Rachael Frost

Objectives Previous systematic reviews show a clear relationship between frailty and depression, however the association with anxiety is much less frequently explored. Previous single studies indicate evidence is mixed. We completed a systematic review and meta‐analysis to identify the relationship between frailty and anxiety. Methods We searched five electronic databases for observational studies in older people in community, care home and outpatient settings with any/no health conditions that measured the association between anxiety and frailty using validated measures. Studies were screened by one reviewer with 10% checked by a second reviewer. The Mixed Methods Appraisal Tool was used to assess study quality. We used meta‐analysis to aggregate study findings, with subgroup analyses to explore heterogeneity. Results Out of 1272 references, a total of 20 cross‐sectional and 1 longitudinal studies were eligible. Older adults with frailty were substantially more likely to display anxiety symptoms than robust populations, across both dichotomous and continuous data sets ( n = 10, OR = 3.48, 95% CI: 2.08, 5.81, p < 0.0001, I 2 = 94%; N = 5, SMD = 3.13, 95% CI: 1.06, 5.21, I 2 = 98%). Similarly, pre‐frail older adults were more likely to have anxiety symptoms than robust older adults but to a lesser extent ( N = 6, OR = 1.95, 95% CI: 1.41, 2.71, I 2 = 63%; N = 3, SMD = 1.70, 95% CI: 0.01, 3.38, I 2 = 98%). Conclusions There is a clear association between pre‐frailty/frailty and anxiety in older adults. However, data are heterogeneous and primarily from cross‐sectional studies so causality cannot be determined. Future research should evaluate the effectiveness of anxiety screening and treatments in frail older adults.