M, Bush B, Tian J, Yamaguchi A, Walston J, et al. Observational Study Examining the Association of Baseline Frailty and Postcardiac Surgery Delirium and Cognitive Change. Anesth Analg. 2019;129(2):507-14. Doi: 10.1213/ANE.0000000000003967 https://doi.org/10.1213/ANE.000000000000...	Japan	Cardiac surgery	To examine the hypothesis that baseline frailty would be associated with postoperative delirium and to cognitive changes from 1 to 12 months after a cardiac surgery.	133	Prospective cohort study	Robust 69.3±7.9 Frail 73.4±8.09	Fried’s Phenotype	CAM^† and CAM-ICU^\|\|\|\|\|\|	Prevalence of frailty HR^‡ 0.34 (0.26 - 0.42) Prevalence of delirium HR^‡ 0.48 (0.40 - 0.56) Risk of delirium in frail patients RR^§ 1.04 (0.68 - 1.58)
Goudzwaard, et al., 2018³³33. Goudzwaard JA, de Ronde-Tillmans MJAG, El Faquir N, Acar F, Van Mieghem NM, Lenzen MJ, et al. The Erasmus Frailty Score is associated with delirium and 1-year mortality after Transcatheter Aortic Valve Implantation in older patients. The TAVI Care & Cure program. Int J Cardiol. 2019;276:48-52. Doi: 10.1016/j.ijcard.2018.10.093 https://doi.org/10.1016/j.ijcard.2018.10...	Netherlands	Cardiac surgery (TAVI^‡‡)	To investigate the association between a new Erasmus Frailty Score and short- and long-term results after TAVI^‡‡.	213	Prospective cohort study	82.0 (IQR: 78.2 - 85.6)	Erasmus Frailty Score (>3/5 of the domains)	Geriatric clinical evaluation	Prevalence of frailty HR^‡ 0.29 (0.23 - 0.35) Prevalence of delirium HR^‡ 0.20 (0.15 - 0.26)
Geriatric Medicine Research Collaborative, 2019³⁴34. Geriatric Medicine Research Collaborative. Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day. BMC Med. 2019;17(1):229. Doi: 10.1186/s12916-019-1458-7 https://doi.org/10.1186/s12916-019-1458-...	United Kingdom	Emergency Sector	To evaluate frailty and the patient’s/hospital’s risk factors for delirium.	1507	Prospective cohort study	80.0±8.3	CFS^‡‡‡	4-ATM^§§§ and DSM-5^¶	Prevalence of frailty HR^‡ 0.66 (0.64 - 0.68) Prevalence of delirium HR^‡ 0.15 (0.13 - 0.17) Risk of delirium in frail patients RR^§ 2.83 (2.21 - 3.62)
Saravana-Bawan, et al., 2019³⁵35. Saravana-Bawan B, Warkentin LM, Rucker D, Carr F, Churchill TA, Khadaroo RG. Incidence and predictors of postoperative delirium in the older acute care surgery population: a prospective study. Can J Surg. 2019;62(1):33-8. Doi: 10.1503/cjs.016817 https://doi.org/10.1503/cjs.016817...	Canada	Emergency general surgery	To evaluate the incidence and risk factors of delirium in older adults subjected to emergency surgeries.	332	Prospective cohort study	76.1±7.66	CFS^‡‡‡	CAM^†	Prevalence of frailty HR^‡ 0.24 (0.20 - 0.29) Prevalence of delirium HR^‡ 0.23 (0.19 - 0.28) Risk of delirium in frail patients RR^§ 2.58 (1.76 - 3.79)
Bellelli, et al., 2019¹⁰10. Bellelli PG, Biotto M, Morandi A, Meagher D, Cesari M, Mazzola P, et al. The relationship among frailty, delirium and attentional tests to detect delirium: a cohort study. Eur J Intern Med. 2019;70:33-8. Doi: 10.1016/j.ejim.2019.09.008 https://doi.org/10.1016/j.ejim.2019.09.0...	Italy	Acute care (Geriatric emergency)	To evaluate if frailty is associated with delirium and if it affects performance in three attention tests.	89	Prospective cohort study	83.15±6.05	FI^\|\| (38 items)	4-ATM^§§§ and DSM-5^¶	Prevalence of frailty HR^‡ 0.47 (0.37 - 0.58) Prevalence of delirium HR^‡ 0.42 (0.32 - 0.52) Risk of delirium in frail patients RR^§ 1.84 (1.10 - 3.09)
Goudzaard, et al., 2020³⁶36. Goudzwaard JA, de Ronde-Tillmans MJAG, de Jager TAJ, Lenzen MJ, Nuis RJ, van Mieghem NM, et al. Incidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation. Age Ageing. 2020;49(3):389-94. Doi: 10.1093/ageing/afaa001 https://doi.org/10.1093/ageing/afaa001...	Netherlands	Cardiac surgery (TAVI^‡‡)	To investigate the incidence, the determinants and the consequences of postoperative delirium in aged patients subjected to TAVI^‡‡.	543	Prospective cohort study	79.1±8.0	Erasmus Frailty Score (>3/5 of the domains)	Geriatric clinical evaluation	Prevalence of frailty HR^‡ 0.28 (0.25 - 0.32) Prevalence of delirium HR^‡ 0.14 (0.11 - 0.17) Risk of delirium in frail patients RR^§ 2.22 (1.44 - 3.42)
Itagaki, et al., 2020³⁷37. Itagaki A, Sakurada K, Matsuhama M, Yajima J, Yamashita T, Kohzuki M. Impact of frailty and mild cognitive impairment on delirium after cardiac surgery in older patients. J Cardiol. 2020;76(2):147-53. Doi: 10.1016/j.jjcc.2020.02.007 https://doi.org/10.1016/j.jjcc.2020.02.0...	Japan	Cardiac surgery	To examine how physical frailty and cognitive impairment affect the incidence of delirium after cardiac surgeries in older patients.	89	Retrospective study	74.9±5.5	j-CHS^¶¶¶	ICDSC^***	Prevalence of frailty HR^‡ 0.27 (0.19 - 0.37) Prevalence of delirium HR^‡ 0.35 (0.26 - 0.45) Risk of delirium in frail patients RR^§ 2.51 (1.24 - 5.08)
Saljuqi, et al., 2020³⁸38. Saljuqi AT, Hanna K, Asmar S, Tang A, Zeeshan M, Gries L, et al. Prospective Evaluation of Delirium in Geriatric Patients Undergoing Emergency General Surgery. J Am Coll Surg. 2020;230(5):758-65. Doi: 10.1016/j.jamcollsurg.2020.01.029 https://doi.org/10.1016/j.jamcollsurg.20...	USA	Emergency general surgery	To evaluate the impact of frailty on delirium and on other outcomes in geriatric patients subjected to emergency general surgeries.	163	Prospective cohort study	71±7	EGSSFI^****	CAM^†	Prevalence of delirium HR^‡ 0.26 (0.20 - 0.33) Risk of delirium in frail patients RR^§ 2.50 (1.50 - 4.17)
Susano, et al., 2020³⁹39. Susano MJ, Grasfield RH, Friese M, Rosner B, Crosby G, Bader AM, et al. Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery. Anesthesiology. 2020;133(6):1184-91. Doi: 10.1097/ALN.0000000000003523 https://doi.org/10.1097/ALN.000000000000...	USA	Orthopedic surgery (spine)	To test the hypothesis that preoperative screening for frailty or cognitive impairment identifies patients at risk for postoperative delirium (primary endpoint).	229	Prospective cohort study	≥70 to 75	FRAIL	CAM^†	Prevalence of frailty HR^‡ 0.24 (0.19 - 0.30) Prevalence of delirium RR^§ 0.25 (0.20 - 0.31)
Mahanna-Gabrielli, et al., 2020⁴⁰40. Mahanna-Gabrielli E, Zhang K, Sieber FE, Lin HM, Liu X, Sewell M, et al. Frailty Is Associated with Postoperative Delirium but Not With Postoperative Cognitive Decline in Older Noncardiac Surgery Patients. Anesth Analg. 2020;130(6):1516-23. Doi: 10.1213/ANE.0000000000004773 https://doi.org/10.1213/ANE.000000000000...	USA	Major non-cardiac surgery	To examine the relationship between frailty and postoperative delírium after a large-size non-cardiac surgery.	167	Prospective cohort study	70	FRAIL	CAM-ICU^\|\|\|\|\|\|	Prevalence of frailty HR^‡ 0.19 (0.13 - 0.25) Prevalence of delirium HR^‡ 0.25 (0.19 - 0.32) Risk of delirium in frail patients RR^§ 1.78 (1.01 - 3.13)
Chen; Qin, 2021⁴¹41. Chen Y, Qin J. Modified Frailty Index Independently Predicts Postoperative Delirium and Delayed Neurocognitive Recovery After Elective Total Joint Arthroplasty. J Arthroplasty. 2021;36(2):449-53. Doi: 10.1016/j.arth.2020.07.074 https://doi.org/10.1016/j.arth.2020.07.0...	China	Orthopedic surgery	To examine the discriminatory value of the Frailty Index to predict postoperative delirium and cognitive dysfunction after total hip arthroplasty.	383	Prospective cohort study	72 (from 65 to 85)	FI^\|\| (11 items) Frail>0.18)	DSM-5^¶	Prevalence of frailty HR^‡ 0.54 (0.49 - 0.59) Prevalence of delirium HR^‡ 0.17 (0.14 - 0.21) Risk of delirium in frail patients RR^§ 1.70 (1.06 - 2.72)

[1] Corresponding author
Clovis Cechinel. E-mail: cechinelc@hotmail.com

Brasil

Brasil

Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis

Abstract

Objective:

Method:

Results:

Conclusion: