Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis

Purpose Frailty is an important predictor of adverse health events in older people, and improving quality of life (QOL) is increasingly recognised as a focus for services in this population. This systematic review synthesised evidence of the relationship between frailty and QOL in community-dwelling older people, with an emphasis on how this relationship varied across QOL domains. Methods We conducted asystematic review with meta-analysis. We searched five databases for reports of QOL in older people with frailty and included studies based on pre-defined criteria. We conducted meta-analyses comparing frail and not frail groups for each QOL scale where data were available. We compared pooled results to distribution-based and known-group differences to enhance interpretation. We summarised reported cross-sectional and longitudinal analyses. Results Twenty-two studies (24,419 participants) were included. There were medium or larger standardised mean differences for 24 of 31 QOL scales between frail and not frail groups, with worse QOL for frail groups. These scales encompassed constructs of health-related quality of life as well as psychological and subjective well-being. There were similar findings from mean difference meta-analyses and within-study analyses. Conclusions The association between frailty and lower QOL across a range of constructs is clear and often substantial. Future research should establish whether causal mechanisms link the constructs, which aspects of QOL are most important to older people with frailty, and investigate their tractability. Services focused on measuring and improving QOL for older people with frailty should be introduced.