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Peer-reviewedCC BYHealthcare (Basel, Switzerland)

Multidimensional Factors and Predictors of Vulnerability and Frailty in Older Adults: A Systematic Review.

  • Helder Pino1,2
  • Ana Ramos1,3
  • Cesar Fonseca1,4
  • Elisabete Alves1,4
  • Anabela Coelho1,4,5
5 affiliations
  1. 1Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal.
  2. 2Unidade Local de Saúde do Algarve (ULS Algarve), 8000-386 Faro, Portugal.
  3. 3Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem da Universidade de Lisboa, 1600-096 Lisbon, Portugal.
  4. 4Escola Superior de Enfermagem São João de Deus, Universidade de Évora, 7000-811 Évora, Portugal.
  5. 5Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, 1099-085 Lisbon, Portugal.
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Abstract

Background

Population ageing is characterized by rising multimorbidity and multifaceted vulnerability. While vulnerability is inherently a biopsychosocial state, clinical research predominantly operationalizes risk through physical frailty phenotypes, constraining holistic geriatric care. Identifying the interplay across biological, functional, and psychosocial domains is essential for comprehensive risk evaluation.Objectives

To synthesize multidimensional factors associated with vulnerability and frailty in adults aged ≥65, categorizing cross-sectional correlates and prospective longitudinal predictors to inform multidimensional assessment.Methods

Following PRISMA 2020 guidelines, systematic searches were conducted across PubMed, CINAHL, Scopus, Web of Science, and Google Scholar (2020-2025). Independent reviewers performed screening, selection, extraction, and Joanna Briggs Institute (JBI) critical appraisal (PROSPERO: CRD420251039796).Results

Forty studies (22 cross-sectional, 17 cohort, 1 quasi-experimental) comprising 77,229 cumulative participant observations across community, outpatient, inpatient, and residential care settings were synthesized. Thirty-seven candidate determinants were mapped across five domains: biological/clinical, psychological, socioeconomic/relational, lifestyle, and self-care profile. Advanced age, multimorbidity, and polypharmacy were the most frequent clinical factors; prospective cohorts specifically linked high anticholinergic burden and functional dependence in complex activities to incident frailty. Depressive symptoms, cognitive decline, low education, financial strain, and social isolation consistently delineated vulnerable states.Conclusions

Vulnerability in older adults is a multifaceted construct requiring assessment tools that extend beyond isolated physical markers. Rather than a definitive feature set, these identified factors provide an evidence-based pool of candidate variables that may inform future risk-stratification and predictive modeling initiatives, supporting integrated, person-centered care.

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Cite

BibTeXRIS
BibTeX
@article{pino2026multidimensional,
  title = {{Multidimensional Factors and Predictors of Vulnerability and Frailty in Older Adults: A Systematic Review.}},
  author = {Helder Pino and Ana Ramos and Cesar Fonseca and Elisabete Alves and Anabela Coelho},
  journal = {Healthcare (Basel, Switzerland)},
  year = {2026},
  month = oct,
  doi = {10.3390/healthcare14203370},
  url = {https://europepmc.org/article/MED/42940415},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Multidimensional Factors and Predictors of Vulnerability and Frailty in Older Adults: A Systematic Review.
AU  - Helder Pino
AU  - Ana Ramos
AU  - Cesar Fonseca
AU  - Elisabete Alves
AU  - Anabela Coelho
PY  - 2026
DA  - 2026/10/09
JO  - Healthcare (Basel, Switzerland)
DO  - 10.3390/healthcare14203370
UR  - https://europepmc.org/article/MED/42940415
AB  - Background  Population ageing is characterized by rising multimorbidity and multifaceted vulnerability. While vulnerability is inherently a biopsychosocial state, clinical research predominantly operationalizes risk through physical frailty phenotypes, constraining holistic geriatric care. Identifying the interplay across biological, functional, and psychosocial domains is essential for comprehensive risk evaluation.Objectives  To synthesize multidimensional factors associated with vulnerability and frailty in adults aged ≥65, categorizing cross-sectional correlates and prospective longitudinal predictors to inform multidimensional assessment.Methods  Following PRISMA 2020 guidelines, systematic searches were conducted across PubMed, CINAHL, Scopus, Web of Science, and Google Scholar (2020-2025). Independent reviewers performed screening, selection, extraction, and Joanna Briggs Institute (JBI) critical appraisal (PROSPERO: CRD420251039796).Results  Forty studies (22 cross-sectional, 17 cohort, 1 quasi-experimental) comprising 77,229 cumulative participant observations across community, outpatient, inpatient, and residential care settings were synthesized. Thirty-seven candidate determinants were mapped across five domains: biological/clinical, psychological, socioeconomic/relational, lifestyle, and self-care profile. Advanced age, multimorbidity, and polypharmacy were the most frequent clinical factors; prospective cohorts specifically linked high anticholinergic burden and functional dependence in complex activities to incident frailty. Depressive symptoms, cognitive decline, low education, financial strain, and social isolation consistently delineated vulnerable states.Conclusions  Vulnerability in older adults is a multifaceted construct requiring assessment tools that extend beyond isolated physical markers. Rather than a definitive feature set, these identified factors provide an evidence-based pool of candidate variables that may inform future risk-stratification and predictive modeling initiatives, supporting integrated, person-centered care.
SN  - 2227-9032
ER  -