Frailty Among Older Adults with Knee Osteoarthritis: A Scoping Review of Prevalence, Risk Factors, and Functional Outcomes
TL;DR
Frailty and pre-frailty substantially affect pain, mobility, function, and quality of life in older adults with KOA and future high-quality longitudinal and intervention research is essential to elucidate causal mechanisms and establish evidence-based frailty management strategies tailored to KOA populations.
Abstract
Background: Frailty, an age-related syndrome with reduced physiological reserve, compounds KOA-related pain, disability, and functional decline. Evidence heterogeneity limits clear understanding of relationships and optimal interventions. Objective: To synthesize evidence on frailty among older adults with knee osteoarthritis (KOA) regarding prevalence, assessment, risk factors, and functional outcomes. Methods: Scoping review following PRISMA-ScR principles. Searches of Scopus, Web of Science, and PubMed (2010–2025) showed 101 records; 10 studies met inclusion criteria (cross-sectional, longitudinal, and one randomized controlled trial). Results: Frailty prevalence ranged from 4.39% to 12.9%, while pre-frailty prevalence reached 65.6% among community-dwelling older adults with KOA. Consistent risk factors included older age, female sex, severe knee symptoms, obesity, malnutrition, comorbidities, functional impairment, depression, low physical activity, and socioeconomic disadvantage. Longitudinal evidence showed bidirectional relationships: frailty predicted worse pain trajectories, and KOA increased incident frailty. Moderate-to-vigorous physical activity was associated with better symptoms; sedentary behavior was linked to worse stiffness. Chair yoga reduced pain, particularly in frailer participants, though short-term studies did not prove significant frailty improvement. Conclusions: Frailty and pre-frailty substantially affect pain, mobility, function, and quality of life in older adults with KOA. Clinical recommendations include: 1) routine frailty screening; 2) early pre-frailty identification; 3) multidomain interventions encompassing physical activity, muscle strengthening, nutrition optimization, pain management, and psychosocial support. Future high-quality longitudinal and intervention research is essential to elucidate causal mechanisms and establish evidence-based frailty management strategies tailored to KOA populations.