Effectiveness of interventions in older adults with cognitive frailty: a systematic review and meta-analysis of randomised controlled trials

Background interventions targeting older adults with cognitive frailty have grown rapidly in recent years with inconsistent findings. However, there is no meta-analysis that has synthesised pooled estimates. Objective to synthesise the pooled effect of current targeted interventions in older people with cognitive frailty. Methods we conducted a systematic search in PubMed, Embase, Web of Science, the Cochrane Library, the JBI database and three Chinese databases (CNKI, Wan-Fang and VIP) for literature from the inception of the database until 8 March 2022. The mean difference or standardised mean difference with 95% CIs was calculated. The methodological quality was assessed by the Cochrane RoB 2.0. The certainty of evidence was assessed using the GRADE criteria. Results thirteen randomised controlled trials with a total of 1,089 participants were included. The results of the meta-analysis showed that older adults with cognitive frailty in the intervention groups had significant improvement in frailty score [MD = -1.67, 95% CI (-2.39, -0.95), P < 0.00001, I-2 = 97%], global cognitive function [MD = 3.38, 95% CI (1.90, 4.85), P < 0.00001, I-2 = 93%], mobility [MD = -0.96, 95% CI (-1.27, -1.66), P < 0.00001, I-2 = 0%], muscle strength [SMD = 0.75, 95% CI (0.09, 1.41), P = 0.03, I-2 = 85%] and nutritional status [MNA:MD = 5.64, 95% CI (3.99, 7.29), P < 0.00001, I-2 = 89%; ALB: MD = 3.23, 95% CI (0.76, 5.71), P = 0.01, I-2 = 93%; PALB: MD = 54.52, 95% CI (25.26, 83.77), P = 0.0003, I-2 = 96%; TRF: MD = 0.64, 95% CI (0.22, 1.06), P = 0.003, I-2 = 97%]. The overall certainty of the evidence ranged from low to moderate. Conclusions interventions targeting older adults with cognitive frailty are effective in improving physical frailty, global cognitive function, physical function and nutritional status with low to moderate certainty. More research is still needed in the future to further enrich the evidence in these fields. PROSPERO number CRD42022318758.

Automated summary

This study conducted a meta-analysis of interventions targeting older adults with cognitive frailty. The results showed that these interventions can significantly improve frailty score, global cognitive function, mobility, muscle strength, and nutritional status in older adults. However, the certainty of evidence was low to moderate.