Prevalence of Frailty in Nursing Homes
Approximately 50-60% of nursing home residents are frail, with an additional 20-40% being prefrail, meaning that roughly 90% of the nursing home population demonstrates some degree of frailty.
Evidence-Based Prevalence Estimates
Overall Frailty Rates
The pooled prevalence of frailty in nursing homes is 52.3% (95% CI: 37.9%-66.5%), based on a systematic review and meta-analysis of 9 studies including 1,373 nursing home patients 1
An additional 40.2% (95% CI: 28.9%-52.1%) of nursing home residents are prefrail, representing those at high risk for progression to frailty 1
Individual studies show frailty prevalence ranging from 19.0% to 75.6%, with this wide variation reflecting differences in measurement tools and population characteristics 1
Physical Frailty Specifically
Around 60% of older nursing home residents are physically frail during their first 6 months of residence, based on analysis of 571,139 US Medicare/Medicaid-certified nursing home residents 2
When using multidimensional frailty assessment (MPI), the prevalence in nursing homes reaches 51.5%, which is substantially higher than population-based settings (13.3%) 3
Clinical Context and Assumptions
Multiple deprescribing guidelines (NORGEP_NH, STOPP NH) explicitly define all nursing home residents as frail populations, reflecting the clinical consensus that nursing home placement itself indicates significant frailty 4
The American Heart Association states that "frailty is common in SNF residents" and notes that approximately 20% have a diagnosis of heart failure, with almost 70% having ≥3 noncardiac comorbidities 4
Important Clinical Considerations
Dynamic Nature of Frailty
Frailty status can change over time: Among prefrail residents at admission, 23% improved to robust status by 3 months, while others worsened 2
Both improvement and worsening across frailty levels are observed, indicating that frailty is not necessarily a fixed state in nursing homes 2
Association with Cognitive Impairment
Over 70% of nursing home residents with cognitive impairment are also physically frail 2
Residents with moderate cognitive impairment are 35% more likely (aOR: 1.35) and those with severe impairment are 74% more likely (aOR: 1.74) to be frail compared to those with none/mild impairment 2
Common Pitfalls
Assuming all nursing home residents are equally frail: While the majority are frail or prefrail, approximately 10% may still be robust, particularly early in their stay 1, 2
Failing to reassess frailty status: Given that frailty can improve or worsen, initial assessments should not be considered permanent 2
Using different frailty definitions without recognizing measurement variability: The wide range in reported prevalence (19-75.6%) reflects heterogeneity in assessment tools, making direct comparisons challenging 1