Prevalence of frailty syndrome in Brazil: a systematic review

Fabrício, Daiene de Morais; Luchesi, Bruna Moretti; Alexandre, Tiago da Silva; Chagas, Marcos Hortes Nisihara

doi:10.1590/1414-462X202230040046

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REVIEW ARTICLE • Cad. saúde colet. 30 (4) • Oct-Dec 2022 • https://doi.org/10.1590/1414-462X202230040046 copy

Prevalence of frailty syndrome in Brazil: a systematic review

Prevalência da síndrome da fragilidade no Brasil: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

The population is aging rapidly, which leads to an increased prevalence of frailty syndrome. A large number of investigations on the subject have been conducted in Brazil, but no systematic review of prevalence studies involving the Brazilian population has been carried out considering the characteristics of the sample and the evaluation methods used.

Objective

To develop a systematic review of studies that assess the prevalence of frailty syndrome in Brazil, analyzing the clinical and demographic characteristics of the samples and the methods used for the diagnosis of the syndrome.

Method

The searches were carried out in the PubMed, SciELO and Web of Science databases using the following keywords: (prevalence or epidemiology) and frailty and Brazil.

Results

Forty-seven articles met the eligibility criteria and were included in the review. The prevalence of frailty ranged from 3.85% to 74.1%, depending on the assessment instrument used, context, region and population studied.

Conclusion

The prevalence data are discrepant, and the standardization of screening methods for the frailty syndrome could facilitate the comparison between studies, in order to maximize and create intervention strategies, especially in a country with cultural diversity and regional disparities, such as Brazil

Keywords:
frailty; epidemiology; aging; elderly; systematic review

Study	Sample	Participants	Design	Aim	Study city	Prevalence of frailty	Components of frailty
Abreu da Silva e D’Elboux; 2012¹⁵15 Abreu da Silva V, D’Elboux MJ. Factors associated with urinary incontinence in elderly individuals who meet frailty criteria. Texto Contexto Enferm. 2012;21(2). http://dx.doi.org/10.1590/S0104-07072012000200011. http://dx.doi.org/10.1590/S0104-07072012...	100 older adults attended a Geriatrics Outpatient Clinic	Sex:	Cross-sectional	To analyze the factors associated with urinary incontinence among elderly people who meet frailty criteria (pre-frail and frail)	Campinas (SP)	Frail: 59%	Not explored
		Female: 74%				Pre-frail: 41%
		Male: 26%
		Age: 41% with 80 years or more
		Schooling: 49% with less than 4 years of study
Alvarado et al.¹⁶16 Alvarado BE, Zunzunegui MV, Béland F, Bamvita JM. Life course social and health conditions linked to frailty in Latin American older men and women. J Gerontol A Biol Sci Med Sci. 2008;63(12):1399-406. http://dx.doi.org/10.1093/gerona/63.12.1399. PMid:19126855. http://dx.doi.org/10.1093/gerona/63.12.1...	2143 community older adults	Sex:	Cross-sectional	To check if health and social conditions are associated with frailty;	São Paulo (SP)	Frail: 40.6%	Low level of physical activity:
		Female: 58.9%		To verify if the differential exposure and/or vulnerability of women and men to life-course conditions may explain gender differences in frailty		Pre-frail: 48.8%	Women: 78.7%
		Male: 41.1%				Non-frail: 10.6%	Men: 75.1%
		Age: not explored					Muscle weakness:
		Schooling: 29.3% illiterate women and 21.1% illiterate men					Women: 51.9%
							Men: 51.0%
							Reduced walking speed:
							Women: 48.2%
							Men: 35.9%
Andrade et al.¹⁷17 Andrade JM, Duarte YADO, Alves LC, Andrade FCD, Souza PRBD Jr, Lima-Costa MF, et al. Frailty profile in Brazilian older adults: ELSI-Brazil. Rev Saude Publica. 2018;52(52 Suppl 2):17s. http://dx.doi.org/10.11606/s1518-8787.2018052000616. PMid:30379282. http://dx.doi.org/10.11606/s1518-8787.20...	8556 indivíduos com 50 anos ou mais residentes em comunidades de cinco regiões brasileiras	Sex:	Cross-sectional	To estimate the prevalence of frailty and to evaluate the associated factors in the non-institutionalized Brazilian population aged 50 years or older	Seventy cities in the five Brazilian regions	Frail: 9% (group aged 50 or over); 13.5% (group aged 60 or over) and 16.2% (group aged 65 or over)	Weight loss: 7.4% Reduced walking speed: 20.5% Muscle weakness: 22.6%
		Female: 53.4%					Fatigue: 28.6%
		Male: 46.6%					Low level of physical activity: 19.8%
		Age: 62.7 (95%CI 61.9–63.5)
		Schooling: 31.8% with up to three years of study
Closs et al.¹⁸18 Closs VE, Ziegelmann PK, Flores JHF, Gomes I, Schwanke CHA. Anthropometric Measures and Frailty Prediction in the Elderly: An Easy-to-Use Tool. Curr Gerontol Geriatr Res. 2017;2017:8703503. http://dx.doi.org/10.1155/2017/8703503. PMid:29358947. http://dx.doi.org/10.1155/2017/8703503...	439 older adults registered in a Family Health Unit	Sex:	Cross-sectional	To verify the discriminatory performance of anthropometric measures in identifying frailty in the elderly and to create an easy-to-use tool	Porto Alegre (RS)	Frail + pre-frail: 70.8%	Not explored
		Female: 63.8%				Non-frail: 29.2%
		Male: 36.2%
		Age: 68.7 (±7.2)
		Schooling: 41.7% with up to 4 years of study
Silva et al.¹⁴14 Silva SLA, Vieira RA, Arantes P, Dias RC. Assessment of frailty, functionality and fear of falling in elderly assisted at an outpatient gerontologic and geriatric clinic. Fisioter Pesqui. 2009;16(2):120-5. http://dx.doi.org/10.1590/S1809-29502009000200005. http://dx.doi.org/10.1590/S1809-29502009...	30 older adults registered at a geriatric outpatient clinic	Sex:	Cross-sectional	To determine the frequency of frailty and to search for correlations between frailty and falls, fear of falling, and functionality	Juiz de Fora (MG)	Frail: 20%	Not explored
		Female: 66.7%				Pre-frail: 46.6%
		Male: 33.3%				Non-frail: 33.4%
		Age: 75.7 (±7.6)
		Schooling: 40% with more than 4 years of study
Silva et al.¹⁹19 Silva SLA, Neri AL, Ferrioli E, Lourenço RA, Dias RC. Phenotype of frailty: the influence of each item in determining frailty in community-dwelling elderly: the Fibra Study. Cien Saude Colet. 2016;21(11):3483-92. http://dx.doi.org/10.1590/1413-812320152111.23292015. http://dx.doi.org/10.1590/1413-812320152...	5532 community older adults	Gender	Cross-sectional	To evaluate the contribution of each item to determine the frailty syndrome among elderly Brazilians	Barueri (SP), Belém (PA), Belo Horizonte (MG), Campinas (SP), Cuiabá (MT), Ermelindo Matarazzo (SP), Fortaleza (CE), Ivotí (RS), Juiz de Fora (MG), Parnaíba (PI), Poços de Caldas (MG), Recife (PE), Ribeirão Preto (SP) and Santa Cruz (RN)	Frail: 11.2%	Muscle weakness: 20.6%
		Female: 65.6%				Pre-frail: 51%	Reduced walking speed: 20.9%
		Male: 34.4%				Non-frail: 37.8%	Low level of physical activity: 27.5%
		Age: 73.1 (±6.2)
		Education: not explored
Câmara et al.²⁰20 Câmara SMA, Alvarado BE, Guralnik JM, Guerra RO, Maciel ÁCC. Using the Short Physical Performance Battery to screen for frailty in young ‐old adults with distinct socioeconomic conditions. Geriatr Gerontol Int. 2013;13(2):421-8. http://dx.doi.org/10.1111/j.1447-0594.2012.00920.x. PMid:22882512. http://dx.doi.org/10.1111/j.1447-0594.20...	64 community older adults	Sex:	Cross-sectional	To analyze the Short Physical Performance Battery’s (SPPB) ability in screening for frailty in community-dwelling young elderly from cities with distinct socioeconomic conditions	Santa Cruz (RN)	Frail: 28.1%	Muscle weakness: 48.4%
		Female: 50%				Pre-frail: 54.7%	Fatigue: 37.5%
		Male: 50%				Non-frail: 17.2%	Reduced walking speed: 65.6%
		Age: 69.53 (±2.95)
		Schooling: 40.6% illiterate
Amorim et al.²¹21 Amorim JSC, Silva SLA, Viana JU, Trelha CS. Factors associated with the prevalence of sarcopenia and frailty syndrome in elderly university workers. Arch Gerontol Geriatr. 2019;82:172-8. http://dx.doi.org/10.1016/j.archger.2019.02.002. PMid:30807901. http://dx.doi.org/10.1016/j.archger.2019...	258 elderly workers from a public university	Sex:	Cross-sectional	To estimate the prevalence of sarcopenia and frailty, and their individual and occupational factors among elderly individuals	North Paraná	Frail: 9.4%	Not explored
		Female: 42.2%				Pre-frail: 62.5%
		Male:57.8%				Non-frail: 28.1%
		Age: 62.9 (±2.47)
		Schooling: 58.5% higher education and post-graduation
Andrade et al.²²22 Andrade FB, Lebrao ML, Santos JLF, Oliveira Duarte YA. Relationship Between Oral Health and Frailty in Community ‐Dwelling Elderly Individuals in Brazil. J Am Geriatr Soc. 2013;61(5):809-14. http://dx.doi.org/10.1111/jgs.12221. PMid:23647172. http://dx.doi.org/10.1111/jgs.12221...	1374 community older adults	Sex:	Cross-sectional	To test the hypothesis that clinical oral health conditions are associated with frailty independent of socioeconomic and general health status	São Paulo (SP)	Frail: 8.5%	Not explored
		Female: 59.7%				Pre-frail: 40.7%
		Male: 40.3%				Non-frail: 50.8%
		Age: 58.4% with 60 to 69 years.
		Schooling: 41.8% with) less than 4 years of study
Morais et al.²³23 Morais D, Terassi M, Inouye K, Luchesi BM, Pavarini SCI. Chronic pain in elderly caregivers at different levels of frailty. Rev Gaúcha Enferm. 2017;37(4):e60700. http://dx.doi.org/10.1590/1983-1447.2016.04.60700. PMid:28198946. http://dx.doi.org/10.1590/1983-1447.2016...	187 elderly caregivers registered in a Family Health Unit	Sex:	Cross-sectional	To determine whether there are differences in the intensity of chronic pain of elderly caregivers who are frail, pre-frail and non-frail	São Carlos (SP)	Frail: 24.1%	Not explored
		Female: 80.7%				Pre-frail: 55.1%
		Male: 19.3%				Non-frail: 20.9%
		Age: 68.95 (±7.07)
		Schooling: 4.13 years (±3.62)
Santos Amaral et al.²⁴24 Santos Amaral FLJ, Oliveira Guerra R, Freire Falcão Nascimento A, Campos Cavalcanti Maciel À. Social support and the frailty syndrome among elderly residents in the community. Cien Saude Colet. 2013;18(6):1.	300 community older adults	Sex:	Cross-sectional	To analyze the association between social support and frailty syndrome among elderly residents in the community	Natal (RN)	Frail: 18.3%	Weight loss: 30.7%
		Female: 67.3% Male: 32.7%				Pre-frail: 54.3%	Fatigue: 38.7%
		Age: 74.3 (± 6.9)				Non-frail: 25.7%	Low level of physical activity: 26.7%
		Schooling: 4.7 years (± 3.8)
Santos Tavares et al.²⁵25 Santos Tavares DM, Nader ID, Paiva MM, Dias FA, Pegorari MS. Association of socioeconomic and clinical variables with the state of frailty among older inpatients. Rev Lat Am Enfermagem. 2015;23(6):1121-9. http://dx.doi.org/10.1590/0104-1169.0660.2657. http://dx.doi.org/10.1590/0104-1169.0660...	255 hospitalized older adults	Sex:	Cross-sectional	To identify the prevalence of frailty among hospitalized elderly people in a Clinic Hospital and to verify the association between socioeconomic and clinical characteristics with the state of frailty	Uberaba (MG).	Frail: 26.3%	Not explored
		Female: 38.8%				Pre-frail: 53.3%
		Male: 61.2%				Non-frail: 23.4%
		Age: 68.7 (±6.6)
		Schooling: 56.3% with between 1-4 years of study
Santos Tavares et al.²⁶26 Santos Tavares DM, Freitas Corrêa TA, Dias FA, Santos Ferreira PC, Pegorari MS. Frailty syndrome and socioeconomic and health characteristics among older adults. Colomb Med (Cali). 2017;48(3):126-31. http://dx.doi.org/10.25100/cm.v48i3.1978. PMid:29213155. http://dx.doi.org/10.25100/cm.v48i3.1978...	1609 community older adults	Sex:	Cross-sectional	To investigate the association between the frailty syndrome and socioeconomic and health variables	Uberaba (MG)	Frail: 13.6%	Not explored
		Female: 64.4%				Pre-frail: 51.9%
		Male: 35.6%				Non-frail: 34.4%
		Age: 44% with between 70 and 79 years old
		Schooling: 52% with 1 to 4 years of study
Assis Faria²⁷27 Assis Faria C, Lourenco RA, Ribeiro PCC, Lopes CS. Cognitive performance and frailty in older adults clients of a private health care plan. Rev Saude Publica. 2013;47(5):923-30. PMid:24626497.	847 older adults clients of a private health care plan	Sex:	Cross-sectional	To investigate the association between frailty syndrome and	Rio de Janeiro (RJ)	Frail: 9.2%	Not explored
		Female: 66.9% Male: 33.1%		cognitive performance in older adults and the effect of schooling and age on this association		Pre-frail: 46.5%
		Age: 76.7				Non-frail: 44.3%
		Schooling:
		31.8% with 9 to 12 years of study
Ferreira et al.²⁸28 Ferreira LMBM, Jerez-Roig J, Andrade FLJP, Oliveira NPD, Araújo JRT, Lima KC. Prevalence of falls and evaluation of mobility among institutionalized elderly persons. Rev Bras Geriatr Gerontol. 2016;19(6):995-1003. http://dx.doi.org/10.1590/1981-22562016019.160034. http://dx.doi.org/10.1590/1981-225620160...	63 institutionalized older adults	Sex:	Cross-sectional	To estimate the prevalence of falls in elderly residents in 10 long-stay institutions registered in the Health Surveillance, as well as to establish associations between elderly mobility and falls	Natal (RN)	Frail + pre-frail: 85.71%	Not explored
		Female: 79.4%				Non-frail: 14.28%
		Male: 20.6%
		Age: median of 79 years
		Schooling: 55.5% illiterate
Gross et al.²⁹29 Gross CB, Kolankiewicz ACB, Schmidt CR, Berlezi EM. Níveis de fragilidade de idosos e sua associação com as características sociodemográficas. Acta Paul Enferm. 2018;31(2):209-16. http://dx.doi.org/10.1590/1982-0194201800030. http://dx.doi.org/10.1590/1982-019420180...	555 older adults registered in Family Health Units	Sex:	Cross-sectional	Verify the association between frailty in the elderly and sociodemographic characteristics	Northwest of the State of Rio Grande do Sul	Frail: 17.7%	Fatigue: 31.89%
		Female: 60.9%				Pre-frail: 45.4%	The prevalence of the other components ranged from 14.9% (weight loss) to 18% (muscle weakness)
		Male:39.1%				Non-frail: 36.9%
		Age: 71.1(±8.3)
		Schooling: 65% have not completed elementary school
Reis et al.³⁰30 Reis WM Jr, Carneiro JAO, Silva Coqueiro R, Santos KT, Fernandes MH. Pre-frailty and frailty of elderly residents in a municipality with a low Human Development Index. Rev Lat Am Enfermagem. 2014;22(4):654-61. http://dx.doi.org/10.1590/0104-1169.3538.2464. http://dx.doi.org/10.1590/0104-1169.3538...	236 community older adults	Sex:	Cross-sectional	To identify the prevalence and factors associated with the pre-frailty and frailty of the elderly living in a community with a low Human Development Index (HDI)	Lafaiete Coutinho (BA)	Frail: 23.8%	Not explored
		Female: 58.9%				Pre-frail: 57.8%
		Male: 41.1%				Non-frail: 18.4%
		Age: 69.5% with 60-79 years
		Schooling: 68.2% could not read and write a message
Liberalesso et al.³¹31 Liberalesso MTE, Dallazen F, Bandeira VAC, Berlezi EM. Prevalence of frailty in a long-lived population in the Southern region of Brazil. Saúde Debate. 2017;41(113):30. http://dx.doi.org/10.1590/0103-1104201711316. http://dx.doi.org/10.1590/0103-110420171...	69 octogenarians, nonagenarians and centenarians community older adults	Sex:	Cross-sectional	To investigate the prevalence of frailty in a long-lived population	Erval Seco (RS)	Frail: 58%	Reduced walking speed: 100%
		Female: 62.3%				Pre-frail: 42%	Weight loss: 66.7%
		Male: 37.7%					Fatigue: 65.2%
		Age: 85.0 (±5.6)					Low level of physical activity: 23.2%
		Schooling: 73.9% with more than 8 years of study					Muscle weakness: 4.3%
Mello et al.³²32 Mello ADC, Carvalho MS, Alves LC, Gomes VP, Engstrom EM. Food consumption and anthropometry related to the frailty syndrome in low-income community-living elderly in a large city. Cad Saude Publica. 2017;33(8):e00188815. http://dx.doi.org/10.1590/0102-311x00188815. PMid:28832786. http://dx.doi.org/10.1590/0102-311x00188...	137 community older adults	Sex:	Cross-sectional	To describe anthropometric and feeding data related to frailty syndrome in the elderly	Manguinhos (RJ)	Frail: 12.4%	Muscle weakness: 23.4%
		Female: 67.9%				Pre-frail: 61.3%	Fatigue: 33.6%
		Male: 32.1%				Non-frail: 26.3%	Weight loss: 21.2%
		Age: 70.2 (±7.4)
		Schooling: 58.4% with 1 to 7 years
Moreira e Lourenço³³33 Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study. Clinics (São Paulo). 2013;68(7):979-85. http://dx.doi.org/10.6061/clinics/2013(07)15. PMid:23917663. http://dx.doi.org/10.6061/clinics/2013(0...	754 community older adults	Sex:	Cross-sectional	To determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities	Rio de Janeiro (RJ)	Frail: 9.1%	Weight loss: 30.2%
		Female: 66.9%				Pre-frail: 47.3%	Muscle weakness: 24.1%
		Male: 33.1%				Non-frail: 43.6%
		Age: 76.6 (±6.9)
		Schooling: 10.02 years (±5)
Nóbrega et al.³⁴34 Nóbrega PVDN, Maciel ÁCC, De Almeida Holanda CM, Oliveira Guerra R, Araújo JF. Sleep and frailty syndrome in elderly residents of long ‐stay institutions: a cross ‐sectional study. Geriatr Gerontol Int. 2014;14(3):605-12. http://dx.doi.org/10.1111/ggi.12144. PMid:24020502. http://dx.doi.org/10.1111/ggi.12144...	69 institutionalized older adults	Sex:	Cross-sectional	To evaluate the relationship between sleep and frailty syndrome in residents of long-stay institutions	João Pessoa (PB)	Frail: 49.3%	Not explored
		Female: 62.3%				Pre-frail: 45%
		Male: 37.7%				Non-frail: 5.7%
		Age: 77.5 (±7.8)
		Schooling:
		4.6 years (±4.3)
Pegorari et al.³⁵35 Pegorari MS, Ruas G, Patrizzi LJ. Relationship between frailty and respiratory function in the community-dwelling elderly. Braz J Phys Ther. 2013;17(1):9-16. http://dx.doi.org/10.1590/S1413-35552012005000065. PMid:23538454. http://dx.doi.org/10.1590/S1413-35552012...	51 older adults registered in the Family Health Unit	Sex:	Cross-sectional	To evaluate the impact of frailty on respiratory function in a community-dwelling elderly.	Uberaba (MG)	Frail: 9.8%	Weigh loss: 31.4%
		Female: 43.3%				Pre-frail: 47.1%	Reduced walking speed: 23.5%
		Male: 56.7%				Non-frail: 43.1%	Low level of physical activity: 19.6%
		Age: 73 (±6)
		Schooling:
		74.5% primary level
Ramos Oliveira et al.³⁶36 Ramos Oliveira D, Bettinelli LA, Pasqualotti A, Corso D, Brock F, Erdmann AL. Prevalence of frailty syndrome in old people in a hospital institution. Rev Latino-Am Enferm. 2013;21(4):1.	99 institutionalized older adults	Sex:	Cross-sectional	To measure the prevalence of the frailty syndrome in the elderly in a hospital, regarding socio-demographic, clinical and anthropometric variables	São Vicente (SP)	Frail: 46.5%	Frail:
		Female: 50.5%				Pre-frail: 49.5%	Low level of physical activity: 77.8%
		Male: 45.5%				Non-frail: 4%	Reduced walking speed: 77.5%
		Age: 74.5 (±6.8)					Pre-frail:
		Schooling: 5.2 years (±4.5)					Muscle weakness: 44.3%
							Fatigue: 34.5%
Santos et al.³⁷37 Santos PHS, Fernandes MH, Casotti CA, Silva Coqueiro R, Carneiro JAO. The profile of fragility and associated factors among the elderly registered in a Family Health Unit. Cien Saude Colet. 2015;20(6):1917-24. http://dx.doi.org/10.1590/1413-81232015206.17232014. PMid:26060970. http://dx.doi.org/10.1590/1413-812320152...	139 older adults registered in the Family Health Unit	Gender:	Cross-sectional	To identify the profile of fragility and associated factors among the elderly registered in a Family Health Unit	Jequié (BA)	Frail: 16.9%	Not explored
		Female: 75.5%				Pre-frail: 61.8%
		Male: 24.5%				Non-frail: 21.3%
		Age: 72,32 (±8.4)
		Schooling: 73.1% illiterate or did not finish high school
Santos-Orlandi et al.³⁸38 Santos-Orlandi AA, Brito TRP, Ottaviani AC, Rossetti ES, Zazzetta MS, Pavarini SCI. Elderly who take care of elderly: a study on the Frailty Syndrome. Rev Bras Enferm. 2017;70(4):822-9. http://dx.doi.org/10.1590/0034-7167-2016-0474. PMid:28793114. http://dx.doi.org/10.1590/0034-7167-2016...	40 elderly caregivers of other elderly and registered in a Family Health Unit	Sex:	Cross-sectional	To identify the prevalence of frailty in elderly caregivers inserted in a context of high social vulnerability and its correlation with sociodemographic and health aspects	São Carlos (SP)	Frail: 10.0%	Not explored
		Female: 67.5%				Pre-frail: 50.0%
		Male: 32.5%				Non-frail: 40.0%
		Age: 70.1 (±8.2)
		Schooling: 40% with 1-4 years of with 1-4 years of study
Tribess e Oliveira³⁹39 Tribess S, Oliveira RJ. Physical activity as a predictor of absence of frailty in the elderly. Rev Assoc Med Bras. 2012;58(3):341-7. PMid:22735227.	622 community older adults	Sex:	Cross-sectional	To analyze the predictive power and identify the cutoffs of physical activity, in its different domains, for the absence of frailty in the elderly of both gender	Uberaba (MG)	Frail: 19.9%	Not explored
		Female: 65%				Non-frail: 80.1%
		Male: 35%
		Age: 71.1 (±7.8)
		Schooling: 40.3% had up to 2 years of study
Viana et al.⁴⁰40 Viana JU, Silva SL, Torres JL, Dias J, 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. 2013;17(4):373-81. http://dx.doi.org/10.1590/S1413-35552013005000102. PMid:23970115. http://dx.doi.org/10.1590/S1413-35552013...	53 older adults users of a health service	Sex:	Cross-sectional	To evaluate whether the indirect indicators of sarcopenia and functionality influence the frailty profile in elderly subjects	Belo Horizonte (MG)	Frail: 15.1%	Low level of physical activity: 41.5%
		Female: 75%				Pre-frail: 54.7%	Reduced walking speed: 39.6%
		Male: 25%				Non-frail: 30.2%
		Age: 76.72 (±5.89)
		Schooling: not explored
Virtuoso et al.⁴¹41 Virtuoso JS Jr, Martins CA, Roza LB, de Paulo TRS, Ribeiro MCL, Tribess S. Prevalence of disability and associated factors in the elderly. Texto Contexto Enferm. 2015;24(2):521-9. http://dx.doi.org/10.1590/0104-07072015001652014. http://dx.doi.org/10.1590/0104-070720150...	624 community older adults	Sex:	Cross-sectional	To estimate the prevalence and factors associated with functional disability in the elderly people	Uberaba (MG)	Frail: 37.1%	Not explored
		Female: 65.1%				Pre-frail: 16.8%
		Male: 34.9%				Non-frail: 6.4%
		Age: 71 (±7.77)
		Schooling:
		40,3% had a maximum of two years of study
Zazzetta et al.⁴²42 Zazzetta MS, Gomes GAO, Orlandi FS, Gratão AC, Vasilceac FA, Gramani-Say K, et al. Identifying frailty levels and associated factors in a population living in the context of poverty and social vulnerability. J Frailty Aging. 2017;6(1):29-32. http://dx.doi.org/10.14283/jfa.2016.116. PMid:28244555. http://dx.doi.org/10.14283/jfa.2016.116...	304 community older adults	Sex:	Cross-sectional	To investigate a vulnerable population living in the context of poverty in a Brazilian municipality, in order to identify the factors associated with the frailty syndrome in the elderly	São Carlos (SP)	Frail: 27.3%	Not explored
		Female: 56.9%				Pre-frail: 60.5%
		Male: 43.1%				Non-frail: 12.2%.
		Age: 70.1 (±7.6)
		Schooling: 2.5 years (±2.6)
Zeballos et al.⁴³43 Zeballos D, Lins L, Brites C. Frailty and Its Association with Health Related Quality of Life in Older HIV Patients, in Salvador, Brazil. AIDS Res Hum Retroviruses. 2019;35(11-12):1074-81. http://dx.doi.org/10.1089/aid.2019.0103. PMid:31373215. http://dx.doi.org/10.1089/aid.2019.0103...	201 individuals living with HIV, aged 50 years or	Sex:	Cross-sectional	To determine the prevalence and factors associated with frailty and to define the impact of frailty on quality of life	Salvador (BA)	Frail: 19.4%	Most common
	older at University	Female: 63.7%				Pre-frail: 49.3%	low physical activity: 38.8%
	Hospital Professor Edgard Santos (HUPES)	Male: 36.3%				Non-frail: 31.3%	Fatigue: 34.8% and Muscle weakness: 32.3%
		Age: 55.0 (range 50 to 83 years)
		Schooling:51.7% with higher education
Zukeran et al.⁴⁴44 Zukeran MS, Ritti-Dias RM, Franco FGM, Cendoroglo MS, Matos LDN, Ribeiro SL. Nutritional Risk by Mini Nutritional Assessment (MNA), but not anthropometric measurements, has a good discriminatory power for identifying frailty in elderly people: data from brazilian secondary care clinic. J Nutr Health Aging. 2019;23(2):217-20. http://dx.doi.org/10.1007/s12603-018-1128-z. PMid:30697634. http://dx.doi.org/10.1007/s12603-018-112...	254 older adults from a geriatric secondary care outpatient clinic	Sex:	Cross-sectional	To investigate, in elderly individuals registered at a secondary outpatient clinic, the prevalence of frailty and pre-frailty and to identify the discriminatory power of anthropometric measurements and nutritional risk in identifying these conditions	Southeast of São Paulo	Frail: 31.1%	Not explored
		Female: 70%				Pre-frail: 53.5%
		Male: 30%				Non-frail: 15.4%
		Age: Non-frail: 73.6 (±5.7); Pre-frail: 75.3 (±7.2); Frail: 78.9 (±7.6)
		Schooling: Not explored

Study	Sample	Participants	Design	Aim	Study city	Instrument used for screening frailty	Prevalence of frailty	Components of frailty
Almeida Carneiro et al.⁴⁵45 Almeida Carneiro J, Rodrigues Cardoso R, Silva Durães M, Guedes MCA, Santos FL, Costa FM, et al. Frailty in the elderly: prevalence and associated factors. Rev Bras Enferm. 2017;70(4):747-52. http://dx.doi.org/10.1590/0034-7167-2016-0633. PMid:28793104. http://dx.doi.org/10.1590/0034-7167-2016...	511 community older adults	Sex:	Cross-sectional	To verify the prevalence and factors associated with frailty in non-institutionalized elderly people	Minas Gerais (MG)	EFS	Frail: 41.3% (severe, moderate or mild)	Not explored
		Female: 64.0%
		Male: 36.0%
		Age: 74 (±7.14)
		Schooling: 80.4%
		with up to 4 years
Aprahamian et al.⁴⁶46 Aprahamian I, Castro Cezar NO, Izbicki R, Lin SM, Paulo DLV, Fattori A, et al. Screening for frailty with the FRAIL Scale: A comparison with the phenotype criteria. J Am Med Dir Assoc. 2017;18(7):592-6. http://dx.doi.org/10.1016/j.jamda.2017.01.009. PMid:28279607. http://dx.doi.org/10.1016/j.jamda.2017.0...	124 older adults attended two university-based geriatric outpatient units	Sex:	Cross-sectional	To investigate the diagnostic accuracy of the Brazilian version of the Frailty Scale with the CHS frailty phenotype in a sample derived from 2 geriatric outpatient units	São Paulo (SP) and Campinas (SP)	Frailty Scale + CHS (Fried et al. 2001)	FRAIL-BR:	Not explored
		Female: 83%					Frail: 23.3%
		Male: 17%					Non-frail: 20.16%
		Age: 78.6 (±7.1)					Fried et al, 2001:
		Schooling: 7.7 years (±5.2)					Frail: 14.3%
							Non-frail: 24.19%
Cezar et al.⁴⁷47 Cezar NO, Izbicki R, Cardoso D, Almeida JG, Valiengo L, Camargo MVZ, et al. Frailty in older adults with amnestic mild cognitive impairment as a result of Alzheimer’s disease: a comparison of two models of frailty characterization. Geriatr Gerontol Int. 2017;17(11):2096-102. http://dx.doi.org/10.1111/ggi.13028. PMid:28488297. http://dx.doi.org/10.1111/ggi.13028...	66 older adults (40 with MCI and 26 healthy) from a Psychogeriatric Outpatient Clinic	Sex:	Cross-sectional	To verify the prevalence and the presence of markers of frailty and its relation with the cognitive function among the elderly with amnestic MCI	São Paulo (SP)	CHS (Fried et al 2001) + EFS	CHS – MCI group:	Not explored
		Female: 85% MCI group and 73.0% healthy group					Frail: 30%
		Male: 15% MCI group and 26.9% healthy group					Pre-frail: 70%
		Age: MCI group: 77.0 (±5.6) Healthy group: 75.3 (±4.6)					Non-frail: 0%
		Schooling: MCI group: 9.7 years (±5.3). Healthy group: 11.9 years (±4.7)					CHS – Control group:
							Frail: 26.93%
							Pre-frail: 65.38%
							Non-frail: 7.69%
							EFS – MCI group:
							Frail: 7,5%
							Pre-frail: 62.5%
							Non-frail: 30%
							EFS – Control group:
							Frail: 3.85%
							Pre-frail: 34.61%
							Non-frail: 61.54%
Costa Souto Duarte et al.⁴⁸48 Costa Souto Duarte M, Melo Fernandes MDG, Partezani Rodrigues RA, Lima da Nóbrega MM. Prevalence and sociodemographic factors associated with frailty in elderly women. Rev Bras Enferm. 2013;66(6):901-6. http://dx.doi.org/10.1590/S0034-71672013000600014. PMid:24488463. http://dx.doi.org/10.1590/S0034-71672013...	166 elderly women in the community	Sex: 100% female	Cross-sectional	To estimate the prevalence of frailty in elderly women;	João Pessoa (PB)	EFS	Frail: 39.1% (7.8% severe frailty, 7.8% moderate frailty, 23.5% light frailty)	Not explored
		Age: 73.2 (±8.9)		To identify possible associations between frailty and sociodemographic variables			Apparently vulnerable: 21.7%
		Schooling: 6.5 years (±6.1)					Non-frail: 39.2%
Llano et al.⁴⁹49 Llano PMP, Lange C, Nunes DP, Pastores CA, Pinto AH, Casagranda LP. Frailty in rural older adults: development of a care algorithm. Acta Paul Enferm. 2017;30(5):520-30. http://dx.doi.org/10.1590/1982-0194201700075. http://dx.doi.org/10.1590/1982-019420170...	820 older adults registered in Family Health Units in rural areas	Sex:	Cross-sectional	To present an algorithm of care for frailty syndrome in the elderly	Pelotas (RS)	Self-reported instrument of Nunes et al.	Frail: 43.4%	Not explored
		Female: 56.1%					Pre-frail: 37%
		Male: 43.9%					Non-frail: 19.5%
		Age: 54.9% with 60-69 years
		Schooling: 52.7% with more than 3 years
Souza Orlandi e Dutra Gesualdo⁵⁰50 Souza Orlandi F, Dutra Gesualdo G. Assessment of the frailty level of elderly people with chronic kidney disease undergoing hemodialysis. Acta Paul Enferm. 2014;27(1):29-34. http://dx.doi.org/10.1590/1982-0194201400007. http://dx.doi.org/10.1590/1982-019420140...	60 participants in a Renal Replacement Therapy Unit	Sex:	Cross-sectional	To assess the level of the frailty of chronic renal disease patients undergoing Hemodialysis treatment	State of Sao Paulo, southeast region of Brazil	EFS	Frail: 38.3% (5% severe frailty, 13.3% moderate frailty, 20% light frailty)	Not explored
		Female: 30%					Apparently vulnerable: 26.7%
		Male: 70%					Non-frail: 35%
		Age: 71.1 (±6.9)
		Schooling:
		36.7% with 1-4 years
Farías-Antúnez et al.⁵¹51 Farías-Antúnez S, Fassa AG. Prevalência e fatores associados à fragilidade em população idosa do Sul do Brasil, 2014. Epidemiol Serv Saude. 2019;28(1):e2017405. http://dx.doi.org/10.5123/S1679-49742019000100008. PMid:30916238. http://dx.doi.org/10.5123/S1679-49742019...	1399 community older adults	Sex:	Cross-sectional	To analyze the prevalence and factors associated with frailty in the elderly in the city of Pelotas, RS, Brazil, in 2014	Pelotas (RS)	EFS	Non-frail: 69.5%	Not explored
		Female: 36.8%					Vulnerable: 16.7%
		Male: 63.2%					Mild frailty: 8.6%
		Age: 28.3% had ≥75 years					Moderate frailty: 4%
		Schooling: 31% had 4 to 7 years of study					Severe frailty: 1.2%
Fhon et al.⁵²52 Fhon JRS, Rosset I, Freitas CP, Silva AO, Santos JLF, Rodrigues RAP. Prevalence of falls among frail elderly adults. Rev Saude Publica. 2013;47(2):266-73. http://dx.doi.org/10.1590/S0034-8910.2013047003468. PMid:24037353. http://dx.doi.org/10.1590/S0034-8910.201...	240 community older adults	Sex:	Cross-sectional	To analyze the prevalence of falls in frail elderly, their consequences and associated demographic factors	Ribeirão Preto (SP)	EFS	Frail: 39.2% (9.6% severe frailty, 11.3% moderate frailty, 18.3% light frailty)	Not explored
		Female: 62.9%					Apparently vulnerable: 24.6%
		Male: 37.1%					Non-frail: 36.3%
		Age: 73.5 (±8.4)
		Schooling:
		5.4 years (±5.0)
Grden et al.⁵³53 Grden CRB, Barreto MFC, Sousa JAV, Chuertniek JA, Reche PM, Borges PKO. Association between physical frailty and cognitive scores in older adults. Rev Rene. 2016;16(3). http://dx.doi.org/10.15253/2175-6783.2015000300012. http://dx.doi.org/10.15253/2175-6783.201...	100 community older adults	Sex:	Cross-sectional	To investigate the association between physical frailty and cognitive scores in older adults at an Open University of the Third Age in Southern Brazil	Ponta Grossa (PR)	EFS	Moderate frailty: 3%	Not explored
		Female: 93.0%					Apparently vulnerable: 16%
		Male: 7.0%					Non-frail: 81%
		Age: 60-65 years (59%)
		Schooling: 43% with 11-15 years
Lira Borges et al.⁵⁴54 Lira Borges C, Silva MJ, Bezerra Clares JW, Peixoto Bessa ME, De Freitas MC. Frailty assessment of institutionalized elderly. Acta Paul Enferm. 2013;26(4). http://dx.doi.org/10.1590/S0103-21002013000400004. http://dx.doi.org/10.1590/S0103-21002013...	54 institutionalized older adults	Sex:	Cross-sectional	To evaluate the presence of frailty and its relation with sociodemographic and clinical characteristics in a group of institutionalized elderly	Fortaleza (CE)	EFS	Frail: 74.1% (37.5% light frailty, 35% moderate frailty and 27.5% severe frailty)	Not explored
		Female: 38.9%					Apparently vulnerable: 22.2%
		Male: 61.1%					Non-frail: 3.7%
		Age: 42.6% with 80 years or more
		Schooling: 46.3% illiterate and 46.3% with up to 8 years
Lima Fernandes et al.⁵⁵55 Lima Fernandes HDC, Correia Gaspar J, Hitomi Yamashita C, Amendola F, Alvarenga MRM, de Campos Oliveira MA. Frailty assessment in the elderly assisted at a Family health unit. Texto Contexto Enferm. 2013;22(2). http://dx.doi.org/10.1590/S0104-07072013000200019. http://dx.doi.org/10.1590/S0104-07072013...	128 older adults registered in a Family Health Unit	Sex:	Cross-sectional	To verify the presence of frailty in a group of elderly people registered in a Health Unit, through the application of the Edmonton Frail Scale, and the applicability of this scale in Primary Care	Embu (SP)	EFS	Only 103 elderly people who answered all the questions on the scale had the degree of frailty assessed. Of these:	Not explored
		Female: 67.2%					Frail: 30.1% (light, moderate and severe)
		Male: 32.8%					Apparently vulnerable: 21.4%
		Age: 68.9 (±7.8)					The 25 who failed to answer any question were vulnerable to frailty
		Schooling:
		56.3% did not complete primary school
Mansur et al.⁵⁶56 Mansur HN, Damasceno VDO, Bastos MG. Prevalence of frailty in patients in chronic kidney disease on conservative treatment and on dialysis. J Bras Nefrol. 2012;34(2):153-60. http://dx.doi.org/10.1590/S0101-28002012000200008. PMid:22850917. http://dx.doi.org/10.1590/S0101-28002012...	146 patients (86 on conservative treatment, 37 on hemodialysis and 23 on peritoneal dialysis)	Sex:	Cross-sectional	To evaluate the prevalence of frailty and associated factors in patients with chronic renal disease in conservative treatment, hemodialysis and peritoneal dialysis	Juiz de Fora (MG)	Johansen et al. 2007	Frail: 38.4%.	Low level of physical activity among the pre-frail (83.6%) and muscle weakness among the frail (100%)
		Female: 49.3%					Pre-frail: 39.7%
		Male: 50.7%					Non-frail: 21.9%
		Age: 57.7 (±13.1) Schooling:
		not explored
Mansur et al.⁵⁷57 Mansur HN, Lovisi JCM, Colugnati FAB, Raposo NRB, Silva Fernandes NM, Bastos MG. Association of frailty with endothelial dysfunction and its possible impact on negative outcomes in Brazilian predialysis patients with chronic kidney disease. BMC Nephrol. 2015;16(1):157. http://dx.doi.org/10.1186/s12882-015-0150-1. PMid:26395776. http://dx.doi.org/10.1186/s12882-015-015...	57 pre-dialysis patients from a Federal University outpatient clinic	Sex:	Longitudinal	To evaluate the relationship between frailty and endothelial dysfunction in Brazilian pre-dialysis patients with chronic renal disease, and to evaluate the impact of frailty on all causes of mortality and the need for renal replacement therapy	Juiz de Fora (MG)	Johansen et al. 2007	Frail: 42.6% (46% of these cases occurred among non-elderly patients)	Not explored
		Female: 41%
		Male: 59%
		Age: 60 (±11,5)
		Schooling:
		not explored
Mori Lin et al.⁵⁸58 Mori Lin S, Aliberti MJR, Fortes-Filho SQ, Araújo Melo J, Aprahamian I, Suemoto CK, et al. Comparison of 3 frailty instruments in a geriatric acute care setting in a low-middle income country. J Am Med Dir Assoc. 2018 Apr;19(4):310-314.e3. http://dx.doi.org/10.1016/j.jamda.2017.10.017. PMid:29289543. http://dx.doi.org/10.1016/j.jamda.2017.1...	534 older adults admitted to a Geriatric Day Hospital	Sex	Prospective cohort	To compare the performance of three frequently used frailty instruments in the prediction of adverse outcomes in a 1-year follow-up among elderly initially admitted to an intensive care setting in low-income countries	São Paulo (SP)	Fried et al. (5 components)	Fried et al:	Not explored
		Female: 63.5%				SOF (3 components)	Frail: 51%
		Male: 36,5%				Frail Scale (5 components)	SOF:
		Age: 79.6 (±8.4)					Frail: 38%
		Schooling: 5.3 years (±4.7)					Frail Scale:
							Frail: 37%
Ramos et al.⁵⁹59 Ramos GCF, Carneiro JA, Barbosa ATF, Mendonça JMG, Caldeira AP. Prevalence of depressive symptoms and associated factors among elderly in northern Minas Gerais: a population-based study. J Bras Psiquiatr. 2015;64(2):122-31. http://dx.doi.org/10.1590/0047-2085000000067. http://dx.doi.org/10.1590/0047-208500000...	639 community older adults	Sex:	Cross-sectional	To evaluate the prevalence and factors associated with depressive symptoms in community-based elderly	Montes Claros (MG)	EFS	Frail: 33.6%	Not explored
		Female: 64%					Non-frail: 66.4%
		Male: 36%
		Age: 70.6 (±7.8)
		Schooling:
		3.7 years
Santiago e Mattos⁶⁰60 Santiago LM, Mattos IE. Prevalence and factors associated to frailty in institutionalized elderly of Southeastern and Middle-Western Brazil. Rev Bras Geriatr Gerontol. 2014;17(2):327-37. http://dx.doi.org/10.1590/S1809-98232014000200010. http://dx.doi.org/10.1590/S1809-98232014...	442 institutionalized older adults	Sex:	Cross-sectional	To estimate the prevalence of frailty and to identify factors associated with frailty in individuals living in long-term institutions for the elderly	Rio de Janeiro (RJ), Juiz de Fora (MG), Campo Grande (MS) and Cuiabá (MT).	Tilburg Frailty Indicator	Frail: 52%	The mean score was higher in the physical domain: 2.8 (1.7) and psychological: 1.3 (0.9)
		Female: 31.9%				Frail>=5
		Male: 68.1%				Physical component: 0-8
		Age: 75.0 (±9.9)
		Schooling:
		68.5% literate

Instituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de Janeiro Avenida Horácio Macedo, S/N, CEP: 21941-598, Tel.: (55 21) 3938 9494 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@iesc.ufrj.br

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[1] Correspondence: Daiene de Morais Fabrício. E-mail: daienemorais1@gmail.com