Impact of Frailty on Activities of Daily Living in Hospitalized Older Adults: A Systematic Review and Meta‐Analysis

Vollständiger Abstract

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ABSTRACT Aim To determine whether frailty is associated with activities of daily living (ADL) and other clinical outcomes in hospitalized older adults. Methods MEDLINE, Embase and CENTRAL were searched for English‐language cohort studies published from 1 January 2001 to 23 October 2025. Eligible studies included hospitalized adults aged ≥ 65 years (or samples with ≥ 80% aged ≥ 65 years), used a defined frailty measure and compared frail with non‐frail participants. Two reviewers independently selected studies, extracted data and assessed risk of bias using the Quality In Prognosis Studies tool. Random‐effects meta‐analyses generated standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results Fifty‐seven cohort studies were included. Frailty was associated with worse ADL status (SMD −1.04, 95% CI −1.89 to −0.20), higher mortality (RR 2.26, 95% CI 1.86–2.76), lower likelihood of discharge home (RR 0.79, 95% CI 0.73–0.86), and higher 30‐day (RR 1.47, 95% CI 1.13–1.90) and 90‐day readmission risks (RR 1.75, 95% CI 1.07–2.86). Pneumonia risk was not statistically significant. Heterogeneity was substantial to considerable for all pooled outcomes. Conclusions Frailty identifies hospitalized older adults at increased risk of functional dependence, mortality, non‐home discharge, and readmission. Substantial heterogeneity and residual confounding warrant cautious interpretation and support standardized frailty and functional‐outcome assessment.