Welcome to the latest key papers and publications focussing mainly on health inequalities.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
What are health inequalities?
Abstract: Health inequalities are avoidable, unfair and systematic differences in health between different groups of people. There are many kinds of health inequality, and many ways in which the term is used. That’s why, when we talk about ‘health inequality’, it’s useful to be clear about which measure is unequally distributed and between which people.
Source: Jefferies D. The King’s Fund, Sep 2025
The Equality and Health Inequalities Hub
Abstract: Within this hub you will find information about NHS England’s statutory responsibilities around equalities and health inequalities and the national NHS programmes in these areas.
Programmes work across the NHS and with other agencies, people and communities to advance equalities; and achieve equitable access, excellent experience and optimal outcomes for the people we serve and the colleagues we work with.
Source: NHS England, 2025
Health inequalities hub
Abstract: Our health inequalities hub shines a light on case studies focusing on health inequalities from councils across the country.
Source: Local Government Association, 2025
Reducing health inequalities in your local area: a toolkit for clinicians
Abstract: This toolkit is intended to support clinicians working across the UK.
Source: BMA, Mar 2026
How we Support Reducing Health Inequalities
Abstract: At the TU, we are committed to addressing health inequalities in all areas of our work.
Guided by our enabling ethos and focus on population health, we work with our clients to improve patient health outcomes through inclusive, data-informed approaches. Our commitment to addressing health inequalities and championing equality, diversity and inclusion involve a comprehensive and sustained effort across all our work to ensure fair and equitable health outcomes for all.
Source: Transformation Unit, Aug 2025
Social determinants of health
Abstract: Social determinants of health – broadly defined as the conditions in which people are born, grow, live, work and age, and people’s access to power, money and resources – have a powerful influence on health inequities. These are the unfair and avoidable differences in health status seen within and between countries.
Source: World Health Organisation, 2026
Social security cuts and life expectancy: a longitudinal analysis of local authorities in England, Scotland and Wales
Abstract:
The UK Government's 'welfare reform' programme included reductions to social security payments, phased in over the financial years 2011/2012-2015/2016. Previous studies of social security cuts and health outcomes have been restricted to analysing single UK countries or single payment types (eg, housing benefit). We examined the association between all social security cuts fully implemented by 2016 and life expectancy, for local authorities in England, Scotland and Wales.
METHODS: Our unit of analysis was 201 upper tier local authorities (unitary authorities and county councils: 147 in England, 32 in Scotland, 22 in Wales). Our exposure was estimated social security loss per head of the working age population per year for each local authority, calculated against the baseline in 2010/2011. The primary outcome was annual life expectancy at birth between the calendar years 2012 and 2016 (year lagged following exposure). We used a panel regression approach with fixed effects.
RESULTS: Social security cuts implemented by 2016 were estimated to be 475 per head of the working age population in England, 390 in Scotland and 490 in Wales since 2010/2011. During the study period, there was either no improvement or only marginal increases in national life expectancy. Social security loss and life expectancy were significantly associated: an estimated 100 decrease in social security per head of working age population was associated with a 1-month reduction in life expectancy.
CONCLUSIONS: Social security cuts, at the UK local authority level, were associated with lower life expectancy. Further research should examine causality.
Source: Seaman R. Journal of Epidemiology and Community Health, Feb 2024; 78(2): 82-87
Black maternal health: third report of session 2024–26
Abstract: This report finds that Black women in England face disproportionately poor outcomes in maternity care, shaped by systemic failings in leadership, training, data collection and accountability. The report acknowledges that failings in care for Black women are taking place in the context of a maternity system that is failing women more broadly, with the NHS in England having paid 27.4 billion in maternity negligence since 2019, estimated at, a figure greater than the total maternity budget for the same period.
Source: Moran L. Health and Social Care Committee, Black Maternal Health, 2025
Government response to the Health and Social Care Committee’s third report of session 2024 to 2026: Black maternal health
Abstract: This is the government's formal response to the recommendations made by the Health and Social Care Committee's report on Black maternal health, which was published on 17 September 2025.
Source: Department of Health and Social Care (DHSC), 2025
Monitoring the Mental Health Act in 2024/25
Abstract: This report into the use of the Mental Health Act finds that increasing demand for services and higher thresholds for admission are leading to long waits for mental health care. The report, which was built on interviews with over 3,000 patients and over 700 family members and carers, reveals reoccurring issues of staff shortages, a lack of beds, and inconsistencies in experiences. It also finds that out-of-area placements on the rise even though there was a national commitment to end this practice by March 2021.
Source: Care Quality Commission, 2026
How ICBs are improving men’s health
Abstract: Following the launch of the Men's Health Strategy Kathy Oxtoby takes a look at the state of healthcare for men across the NHS system.
Source: Oxtoby K. Healthcare Leader, Jan 2026
Government response to Lords Select Committee's report 'Time to deliver: The Autism Act 2009 and the new autism strategy'
Abstract: The command paper sets out the government's response to the recommendations made by the House of Lords Autism Act 2009 Committee in their report 'Time to deliver: The Autism Act 2009 and the new autism strategy'. The government welcomes the committee's report and will consider their recommendations further during the development of the next strategy. It also sets out the work government is already doing to support autistic people.
Source: Department of Health and Social Care (DHSC), 2026
Reducing inequalities in cancer care: a health system approach to implementing change
Abstract: The brief highlights why inequalities remain a major barrier to progress, and why a broad health systems approach matters. It sets out practical actions across governance, financing, service delivery and workforce to translate scientific advances into more equitable outcomes.
Source: Myers C. European Observatory on Health Systems and Policies, 2025
Trends in educational inequalities in smoking-attributable mortality and their impact on changes in general mortality inequalities: evidence from England and Wales, Finland, and Italy (Turin)
Abstract:
BACKGROUND: Socioeconomic mortality inequalities are persistent in Europe but have been changing over time. Smoking is a known contributor to inequality levels, but knowledge about its impact on time trends in inequalities is sparse.
METHODS: We studied trends in educational inequalities in smoking-attributable mortality (SAM) and assessed their impact on general mortality inequality trends in England and Wales (E&W), Finland, and Italy (Turin) from 1972 to 2017. We used yearly individually linked all-cause and lung cancer mortality data by educational level and sex for individuals aged 30 and older. SAM was indirectly estimated using the Preston-Glei-Wilmoth method. We calculated the slope index of inequality (SII) and performed segmented regression on SIIs for all-cause, smoking and non-SAM to identify phases in inequality trends. The impact of SAM on all-cause mortality inequality trends was estimated by comparing changes in SII for all-cause with non-SAM. RESULTS: Inequalities in SAM generally declined among males and increased among females, except in Italy. Among males in E&W and Finland, SAM contributed 93 per cent and 76 per cent to declining absolute all-cause mortality inequalities, but this contribution varied over time. Among males in Italy, SAM drove the 1976-1992 increase in all-cause mortality inequalities. Among females in Finland, increasing inequalities in SAM hampered larger declines in mortality inequalities.
CONCLUSION: Our findings demonstrate that differing education-specific SAM trends by country and sex result in different inequality trends, and consequent contributions of SAM on educational mortality inequalities. The following decades of the smoking epidemic could increase educational mortality inequalities among Finnish and Italian women.
Source: Van Hemelrijck Wanda Monika J. Journal of Epidemiology and Community Health, Sep 2024; 78(9): 561-569
Time for action: introduction of a national planning policy to promote a healthier food environment in England
Abstract: This article is a commentary on the National Planning Policy Framework, published in December 2024 by the Ministry of Housing, Communities and Local Government (MHCLG), which breaks new ground in relation to policy on hot food takeaways and fast-food outlets with reference to health inequalities and outlines its relevance to public health as part of a whole systems approach to obesity and overweight.
Source: Bannerman A. Perspectives in Public Health, Sep 2025; 145(5): 243-245
Contact the library for a copy of this article
Equitable inclusion of patients with cancer on the palliative care register: a systematic review in primary care
Abstract:
Background: GPs are instrumental to palliative care in the UK and most practices maintain a register of patients with palliative care needs. However, many people with incurable cancer who could benefit from palliative care are not included on this register, making this a potential source of end-of-life inequity.
Aim: To identify barriers and facilitators to recognising the palliative care needs of patients with cancer in the UK and understand how these factors may have an impact on those vulnerable to end-of-life inequity.
Design and setting: A mixed-methods systematic review. Method Eight electronic databases (Alternative Medicine, CINAHL, Embase, Medline, PsycINFO, Scopus, SocINDEX, and Web of Science) and two preprint servers (medRXiv and Open Science Framework) were searched in November 2024. Qualitative, quantitative, and mixed-methods studies were included. Narrative synthesis was used to integrate study findings, with resulting barriers and facilitators mapped onto the COM-B model domains of capablity, opportunity, and motivation. The impact on equity was evaluated using the PROGRESS-Plus framework.
Results: Searches returned 7190 citations, with 24 studies included in the review. Seven themes were identified, with barriers and facilitators mapped onto COM-B domains: conceptualisation of palliative care; navigating challenging conversations; healthcare organisation; patient help-seeking; time and resource constraints; perceptions shaping practice; and cognitive associations. There was insufficient evidence about the barriers and facilitators that may be having an impact on those vulnerable to end-of-life inequities.
Conclusion: GPs experience many barriers to recognising palliative care needs. There is a need for greater understanding of the extent and nature of inequities in recognising such needs, to ensure strategies to increase recognition do not widen inequities.
Source: Henderson R. British Journal of General Practice, Oct 2025; 75(759): e659-e668
From policy to action: a document content analysis reviewing the adoption of the healthcare inequalities programme in local health system plans in England
Abstract:
OBJECTIVES: This analysis aimed to explore how local health system strategies and plans seek to tackle health and care inequalities and address national policies. Specifically, the analysis considered alignment with five national priority areas: restoring services inclusively, mitigating digital exclusion, ensuring the completeness and timeliness of datasets, accelerating preventative programmes and strengthening leadership and accountability. In addition, the analysis explored the extent to which systems are engaging with the Core20PLUS5 approach, which targets the most deprived 20 per cent of the population ('Core 20') and population groups experiencing disproportionately poor access, outcomes or experiences of care ('PLUS').
DESIGN AND SETTING: Integrated care systems (ICSs) are statutory partnerships that bring together healthcare, social care, local government and wider system organisations to collaboratively address the root causes of ill health and health inequalities. We conducted a document analysis of available ICS strategies, 5-year plans and health inequalities plans published in England between 1 January 2022 and 31 July 2023. A total of 43 strategy documents, 38 5-year plans and seven health inequalities plans were analysed. A data extraction framework was used to guide reviewers and independent quality assurance was completed to ensure internal validity, intrarater reliability, and reproducibility of the project.
RESULTS: the analysis highlighted good alignment with national healthcare inequalities policies and local approaches to tackling healthcare inequalities, with the majority of systems citing the Core20PLUS5 framework. There was notable variation between systems on the adoption of the framework with the children and young people's framework being less widely considered than the adult's framework. Across systems, equity-focused tools were widely used, and numerous systems had developed outcome frameworks to monitor progress. Leadership for health inequalities was strengthened with senior leadership roles being established to hold integrated care boards accountable for improving access, experiences and outcomes. However, competing priorities, particularly concerning implementations of new organisational models and multiple national priorities, were evident within the plans which may challenge progress on reducing health and healthcare inequalities.
CONCLUSIONS: The review concluded that while progress has been made in adopting national healthcare inequalities policies and steers, significant variation exists between systems, possibly reflecting local population needs and varying levels of maturity of the systems across England. The review highlights the need for further evaluations at both national and local levels, allowing for further development of the systems. Additionally, consistent and sustainable funding and more robust training for health inequalities leadership roles is needed to ensure equitable access, experience and outcomes.
Source: Elliott H. BMJ Open, Oct 2025; 15(10): e102163
The Maternal Care Bundle: a care bundle for reducing maternal mortality and morbidity
Abstract: The Maternal Care Bundle (MCB) sets best practice standards across five areas of clinical care, for implementation by NHS providers and commissioners across England. The aim is to reduce maternal mortality and morbidity and reduce inequalities in these adverse outcomes.
Source: NHS England, 2026
Chronic pain: prevalence, demographic inequalities, and healthcare utilisation: a primary care database analysis
Abstract:
BACKGROUND: Chronic pain (CP) is an ill-defined condition, often under-recorded in primary care records.
AIM: To determine prevalence, evidence of health inequalities, primary care consultation rates, and healthcare utilisation costs of CP.
DESIGN & SETTING: Cross-sectional, retrospective study using anonymised primary care data from all GP practices in one inner-city London area.
METHOD; CP was defined on the basis of analgesic medication codes and novel inclusion of diagnostic codes for conditions known to be strongly associated with CP. CP prevalence and consultation rates were determined; comparisons were made with 31 other long-term conditions (LTCs). Consultation cost estimates were based on healthcare professional type and consultation mode.
RESULTS: In total, 358 889 adult patients were registered in sample practices, with continuous (12-month) healthcare records available for 327 800 (91.3 per cent). CP prevalence was 18.6 per cent; the second most prevalent LTC after anxiety at 21.4 per cent. CP mean annual consultation rates were 15.3 per patient, the highest LTC consultation rate. CP incurred the highest primary care consultation costs of any of the included LTCs. Age was the strongest predictor of CP, particularly in those aged >=60 years (adjusted odds ratio [AOR] for 60-69 years: 9.32; 95 per cent confidence interval [CI] = 8.83 to 9.84; compared with those aged 18-29 years). Much smaller AORs were found for ethnicity, social deprivation, sex, and non-UK country of birth.
CONCLUSION: CP represents the most demanding LTC, in terms of consultation rates and costs, managed in primary care. Yet there is considerable uncertainty about optimal management and alternatives to long-term, high-volume primary care consultation rates.
Source: Shetty S. BJGP Open, Oct 2025; 9(3): BJGPO.2024.0147
Locked out: exclusion of deaf and deafblind BSL users from health and social care in the UK
Abstract: This report presents the findings and recommendations of the BSL Advisory Board's Health and Social Care sub-group. The report examines the barriers that BSL users face in navigating the UK's health and social care systems. The report highlights the higher levels of health and social care needs within the deaf and deafblind BSL user communities, as well as the resulting health inequalities. It details how persistent challenges, such as inaccessible communication systems and a lack of qualified interpreters, lead to economic costs and cumulative trauma for BSL users. The BSL Advisory Board puts forward twelve essential priorities and additional areas for action designed to create a more inclusive and equitable future. The aim of these recommendations is to unlock access to services, improve health outcomes, and provide a strong return on investment by reducing avoidable costs in the NHS and social care budgets.
Source: Disability Unit, 2025
Recruitment, retention and reporting of ethnic representativeness in maternity trials: a scoping review
Abstract:
INTRODUCTION: Black and Asian women experience significantly higher rates of mortality and morbidity perinatally compared with white women and are more likely to lose their babies. These groups are also under-represented in clinical research, resulting in evidence that may not be generalisable. Tools have been developed to facilitate the inclusion of ethnic minority groups, but it is unknown to what extent representation and inclusion are considered in maternity trials. AIM: To provide an overview of how ethnically diverse recruitment is considered and reported in maternity trials in the UK.
METHODS: A scoping review was conducted, undertaking a systematic search to identify published trial protocols and their subsequent results papers, conducted within the UK, recruiting women during pregnancy or within six weeks postnatally between 2004 and 2024. Data was extracted from protocols on whether representation of participants was considered in the study design and if specific recruitment and retention strategies were planned for ethnic minority groups. Data extracted from results papers identified whether representation of participants was discussed and if recruitment strategies were discussed; these were compared against the protocol.
RESULTS: A total of 96 published protocols met the inclusion criteria; eight mentioned specific recruitment strategies and 5 mentioned specific retention strategies. Only two included both recruitment and retention strategies. The most common strategies included providing different types of language support and adapting interventions to be culturally appropriate. Strategies were not evaluated. 67 results papers were available. Ethnicity was reported in 57 papers, with heterogeneity of categories between papers. Only 32 papers discussed representativeness of participants.
CONCLUSION: Few maternity trials report considerations on how they ensure they are recruiting and retaining ethnically representative participants. Minimal discussion is undertaken around the extent to which trial participants reflect the population to which findings will be applied. Further work is needed to support implementation and evaluation of inclusive research guidance. Failing to ensure those from ethnic minority groups are included in research can exacerbate inequalities.
Source: Lovell H. BMJ Open, 2025;15(11): e098926
Integrated care systems and strategic authorities: coming together to tackle health inequalities and the wider determinants of health
Abstract: This essay was written by the Centre for Local Economic Strategies and The King's Fund, as part of a programme of work commissioned by The Health Foundation. Strategic authorities and integrated care systems are increasingly powerful entities with the potential to tackle health inequalities and improve population health. However, achieving this will require them to work together effectively. This essay explores the changing policy context in which these bodies exist, and the way the dynamics between them could and should evolve as devolution beds in.
Source: Tiratelli L. Centre for Local Economic Strategies (CLES), 2025
Equalities impact assessment: 10 Year Health Plan for England
Abstract: This equality impact assessment (EQIA) assesses how the Department and Health and Social Care (the department) and NHS England have worked in partnership to address the requirements of the public sector equality duty, section 149(1) of the Equality Act 2010, and related provisions under section 149 more generally, in developing the 10 Year Health Plan. It also highlights if risks have been identified that need to be mitigated as proposals are implemented. The EQIA incorporates assessments for each chapter of the plan which explores the proposals through the lens of each protected characteristic.
Source: Department of Health and Social Care (DHSC), 2025
Technical guide to allocation formulae and convergence for 2026/27 to 2028/29 revenue allocations
Abstract: This is a technical guide to allocation formulae and convergence for the 2026/27 to 2028/29 revenue allocations. The guide provides detailed information on the technical approach to the 2025/26 revenue allocations.
Source: NHS England, 2025
Strategies to improve telehealth access for culturally and linguistically diverse communities: a systematic review
Abstract:
AIMS: CaLD populations face considerable digital health inequities; strategies are needed to ensure telehealth models of care are available to all. We aimed to identify and describe interventions that enhance telehealth access for CaLD communities.
METHODS: We systematically searched four databases (PubMed, Scopus, Embase, and CINAHL). Included studies were published between 2011 and 2024 and reported on at least one of the outcomes described in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Two authors independently screened articles, solutions were synthesized qualitatively.
RESULTS: Twenty-seven articles were included in the review and primarily used videoconferencing as the predominant telehealth modality (n = 14, 52 per cent). Five strategies were identified to promote telehealth use across CaLD communities including: (i) Provide bilingual options; (ii) Enhance staff cultural competence; (iii) Provide flexible adaptions to align with consumer needs; (iv) Supply technology and technological support; and (v) Involve digital health navigators and/or health educators.
CONCLUSIONS: Culturally competent professionals supported by language services and technological support are strategies which can help improve equity of access to telehealth services for people from CaLD communities. Such strategies can support the implementation of practical solutions to overcome health inequities and prevent access gaps.
Source: Gallegos-Rejas Victor M. Journal of Public Health, Sep 2025; 47(3): e374-e390
Starting behind, staying behind: the opportunity gap facing boys from low-income families at age 5 and beyond
Abstract: This report looks beneath the headline data to focus on one group particularly at risk of being overlooked, or under-served, by policy making from an early age: boys from low-income families. It provides a data-driven picture of the opportunity gap facing this group at age five and beyond, the root causes of attainment gaps and how these are linked to systemic failings in the way government works.
Source: Metcalfe S. Institute for Government, 2025
Exploring ethnicity data use and gaps in health care
Abstract: This report identifies the barriers to the collection, availability and use of quality ethnicity data and opportunities and best practice to overcome these barriers. It makes recommendations to leverage existing ethnicity data sets and proposes long-term steps to build coherent and equitable data systems capable of driving real change.
Source: Butt J. Race Equality Foundation, 2025
Independent review into mental health conditions, ADHD and autism: terms of reference
Abstract: This publication sets out the terms of reference for an independent review into the prevalence, trends and inequalities associated with mental health conditions, ADHD and autism in children, young people and adults. The review will seek to understand: the factors behind trends in prevalence, the impact of clinical practice, including social and cultural factors and the risks and benefits of medicalisation, ways to promote the prevention of mental ill health, and ways to create resilience and improve early intervention.
Source: Department of Health and Social Care (DHSC), 2025
Tackling health inequalities together: inclusion health and co-production
Abstract: Trauma-informed approaches acknowledge the impact of trauma on the health of patients and staff, and the ways in which health care is accessed and experienced. There is growing interest in these approaches in both a UK and international primary care context. Intrinsic to a trauma-informed approach (although rarely achieved in practice) is the co-production of health services with those with relevant lived experience. Existing models of patient involvement in primary care tend to rely significantly on feedback forms or surveys, which do not facilitate an ongoing dialogue between patients and healthcare providers. Patient participation groups (PPGs) can provide a more meaningful space in which services can be truly co-produced, in particular where careful attention is given to power dynamics in the room. There is, however, an increasing understanding of the need for flexibility in our approaches to patient involvement, which should incorporate multiple models, recognising individuals' diverse experiences, preferences, and capacity for participation. The Care Quality Commission (CQC) suggests that we may have'... more effective conversations through engaging with different community groups at different times and in different places'. The need for provision of protected spaces with careful attention to sociocultural backgrounds and power dynamics is echoed within the principles of trauma-informed care. The current authors have worked proactively with specific community groups who are often poorly served by our health services. We have sought to create protected spaces and mitigate existing power dynamics to support the free communication of ideas, working together with partnership organisations to improve local primary care provision.
Source: McGeown H. British Journal of General Practice, Oct 2024; 74(747): 469-471
A realist review of how, why, for whom and in which contexts quality improvement in healthcare impacts inequalities
Abstract:
INTRODUCTION: Quality improvement (QI) is aimed at improving care. Equity is one of the six domains of healthcare quality, as defined by the Institute of Medicine. If this domain is ignored, QI projects have the potential to maintain or even worsen inequalities.
AIMS AND OBJECTIVES: We aimed to understand why, how, for whom and in which contexts QI approaches increase, or do not change health inequalities in healthcare organisations.
METHODS: We conducted a realist review by first developing an initial programme theory, then searching MEDLINE, Embase, CINAHL, PsychINFO, Web of Science and Scopus for QI projects that considered health inequalities. Included studies were analysed to generate context-mechanism-outcome configurations (CMOCs) and develop an overall programme theory.
RESULTS: We screened 6259 records. Thirty-six records met our inclusion criteria, the majority of which were from the USA. We developed CMOCs covering four clusters: values and understanding, resources, data, and design. Five of these described circumstances in which QI may increase inequalities and 15 where it may reduce inequalities. We found that QI projects that are values-led and incorporate diverse, patient-led data into design are more likely to address health inequalities. However, when staff and patients cannot engage fully with equity-focused projects, due to practical or technological barriers, QI projects are more likely to worsen inequalities.
CONCLUSIONS: The potential for QI projects to positively impact inequalities depends on embedding equity-focused values across organisations, ensuring sufficient and appropriate resources are provided to staff delivering QI, and using diverse disaggregated data alongside considered user involvement to inform and assess the success of QI projects. Policymakers and practitioners should ensure that QI projects are used to address inequalities.
Source: Johnson Lucy L. BMJ Quality and Safety, Aug 2025; 34(8): 537-546
Understanding health inequalities research capacities: insights and recommendations from comparing two high income settings
Abstract: Generating evidence on health inequalities (HI) is necessary to raise awareness of these issues, describe and monitor their evolution, analyze their causes, and inform interventions aiming to improve health equity. Yet not all cities and countries have the capacity to produce this type of research. Recent research provides new contextual and causal insights into this research production process, and in-depth understanding on why and how this type of research is produced in certain settings. This article aims to analyze two recent case studies that have uniquely explored this process in two high producers of HI research and high-income country settings to identify learning and distil recommendations, which may be insightful for other settings. Expanding and investing in this line of research is critical, particularly in places with lower HI research output and related capacity, in order to identify key contextual conditions and mechanisms that may enable or hinder this process. This new knowledge could guide the development of new HI research capacity strengthening strategies to foster this research in different settings, worldwide. More understanding is also needed on the relationship between HI research, policy, and action in order to tackle HI.
Source: Cash-Gibson L. International Journal of Social Determinants of Health and Health Services, Apr 2024; 54(2): 163-170
The U-shaped curve of health inequalities over the 20th and 21st centuries
Abstract: This article examines historical trends in health inequalities over the 20th and 21st centuries. Drawing on studies from the United States, United Kingdom, Sweden, and Western Europe, it concludes that there is evidence of a u-shaped curve in (relative) health inequalities. These trends in health inequalities broadly parallel those identified by economists with regards to the u-shaped curve of income and wealth inequalities across the 20th and 21st centuries. The article argues that-as with income inequalities-health inequalities generally decreased across the twentieth century through to the early 1980s. They then started to increase and accelerated further from 2010, particularly in the United Kingdom and the United States. The article sets out four distinct policy periods that shaped the evolution of trends in health inequalities: the Interbellum Era, 1920-1950; the Trente Glorieuse, 1950-1980; Neoliberalism, 1980-2010; and the Crisis Age, 2010-present. The u-shaped curve of health inequalities over this period suggests that social policies, health care access, and political incorporation have driven changes over time. Taking this long view of changes in health inequalities emphasizes the importance of politics and policy for future health improvement.
Source: Bambra C. International Journal of Social Determinants of Health and Health Services, Jul 2024; 54(3): 199-205
What is the state of children's health in England?
Abstract: This explainer offers a snapshot of the current state of children's health in England, drawing on the latest available evidence. It focuses on outcomes across physical and mental health, the inequalities and wider determinants that shape those outcomes, and how well the health and care system is responding. It closes with The King's Fund's view on priorities for action and a look ahead to the second explainer, which will map the system for children and young people in England - setting out who is responsible for what, how services are delivered, and the levers available to improve outcomes and reduce inequalities.
Source: Buckingham N. The King’s Fund, 2025
Health for wealth 2025: building a healthier North to boost UK productivity
Abstract: This report reveals that the relationship between health and productivity has become stronger over the last seven years, placing a huge financial burden on the economy and stagnating possible productivity growth. It finds that the scale of health-related economic inactivity is greater in the North of England, with workers more likely to lose their job due to ill health, and those without educational qualifications facing a ninefold higher risk of losing their job if they become ill.
Source: Simpson J. Northern Health Science Alliance, 2025
Affordable infrastructure: how strategic authorities can use housing and public transport to tackle health inequalities
Abstract: This essay was written by the Centre for Local Economic Strategies and The King's Fund, as part of a programme of work commissioned by The Health Foundation. Housing and public transport are critical determinants of health. Strategic Authorities (SAs) are uniquely positioned to influence the affordability of homes and transport - the levers available to them offer promising potential to reduce health inequalities, particularly for those on the lowest incomes. This essay draws on conversations with mayors and SA officers to highlight how innovative housing and transport policies like municipal housebuilding and bus franchising can be scaled and amplified to achieve greater impact on narrowing health inequalities.
Source: Goodwin Tom L. Centre for Local Economic Strategies (CLES), 2025
Structural racism as a fundamental cause of health inequities: a scoping review
Abstract:
BACKGROUND: Structural racism is increasingly recognized as a fundamental cause of health inequities. It operates through laws, institutional policies, and systemic practices that disproportionately disadvantage racially and ethnically minoritized populations. Although the body of evidence on structural racism and health is expanding, much of it remains fragmented across disciplines and sectors. This scoping review synthesized peer-reviewed research by examining the pathways through which structural racism affects health, the most frequent outcomes, and the interventions and policies implemented to address these disparities.
METHODS: The review adhered to frameworks by Arksey and O'Malley, Levac et al., and the Joanna Briggs Institute. Six databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, and Scopus) were searched for English-language, peer-reviewed studies published before February 15, 2025, examining structural, systemic, or institutional racism in relation to health. Two reviewers independently screened and extracted data, and findings were analyzed using thematic synthesis.
RESULTS: Eighty-three studies met the inclusion criteria, covering healthcare, housing, the criminal legal system, environmental exposures, and other intersecting sectors. Structural racism was consistently associated with adverse outcomes in maternal and infant health, cancer, cardiovascular disease, HIV care, mental health, and COVID-19. Key mechanisms included redlining, residential segregation, carceral practices, discriminatory clinical treatment, and environmental injustice. Intersectional burdens were most pronounced among Black, Indigenous, LGBQ, immigrant, and socioeconomically marginalized groups. Although some promising interventions were identified, including culturally tailored perinatal care, community health worker models, and equity-focused quality improvement, few had been rigorously evaluated or embedded in broader structural policy changes.
CONCLUSION: Structural racism was found to operate across institutional and societal systems to perpetuate health disparities. While targeted interventions show promise, significant gaps remain in the development and implementation of scalable, evidence-based reforms. To achieve health equity, public health strategies must prioritize cross-sectoral actions for confronting and dismantling the structural conditions that maintain racial injustice. This synthesis highlights the urgent need for scalable policy reforms and structural accountability measures across sectors.
Source: Kisa A. International Journal for Equity in Health, Oct 2025; 24(257)
Public health under threat: how our leadership must evolve in complex and uncertain times
Abstract: Public health professionals across the UK and around the world are currently grappling with a landscape of unprecedented complexity. Long-standing systemic challenges across the UK have led to stagnating-even declining-life expectancy and widening health inequalities, whilst on a global scale the very foundations of evidence-based public health programs and principles are under threat. Our leadership as public health professionals must evolve in response to these mounting challenges. We need a new paradigm in public health, one that embraces the interconnected nature of modern threats to health, and one that is disruptive, agile, collaborative, and firmly rooted in principles of equity and justice. The world is changing rapidly, and public health leadership must adapt to meet the challenges of a more interconnected and dynamic environment. Many of the population-level health challenges facing the UK stem from the deep-rooted social and economic inequalities faced by communities across England, Scotland, Wales, and Northern Ireland. That life expectancy has recently declined in some of the UK's most deprived areas speaks to a long-term failure to properly support our most vulnerable populations, including marginalized minority ethnic communities.
Source: Fenton K. Journal of Public Health, Jun 2025; 47(2): 111-113
Thursday, June 18, 2026
Thursday, March 5, 2026
Frailty Champions: March 2026
Welcome to the latest key papers and publications focussing mainly on all things frailty in the renal nursing profession.
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Predictors of Social Frailty and Depression in Brazilian Patients With Chronic Kidney Disease: A Cross-Sectional Study
Abstract:
Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.
Predictors of Social Frailty and Depression in Brazilian Patients With Chronic Kidney Disease: A Cross-Sectional Study
Abstract:
BACKGROUND: Social frailty is linked to adverse health outcomes, including depression, especially in older and chronically ill individuals. This study aimed to assess the prevalence and associated factors of social frailty in Brazilian CKD patients undergoing hemodialysis or kidney transplantation and to examine its predictive role in the development of depressive symptoms.
METHODS: This cross-sectional, correlational, and comparative study included 284 patients with CKD from São Paulo, Brazil. Data were collected using validated instruments: HALFT Social Frailty Scale, Patient Health Questionnaire-9 (PHQ-9), and Medical Outcomes Study Social Support Scale (MOS). Two multiple linear regression (MLR) models were used to assess predictors of social frailty and depressive symptoms, adjusting for sociodemographic and clinical variables.
RESULTS: Social frailty was significantly more prevalent among HD patients (51.2%) compared to TX patients (24%). Social support was negatively associated with social frailty (β = -0.40; p < 0.001). Other predictors of greater social frailty included lower income (β = 0.51 for ≤ 1 minimum wage), number of medications (β = 0.11), and lower education (β = -0.13). In turn, social frailty was the strongest predictor of depressive symptoms (β = 0.60; p < 0.001). TX status and male sex were associated with lower depression scores.
CONCLUSION: Social frailty is highly prevalent in CKD patients, particularly those undergoing HD, and strongly predicts depressive symptoms. Strategies to enhance social support and reduce socioeconomic vulnerability may help mitigate mental health burdens in this population.
Source: Dos Santos Diana G Ms. Geriatrics & Gerontology International, Jan 2026; 26(1): e70317
Frailty in Focus: A Scoping Review of Frailty Instruments from the Kidney Disease Aging Research Collaborative
Abstract:
Source: Dos Santos Diana G Ms. Geriatrics & Gerontology International, Jan 2026; 26(1): e70317
Frailty in Focus: A Scoping Review of Frailty Instruments from the Kidney Disease Aging Research Collaborative
Abstract:
BACKGROUND: Frailty is a multi-system syndrome of decreased physiologic reserve with high prevalence, early incidence, and prognostic significance in kidney disease. Apart from the Physical Frailty Phenotype (PFP), less is known regarding psychometric properties of other instruments. We critically appraise the validity and reliability of frailty instruments across the kidney disease continuum, acknowledge limitations, and highlight knowledge gaps. METHODS: Following PRISMA-ScR guidelines, we searched PubMed, EMBASE, Cochrane, CINAHL, Web of Science, ClinicalTrials.gov, and PsycInfo from website inception through 9/2024. Eligible studies applied a validated frailty instrument apart from the PFP to a kidney disease population.
RESULTS: We identified 136 articles after screening 4,048 initial results. The most commonly cited instruments were the Clinical Frailty Scale (CFS; N=56), FRAIL Scale (N=30), and Edmonton Frail Scale (N=16). Most studies included adults receiving hemodialysis (N=85) and with chronic kidney disease (N=39). Median age ranges were 53–83 years. Most frailty instruments demonstrated predictive validity for mortality and hospitalizations. Concurrent validity was most frequently demonstrated between frailty and older age, female sex, greater comorbidities, and lower albumin. Seven studies reported reliability. While some instruments were feasible (CFS, FRAIL scale), their measurement could result in higher frailty prevalence compared to the PFP. Existing instruments do not capture the full spectrum of psychosocial and physiologic domains of frailty.
CONCLUSIONS: The CFS demonstrates the strongest validity, apart from the PFP, although its use may result in higher measured frailty prevalence. Further research should test the feasibility of screening for frailty in clinical practice; the psychometric properties (i.e., responsiveness) of frailty instruments in younger adults, those with acute kidney injury, kidney transplant recipients, and those receiving conservative kidney management; and whether adding psychosocial and/or physiological markers improves frailty measurement validity. Addressing these gaps will facilitate wider frailty measurement in kidney disease research and aid adoption into practice.
Source: Nair D. Clinical Journal of the American Society of Nephrology, Jan 2026;
Patient-reported outcome measures (proms) and frailty in kidney transplant candidates
Abstract:
Source: Nair D. Clinical Journal of the American Society of Nephrology, Jan 2026;
Patient-reported outcome measures (proms) and frailty in kidney transplant candidates
Abstract:
BACKGROUND AND OBJECTIVE: Patient-reported outcomes (PROMs) are key tools for advancing patient-centered clinical practice, with proven benefits for health outcomes. Their application has been extended to different chronic diseases, but there are few studies involving patients with chronic kidney disease (CKD), a population that is aging and frail. The aim of this study was to assess the relationship between frailty and self-reported health-related quality of life in patients with advanced CKD who are eligible for kidney transplantation (KT). MATERIALS AND METHODS: KT candidates who were evaluated in the outpatient clinic were included in the study. The PROMIS-29® and PROMIS-Global Health® questionnaires were administered, and T-scores were calculated for each domain. Frailty was assessed using the Fried scale, categorizing participants as frail/pre-frail if FRIED > 0. Sociodemographic and clinical variables were also collected.
RESULTS: 139 KT candidates were included in the study: 32% were women, the mean age was 63.5 years, 43.9% were on dialysis, and 64.5% were frail. 71.2% responded to the administered PROMIS. Overall, KT candidates reported their mental health as good (48 ± 7.4) and their physical health as fair (42.8 ± 7.3). T-scores for anxiety, fatigue, social functioning, sleep disturbance, pain, and depression were within the normal range compared to the general population. When comparing frail with robust patients, only the physical domain of PROMIS-Global Health® and physical function of PROMIS-29® were worse in the frail group. No differences were found in the other domains.
CONCLUSIONS: Frail kidney transplant candidates report worse physical function when assessed using PROMs tools. The systematic implementation of PROMs might help to implement strategies to optimize access to the waiting list, improve postKT outcomes, and enhance overall patient care.
Source: Redondo-Pachón D. Nefrologia, Jan 2026; 46(1): 501393
Risk Prediction Models for Frailty in Adult Maintenance Haemodialysis Patients: A Systematic Review and Methodological Appraisal
Abstract:
Source: Redondo-Pachón D. Nefrologia, Jan 2026; 46(1): 501393
Risk Prediction Models for Frailty in Adult Maintenance Haemodialysis Patients: A Systematic Review and Methodological Appraisal
Abstract:
BACKGROUND: Frailty affects over 35% of maintenance haemodialysis (MHD) patients globally-2-3 times higher than the general elderly-and is strongly linked to higher mortality, hospitalisation, and functional decline. Despite its clinical impact, frailty is often underdiagnosed in dialysis settings due to inconsistent assessments and limited resources. Existing prediction models vary widely in predictors and methods, requiring systematic review to guide clinical use and improve risk-stratified care.
AIM: To systematically identify, describe, and evaluate the existing risk prediction models for frailty in patients undergoing MHD.
DESIGN: Systematic review and Methodological appraisal.
DATA SOURCES: A comprehensive search was conducted across multiple databases-PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China Biomedical Literature Database (CBM), Wanfang Database, VIP Database-covering studies up to November 1, 2024.
REVIEW METHODS: Two researchers independently conducted literature searches, screening, and data extraction. They used the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk of bias and the applicability of the included models. RESULTS: Fifteen studies (21 models) were analysed, with sample sizes 141-786 and frailty incidence 11.00%-59.57%. Model AUCs ranged 0.720-0.998 (potential overfitting at extreme values). Key predictors included age, serum albumin, gender, Charlson comorbidity index, and activities of daily living scores. Methodological appraisal using PROBAST revealed moderate applicability but high bias risks: 53% of studies used retrospective designs, 95% lacked external validation, and limitations included small samples, non-standard variable selection, and inadequate handling of missing data.
CONCLUSION: While models demonstrate initial predictive utility, widespread bias and developmental-stage limitations hinder clinical application. Future research must prioritise TRIPOD-guided model development, emphasising large prospective cohorts, rigorous validation, and transparent reporting to enhance reliability and clinical utility in frailty risk stratification for MHD patients.
Source: Zhang H. Journal of Advanced Nursing, Jan 2026; 82(1): 188-204
Frailty and pre-frailty prevalence in community-dwelling elderly with multimorbidity: A systematic review and meta-analysis
Abstract:
Source: Zhang H. Journal of Advanced Nursing, Jan 2026; 82(1): 188-204
Frailty and pre-frailty prevalence in community-dwelling elderly with multimorbidity: A systematic review and meta-analysis
Abstract:
BACKGROUND: The relationship between frailty/pre-frailty, and multimorbidity in the elderly is recognized, but specific prevalence among community-dwelling elderly with multimorbidity is unclear. This study aims to determine these rates, analyze subgroup, and identify sources of heterogeneity to bolster evidence-based interventions and health policies.
METHODS: We searched nine databases from inception to November 16, 2023, for cross-sectional and cohort studies on community-dwelling elderly with multimorbidity. Data were extracted to calculate the prevalence of frailty and pre-frailty. Study quality was assessed using AHRQ and NOS tools.
RESULTS: Fifteen studies encompassing 9,683 participants with multimorbidity were analyzed. The pooled prevalence of frailty and pre-frailty was 18.1 % and 48.9 %, respectively. Age-stratified analyses found 17 % frailty and 58.4 % pre-frailty in the 70-74 age group, and 16.7 % and 54.2 % in those above 75 years. Cross-sectional studies showed 18.8 % frailty and 48.1 % pre-frailty, while cohort studies showed 18.1 % and 50.5 %, respectively. Asia had higher rates (22.7 % frailty, 43.5 % pre-frailty) than the Americas (9.9 % frailty, 56.3 % pre-frailty). By sample size, frailty prevalence was 21.3 % (<500), 9.1 % (500-999), and 17.9 % (≥1000), with pre-frailty at 51.1 %, 45.6 %, and 47.7 %. The FP method yielded higher prevalence estimates (17.7 % frailty, 51.6 % pre-frailty) than the FS method (9.5 % frailty, 39.2 % pre-frailty).
CONCLUSION: This study provides insights into the prevalence of frailty and pre-frailty among community-dwelling elderly with multimorbidity. Variations in prevalence rates may be attributed to differences in sample size and measurement tools, which also contribute to heterogeneity observed across subgroups.
Source: Cai S. Archives of Gerontology and Geriatrics, May 2025; 132: 105782
Source: Cai S. Archives of Gerontology and Geriatrics, May 2025; 132: 105782
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A Mixed Methods Study of Risk Factors for Frailty in Peritoneal Dialysis Patients
Abstract:
A Mixed Methods Study of Risk Factors for Frailty in Peritoneal Dialysis Patients
Abstract:
OBJECTIVES: This study uses a convergent mixed methods approach to investigate the frailty phenotypes and risk factors in peritoneal dialysis (PD) patients. DESIGN: A cross-sectional mixed methods research study was employed.
METHODS: This study follows the MMR-RHS reporting guidelines. From November 2023 to August 2024, 213 patients were recruited from the PD centre of a tertiary hospital in Chongqing, China. Quantitative data were collected using a general information questionnaire and standardised scales, including Fried Frailty Phenotype (FFP), Charlson Comorbidity Index (CCI), Mini Nutritional Assessment-Short Form (MNA-SF), Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS). Concurrently, 19 PD patients in pre-frail or frail states participated in semi-structured interviews. The quantitative and qualitative findings were then integrated for analysis.
RESULTS: Amongst the 213 PD patients, 46.5% were non-frail, 41.3% were pre-frail and 12.2% were frail. Integrated analysis indicated that fatigue and low muscle strength were the primary frailty phenotypes amongst the patients. Age, sedentary behaviour, comorbidities, nutritional status, cognitive function, polypharmacy, psychological state and social connections were identified as risk factors for frailty in this patient population.
CONCLUSION: Many factors influence the frailty of PD patients. Future research should further explore the complex interactions amongst these factors and effective modulation strategies to mitigate the frailty progression. Incorporating the patients' perspectives in designing comprehensive intervention programmes will help identify key challenges and focal points for intervention.
IMPACT: This study identifies risk factors for frailty in PD patients, offering healthcare professionals a basis for designing targeted interventions. These factors encompass multiple dimensions, indicating the need for multidisciplinary collaboration in managing frailty.
PATIENT CONTRIBUTION: The PD patients in this study provided valuable quantitative data and shared their frailty experiences, enhancing the research conclusions' practical value.
Source: Cao W. Journal of Clinical Nursing, Sep 2025; 34(9): 3604-3619
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of model performance and methodological quality
Abstract:
Source: Cao W. Journal of Clinical Nursing, Sep 2025; 34(9): 3604-3619
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of model performance and methodological quality
Abstract:
BACKGROUND: Frailty affects outcomes in maintenance hemodialysis (MHD) patients, highlighting the need for reliable predictive tools. Despite the rise of predictive models, the clinical validity and scientific quality of these models remain unknown.
OBJECTIVE: The purpose of this systematic review is to assess the clinical usefulness, predictive accuracy, and methodological quality of the current frailty risk prediction models in patients with MHD.
METHODS: Databases including PubMed, Embase, Cochrane Library, CNKI, and others were comprehensively searched until August 2024. Studies that created or validated frailty risk prediction models for adult MHD patients were considered. The Newcastle-Ottawa Scale (NOS) and PROBAST were used to measure quality. The meta-analysis examined common predictive factors.
RESULTS: Twelve of the 824 papers that reported 14 prediction models satisfied the inclusion criteria. The most common method was logistic regression. Frailty prevalence ranged from 17.2% to 79.2%. Age, albumin, depression, and dietary condition were among the variables that were most often found. Model performance varied considerably, with area under the curve (AUC) ranging from 0.72 to 0.998. All studies had significant methodological deficiencies. CONCLUSIONS: Existing frailty risk prediction models demonstrate potential utility but currently suffer from significant methodological flaws and limited external validation, impairing their clinical applicability. Future models should emphasize rigorous study design, standardized statistical methods, and robust external validation. Clinicians should cautiously interpret existing models while focusing on critical predictors such as age, albumin, depression, and nutrition for frailty management in MHD patients.
Source: Chen Z. Renal Failure, Dec 2025; 47(1): 2522329
Effects of Exercise on Sarcopenia and Frailty in Haemodialysis Patients: A Systematic Review
Source: Chen Z. Renal Failure, Dec 2025; 47(1): 2522329
Effects of Exercise on Sarcopenia and Frailty in Haemodialysis Patients: A Systematic Review
Abstract:
Background and Objectives: Chronic kidney disease is characterized by the progressive loss of functioning nephrons due to structural and functional alterations in the kidneys. It is clinically defined through the presence of a glomerular filtration rate below 60 mL/min/1.73 m(2) or persistent kidney damage lasting at least three months. Patients undergoing haemodialysis frequently present with sarcopenia and frailty. The aim of this study was to evaluate the effects of intradialytic exercise on sarcopenia and frailty in individuals with chronic kidney disease. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. Electronic searches were executed in PubMed, PEDro, Scopus, and Dialnet. Eligible studies included adults (≥18 years) on haemodialysis who engaged in exercise interventions compared with passive control groups. Exclusion criteria included any conditions conflicting with the inclusion criteria, systematic reviews, study protocols, and articles not meeting the PICO framework or contradictory to the inclusion criteria. Outcomes of interest were sarcopenia and frailty, assessed through measures of physical function and muscle strength. Methodological quality was appraised using the PEDro scale, and risk of bias was evaluated with the Cochrane Risk of Bias tool.
Results: Fifteen studies met the inclusion criteria. Most interventions consisted of aerobic training, resistance training, or combined exercise programs. Across studies, exercise interventions consistently improved physical function and muscle strength, although no significant effects on body composition were observed.
Conclusions: This systematic review provides evidence that intradialytic exercise may produce clinically relevant improvements in sarcopenia by enhancing muscle strength and functional performance, as measured by tests such as the sitting-to-standing test. These results suggest that intradialytic exercise could be beneficial for patients with chronic kidney disease.
Source: Garrido-Ardila Elisa M. Medicina (Kaunas, Lithuania), Dec 2025; 61(12): 2204
Comparison of diagnostic characteristics of four frailty screening tools in maintenance hemodialysis patients
Abstract:
Source: Garrido-Ardila Elisa M. Medicina (Kaunas, Lithuania), Dec 2025; 61(12): 2204
Comparison of diagnostic characteristics of four frailty screening tools in maintenance hemodialysis patients
Abstract:
BACKGROUND: A variety of frailty assessment tools are used internationally, and there is variation in the selection of frailty assessment tools for patients undergoing maintenance hemodialysis (MHD). The most suitable tool for this population remains unclear. This study compared the validity of four frailty assessment tools-the Fried Phenotype, FRAIL Scale, Clinical Frailty Scale (CFS), and Tilburg Frailty Index (T)-among MHD patients. The aim is to provide a reference for healthcare professionals selecting appropriate tools.
METHODS: A convenience sample of 385 patients undergoing maintenance hemodialysis at two hemodialysis centers in Sichuan, China, from January to June 2025 was selected as the study population. All patients were assessed for frailty severity using four instruments. To minimize inclusion bias, the "leave-one-out" composite index (CI) was employed as the reference standard. Kappa statistics and McNemar's test were used to evaluate agreement between each tool and its corresponding CI. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, specicity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Decision curve analysis (DCA) evaluated clinical utility.
RESULTS: The Fried Phenotype demonstrated the strongest agreement with its CI (Kappa = 0.789, P < 0.001), indicating excellent concordance and no signicant marginal heterogeneity (McNemar's P = 1.000). The CFS also showed good agreement with its CI (Kappa = 0.716, P < 0.001) without signicant marginal heterogeneity (McNemar's P = 0.074). In contrast, while the FRAIL and T showed moderate agreement with their respective CIs (Kappa = 0.705 and 0.537; both P < 0.001), McNemar's test indicated signicant marginal heterogeneity for both (P < 0.001). The AUC was highest for the Fried Phenotype (0.90), followed by CFS (0.85), T (0.84), and FRAIL (0.82). The Fried Phenotype achieved the best balance between sensitivity (93%) and specicity (86%). Decision curve analysis conrmed its superior net benet across most clinical threshold probabilities.
CONCLUSION: The Fried Phenotype demonstrated the highest validity and diagnostic accuracy for frailty screening in MHD patients when benchmarked against a robust "leave-one-out" composite standard. The CFS also performed well with good agreement and discriminative ability. The FRAIL scale showed high sensitivity but lower specicity, while the T exhibited high specicity but poor sensitivity. Tool selection should be guided by clinical purpose-whether for screening, conrmation, or balanced assessment-to optimize frailty management in MHD patients and improve clinical outcomes.
Source: Guo, Xuemei. International Urology and Nephrology, Oct 2025;
Cognitive Frailty and Its Risk Factors Among Patients With Chronic Kidney Disease Receiving Hemodialysis: A Cross-Sectional Study
Abstract: Cognitive frailty can lead to an impaired functional capacity and a poor quality of life, especially in patients on hemodialysis. This study aimed to investigate cognitive frailty and its risk factors in patients with chronic kidney disease (CKD) receiving hemodialysis. A cross-sectional study was conducted between April and June 2021 involving 220 patients with CKD receiving hemodialysis at a hospital-based hemodialysis center in northern Taiwan. Data were collected using a structured survey covering demographics, cognitive function, physical frailty, depressive symptoms, physical activity, and nutritional status. Univariate and multivariate logistic regression models were used to identify risk factors for cognitive frailty. In total, 220 patients were recruited. Prevalences of cognitive impairment, physical frailty, depressive symptoms, and cognitive frailty were 46.8%, 10.0%, 52.3%, and 9%, respectively. Univariate and multivariate logistic regression analyses, adjusted for age, sex, and years of hemodialysis, identified malnutrition (aOR = 12.405; 95% CI = 3.29-46.81) and physical inactivity (aOR = 89.445; 95% CI = 5.87-1363.93) as significant risk factors for cognitive frailty. The study suggests the need for strategies to enhance physical activity and nutritional status to prevent cognitive frailty in patients with CKD receiving hemodialysis.
Source: Ho M. Nursing and Health Sciences, Sep 2025; 27(3): e70197
Multidimensional Determinants of Frailty in Haemodialysis Patients: The Overlooked Roles of Depression and Cognitive Function
Abstract:
Source: Guo, Xuemei. International Urology and Nephrology, Oct 2025;
Cognitive Frailty and Its Risk Factors Among Patients With Chronic Kidney Disease Receiving Hemodialysis: A Cross-Sectional Study
Abstract: Cognitive frailty can lead to an impaired functional capacity and a poor quality of life, especially in patients on hemodialysis. This study aimed to investigate cognitive frailty and its risk factors in patients with chronic kidney disease (CKD) receiving hemodialysis. A cross-sectional study was conducted between April and June 2021 involving 220 patients with CKD receiving hemodialysis at a hospital-based hemodialysis center in northern Taiwan. Data were collected using a structured survey covering demographics, cognitive function, physical frailty, depressive symptoms, physical activity, and nutritional status. Univariate and multivariate logistic regression models were used to identify risk factors for cognitive frailty. In total, 220 patients were recruited. Prevalences of cognitive impairment, physical frailty, depressive symptoms, and cognitive frailty were 46.8%, 10.0%, 52.3%, and 9%, respectively. Univariate and multivariate logistic regression analyses, adjusted for age, sex, and years of hemodialysis, identified malnutrition (aOR = 12.405; 95% CI = 3.29-46.81) and physical inactivity (aOR = 89.445; 95% CI = 5.87-1363.93) as significant risk factors for cognitive frailty. The study suggests the need for strategies to enhance physical activity and nutritional status to prevent cognitive frailty in patients with CKD receiving hemodialysis.
Source: Ho M. Nursing and Health Sciences, Sep 2025; 27(3): e70197
Multidimensional Determinants of Frailty in Haemodialysis Patients: The Overlooked Roles of Depression and Cognitive Function
Abstract:
AIM: This study aims to examine the level of frailty in patients undergoing haemodialysis treatment and investigate the effects of sociodemographic, psychological and clinical variables on frailty.
METHOD: A cross-sectional and correlational research design was employed with 386 haemodialysis patients over the age of 50. Data were collected using the Edmonton Frail Scale, Beck Depression Inventory, Standardized Mini-Mental Test and Eysenck Personality Questionnaire.
RESULTS: The study revealed that 48.4% of haemodialysis patients fell into the 'apparently frail' category, and frailty levels were significantly associated with age, depression and cognitive functions (p < 0.05). However, no significant effect of gender, marital status, educational level, chronic diseases or personality traits on frailty was identified. CONCLUSIONS: Most haemodialysis patients were found to be apparently frail, with frailty levels increasing with age. Furthermore, frailty was linked to higher levels of depressive symptoms and lower cognitive function. Evaluating depression and cognitive function is crucial for alleviating frailty symptoms and improving quality of life.
Source: İncazlı Seçil B. International Journal of Nursing Practice, Oct 2025; 31(5): e70042
Prevalence and Influence Factors of Cognitive Frailty in the Older Adult Patients Undergoing Maintenance Haemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
Source: İncazlı Seçil B. International Journal of Nursing Practice, Oct 2025; 31(5): e70042
Prevalence and Influence Factors of Cognitive Frailty in the Older Adult Patients Undergoing Maintenance Haemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
AIMS: To examine the prevalence of factors of cognitive frailty in patients undergoing maintenance haemodialysis (MHD).
DESIGN: A cross-sectional study.
METHODS: From September 2023 to January 2024, 1023 patients undergoing MHD were recruited from 11 hospitals in Chengdu, China, using convenience sampling. The participants' sociodemographic and lifestyle factors, health information and laboratory indicators were assessed using a general information questionnaire. Cognitive frailty was assessed using the Fried Frailty Phenotype and Montreal Cognitive Assessment Scales. Multivariate logistic regression was used to examine the associations between cognitive frailty and sociodemographic and clinical characteristics. Independent variables for the multivariate logistic regression model encompassing age, sex, educational level, marital status, visual impairment, hearing impairment, falls within a year, depression, weight, height, Malnutrition-inflammation score and serum albumin, sodium, phosphorus, total cholesterol and creatinine levels.
RESULTS: Among 1023 participants with a mean age of 69.52 years, 300 (29.3%) had cognitive frailty, with a predominance of older patients. Regression analysis showed that advanced age, low literacy and low serum creatinine, sodium and total cholesterol levels were positively correlated with cognitive frailty. Furthermore, 17.1% of the participants experienced depression, a risk factor for cognitive frailty, and malnutrition was an independent risk factor for cognitive frailty.
CONCLUSION: Older adult patients undergoing (MHD) are at an increased risk of developing cognitive frailty. The aetiology of cognitive frailty in this cohort was multifactorial. Targeted interventions should be designed and implemented based on these factors, prioritising nutritional guidance and mood management to prevent or reverse cognitive frailty. REPORTING METHOD: The study adhered to the STROBE checklist.
IMPACT: Older adult patients undergoing MHD are at increased risk of developing cognitive frailty. Cognitive frailty screening must be incorporated into the routine assessment of older patients undergoing MHD.
PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Source: Li S. Journal of Clinical Nursing, Sep 2025; 34(9): 3693-3703
Frailty and Outcomes in Elderly ICU Patients: Insights from a Portuguese Cohort
Abstract:
Source: Li S. Journal of Clinical Nursing, Sep 2025; 34(9): 3693-3703
Frailty and Outcomes in Elderly ICU Patients: Insights from a Portuguese Cohort
Abstract:
Background: Frailty is a key determinant of outcomes in critically ill elderly patients, but data from Portugal remain limited. To our knowledge, this is the first study to examine the prevalence and prognostic impact of frailty among elderly ICU patients in a Portuguese hospital setting.
Objective: To determine the prevalence of frailty among elderly patients admitted to an intensive care unit (ICU) in southern Portugal and to examine its crude associations with illness severity, organ support, and mortality outcomes.
Methods: We conducted a retrospective cohort study including 125 patients aged ≥ 65 years admitted to the polyvalent ICU of Hospital de Faro over the last six months of 2024. Data included demographics, comorbidities, Charlson Comorbidity Index (CCI), severity scores (SOFA, SAPS II, APACHE II), and frailty status assessed by the Clinical Frailty Scale (CFS). Outcomes were the need for organ support, ICU and hospital mortality, and length of stay. Results: Frailty (CFS ≥ 5) was identified in 30.4% of patients. Frail patients were older, had higher comorbidity burden (CCI), and presented with significantly higher severity scores at admission. They also required more invasive support, including vasopressors and invasive mechanical ventilation, while acute kidney injury (AKI) requiring renal replacement therapy (RRT) was similar between groups. ICU mortality was significantly higher among frail patients (50.0% vs. 31.0%), as was hospital mortality (76.3% vs. 33.3%). Length of ICU stay did not differ, although frail patients tended to have longer hospitalizations overall.
Conclusions: Frailty was highly prevalent and strongly associated with increased severity, greater need for organ support, and higher mortality. Routine frailty assessment at ICU admission may enhance prognostic accuracy and support patient-centered decision-making.
Source: Lourenço E. Healthcare (Basel, Switzerland), Nov 2025; 13(23): 3063
Falls, Frailty and Quality of Life Among Individuals on a Regular Haemodialysis Programme: Implications for Rehabilitation Nursing
Abstract:
Source: Lourenço E. Healthcare (Basel, Switzerland), Nov 2025; 13(23): 3063
Falls, Frailty and Quality of Life Among Individuals on a Regular Haemodialysis Programme: Implications for Rehabilitation Nursing
Abstract:
BACKGROUND: Chronic kidney disease and haemodialysis treatment are associated with physiological and functional alterations that compromise postural stability, favouring frailty and the risk of falls. These conditions directly affect the quality of life and autonomy of people undergoing haemodialysis, constituting an important challenge for rehabilitation nursing. In this sense, the aim of this study was to analyse the relationship between falls, frailty and quality of life in people with chronic kidney disease on a regular haemodialysis programme, identifying implications for rehabilitation nursing care.
METHODS: This was a quantitative, observational and cross-sectional study conducted with 62 participants from a haemodialysis unit in northern Portugal. The Tilburg Frailty Indicator and the Kidney Disease Quality of Life Instrument (KDQOL-SF™ 1.3) were applied. Statistical analysis used parametric and non-parametric tests, considering a significance level of p < 0.05.
RESULTS: The prevalence of falls in the year preceding the data collection was 32.2%, and the prevalence of frailty was 40.3%. A significant association was found between frailty and falls (p = 0.038) and between sex and falls (p = 0.002). The dimensions Symptoms/problems and Effects of kidney disease on daily life showed lower scores among participants with falls (p < 0.001).
CONCLUSIONS: Frailty and poorer illness perception were associated with the occurrence of falls and with lower quality of life. Comprehensive assessment and the implementation of rehabilitation programmes led by specialist nurses in rehabilitation nursing are essential to promote functionality, safety and autonomy in people undergoing haemodialysis.
Source: Martins Marisa P. International Journal of Environmental Research and Public Health, Dec 2025; 23(1): 15
The Effect of Frailty on Quality of Life in Older Patients Receiving Hemodialysis and Associations With Fear of Falling
Abstract:
Source: Martins Marisa P. International Journal of Environmental Research and Public Health, Dec 2025; 23(1): 15
The Effect of Frailty on Quality of Life in Older Patients Receiving Hemodialysis and Associations With Fear of Falling
Abstract:
PURPOSE: This study investigated the effect of frailty and avoidance behavior due to fear of falling on the quality of life in older patients receiving hemodialysis treatment.
METHODS: This study is cross-sectional and descriptive. The study was conducted between January 2 and 31, 2022, with 154 individuals aged 65 years and over receiving treatment in dialysis centers. The study data were collected using the Patient Information Form, Edmonton Frail Scale, Fear of Falling Avoidance-Behavior Questionnaire, and Quality of Life Scale (SF-12).
RESULTS: The Mean Edmonton Frail Scale score was found to be 8.7 ± 3.36, the mean Fear of Falling Avoidance-Behavior Questionnaire score was found to be 33.17 ± 9.11, the mean SF-12 physical component score was found to be 34.32 ± 8.51, and the mean mental component score was seen as 41.77 ± 8.35. The Fear of Falling Avoidance-Behavior Questionnaire was an associated factor in the effect of the Edmonton Frail Scale on quality of life. It strengthened the negative impact of the Edmonton Frail Scale on quality of life. The predictive effect of these two variables in explaining quality of life was 59.3%.
CONCLUSION: It was found that the participants had moderate levels of frailty, moderate levels of activity limitation, and participation restriction due to fear of falling, and low levels of physical and mental quality of life. It was determined that frailty had a direct impact on quality of life. Also, the indirect effect of frailty on quality of life was determined through the role of avoidance behavior due to fear of falling.
Source: Özer Z. Hemodialysis International. International Symposium on Home Hemodialysis, Jul 2025; 29(3): 371-380
Renal frailty
Abstract: Renal Frailty is a quality improvement project to improve the experiences and outcomes for frail or older patients with advanced kidney disease by integrating assessment and support into routine care.
Information for patients and carers about being an older person with kidney failure.
Source: Prima G. Imperial College Healthcare NHS Trust, Sep 2025
Quality of life experience in physically frail people on renal dialysis: A qualitative meta-synthesis on the difficulties and resources for better health care
Abstract:
Source: Özer Z. Hemodialysis International. International Symposium on Home Hemodialysis, Jul 2025; 29(3): 371-380
Renal frailty
Abstract: Renal Frailty is a quality improvement project to improve the experiences and outcomes for frail or older patients with advanced kidney disease by integrating assessment and support into routine care.
Information for patients and carers about being an older person with kidney failure.
Source: Prima G. Imperial College Healthcare NHS Trust, Sep 2025
Quality of life experience in physically frail people on renal dialysis: A qualitative meta-synthesis on the difficulties and resources for better health care
Abstract:
OBJECTIVE: This study aimed to summarize the quality of life experiences of individuals with physical frailty undergoing hemodialysis or peritoneal dialysis and to identify the difficulties and resources that enable better person-centered health care.
METHODS: The study described is a qualitative meta-synthesis literature review. The search was performed in databases such as CINAHL, Scopus, PubMed, Web of Science, the Cochrane Library, and Cuiden Plus through Medical Subject Headings and free terms. Qualitative and mixed studies were included on individuals undergoing hemodialysis or peritoneal dialysis, 18 years of age or older, published in English or Spanish, between January 2013 and January 2024. The Mixed Methods Appraisal Tool was used to assess the methodological quality. The information was analyzed and coded through a socioecological model and the social determinants of health.
RESULTS: Fourteen qualitative and two mixed articles were selected. A total of 256 individuals participated in the study. Seventeen themes and 25 sub-themes were identified and grouped into two blocks (difficulties and resources). The difficulties that stood out were a low tolerance for activities of daily living and physical activity, loss of self-control over life and social roles, and lack of community and public resources. As for the resources, the following was found: the positive meaning of dialysis, the safety offered by close individuals and the healthcare team, the activation of specific programs, and person-centered policies.
CONCLUSIONS: The analysis and interpretation of the identified difficulties and resources revealed key elements to consider when designing and implementing health programs for individuals undergoing dialysis. Future research should explore these dimensions in diverse cultural and geographical contexts to enhance generalizability and support health equity.
Source: Ramírez-García A. International Journal of Nursing Sciences, Jun 2025; 12(4): 344-351
Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis
Abstract:
Source: Ramírez-García A. International Journal of Nursing Sciences, Jun 2025; 12(4): 344-351
Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis
Abstract:
OBJECTIVES: This study aims to systematically quantify the prevalence of falls in people on hemodialysis and to assess risk factors associated with falls by synthesizing emerging best evidence.
METHODS: A comprehensive search was conducted across ten databases from their inception to February 27, 2025. The research team independently conducted study selection, quality assessments, data extraction, and analyses of all included studies. Meta-analysis was performed using random-effects and fixed-effects models. The PRISMA guidelines were used to report the systematic review and meta-analysis.
RESULTS: A total of 31 studies, comprising 191,800 individuals, were included in the analysis. The pooled prevalence of falls in people on hemodialysis was 27.1%. The meta-analysis of risk factors included 19 studies. After controlling for confounding variables, 12 risk factors were associated with falls, including older age, female gender, longer dialysis duration, diabetes mellitus, peripheral vascular disease, paralysis, antidepressant use, frailty, use of walking aids, malnutrition, intradialytic hypotension, and low hemoglobin levels.
CONCLUSIONS: This study provides an updated, evidence-based assessment of the prevalence and risk factors of falls in people on hemodialysis, confirming their multifactorial etiology. Screening and interventions should be implemented promptly to mitigate the adverse outcomes of falls in people on hemodialysis.
REGISTRATION NUMBER: PROSPERO CRD42024525375.
Source: Tang J. Renal Failure, Dec 2025; 47(1): 2485375
A qualitative study describing the perspectives on frailty and its management in individuals with kidney failure
Abstract:
Source: Tang J. Renal Failure, Dec 2025; 47(1): 2485375
A qualitative study describing the perspectives on frailty and its management in individuals with kidney failure
Abstract:
Key Points:
Methods: We recruited participants from four Canadian kidney programs in Alberta, Manitoba, and Nova Scotia from January 2021 to June 2023. We conducted focus groups and semistructured interviews with patients (50 years or older with dialysis-dependent or nondependent kidney failure), caregivers, allied health care professionals, and nephrologists. We used qualitative description and inductive thematic analysis to describe their perspectives.
Results: Ninety-one people participated: patients (N=31), caregivers (N=8), kidney allied health care professionals (N=38), and nephrologists (N=14). We identified three themes, each with subthemes: (1) What is frailty? All groups expressed uncertainty, but frailty was commonly described as physical, visible, inevitable, and fixed; (2) discussing frailty: the value of knowing what to expect with frailty, and frailty as a difficult topic to discuss; (3) frailty assessment and management: skepticism from patients and caregivers that frailty is measurable; support from clinicians for a systematic approach to identifying frailty but a lack of knowledge on multidisciplinary roles and potential interventions. For all groups, having actionable solutions after identifying frailty was key for acceptability and successful implementation.
Conclusions: Education on the nature and potentially modifiable aspects of frailty as well as the scope and potential benefits of frailty interventions is necessary for successful implementation of frailty detection and management in kidney care.
- The term, frailty, had unclear meaning for most participants but was commonly explained as weakness, dependence, and unmodifiable.
- Knowledge of frailty assessment tools and the evidence to support their prognostic utility was low among clinicians.
- Though patients and caregivers saw value in discussing frailty, the label of frailty was often viewed as pejorative.
Methods: We recruited participants from four Canadian kidney programs in Alberta, Manitoba, and Nova Scotia from January 2021 to June 2023. We conducted focus groups and semistructured interviews with patients (50 years or older with dialysis-dependent or nondependent kidney failure), caregivers, allied health care professionals, and nephrologists. We used qualitative description and inductive thematic analysis to describe their perspectives.
Results: Ninety-one people participated: patients (N=31), caregivers (N=8), kidney allied health care professionals (N=38), and nephrologists (N=14). We identified three themes, each with subthemes: (1) What is frailty? All groups expressed uncertainty, but frailty was commonly described as physical, visible, inevitable, and fixed; (2) discussing frailty: the value of knowing what to expect with frailty, and frailty as a difficult topic to discuss; (3) frailty assessment and management: skepticism from patients and caregivers that frailty is measurable; support from clinicians for a systematic approach to identifying frailty but a lack of knowledge on multidisciplinary roles and potential interventions. For all groups, having actionable solutions after identifying frailty was key for acceptability and successful implementation.
Conclusions: Education on the nature and potentially modifiable aspects of frailty as well as the scope and potential benefits of frailty interventions is necessary for successful implementation of frailty detection and management in kidney care.
Source: Thompson S. Clinical Journal of the American Society of Nephrology, 2025; 10.2215
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The Relationship Between Xerostomia, Nutrition, and Frailty in Older Patients Undergoing Hemodialysis
Abstract: Older adults receiving hemodialysis are at increased risk for xerostomia, poor nutritional status, and frailty, all of which significantly impact clinical outcomes and quality of life. This cross-sectional study examined interrelationships among xerostomia, nutrition, and frailty in patients aged 60 and older undergoing maintenance hemodialysis. Conducted between October 2022 and June 2023 in five dialysis centers, the study included 176 participants on hemodialysis for at least 3 months. Data were collected through face-to-face interviews using validated instruments: the Short Xerostomia Inventory, Mini Nutritional Assessment-Short Form, and Edmonton Frailty Scale. Pearson's correlation and path analysis using the Maximum Likelihood method were employed. Although xerostomia was reported at a low rate, many patients were at risk of malnutrition and showed varying degrees of frailty. Xerostomia was negatively associated with nutritional status and positively with frailty, while better nutritional status was linked to lower frailty. Path analysis revealed that xerostomia and nutritional status together explained nearly 50% of frailty variance. These findings underscore the importance of early identification and multidisciplinary management to reduce frailty and improve outcomes in older adults undergoing hemodialysis.
Source: Uslu A. Nursing and Health Sciences, Sep 2025; 27(3): e70203
Prevalence and influencing factors of cognitive frailty in Chinese maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
The Relationship Between Xerostomia, Nutrition, and Frailty in Older Patients Undergoing Hemodialysis
Abstract: Older adults receiving hemodialysis are at increased risk for xerostomia, poor nutritional status, and frailty, all of which significantly impact clinical outcomes and quality of life. This cross-sectional study examined interrelationships among xerostomia, nutrition, and frailty in patients aged 60 and older undergoing maintenance hemodialysis. Conducted between October 2022 and June 2023 in five dialysis centers, the study included 176 participants on hemodialysis for at least 3 months. Data were collected through face-to-face interviews using validated instruments: the Short Xerostomia Inventory, Mini Nutritional Assessment-Short Form, and Edmonton Frailty Scale. Pearson's correlation and path analysis using the Maximum Likelihood method were employed. Although xerostomia was reported at a low rate, many patients were at risk of malnutrition and showed varying degrees of frailty. Xerostomia was negatively associated with nutritional status and positively with frailty, while better nutritional status was linked to lower frailty. Path analysis revealed that xerostomia and nutritional status together explained nearly 50% of frailty variance. These findings underscore the importance of early identification and multidisciplinary management to reduce frailty and improve outcomes in older adults undergoing hemodialysis.
Source: Uslu A. Nursing and Health Sciences, Sep 2025; 27(3): e70203
Prevalence and influencing factors of cognitive frailty in Chinese maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
OBJECTIVE: Chronic kidney disease (CKD) has become a major challenge in global public health, and China has one of the heaviest burdens of CKD in the world, approximately 89.5% of patients require hemodialysis. Cognitive frailty (CF) is a condition characterized by physical frailty and cognitive impairment while excluding Alzheimer's disease and other dementias. CF is associated with adverse clinical outcomes, including hospitalization, disability, and increased mortality. The purpose of this study was to explore the prevalence and influencing factors of CF in Chinese maintenance hemodialysis (MHD) patients through systematic review and meta-analysis.
METHODS: We searched PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journal Database (VIP) and Chinese Biomedical Database (CBM) for epidemiological data on CF in Chinese patients undergoing MHD from inception to December 2024. A random-effects model was used to estimate the overall prevalence of CF in Chinese patients undergoing MHD. Odds ratios (OR) and 95% confidence intervals (CI) were used to estimate factors associated with CF in Chinese patients undergoing MHD. Stata 15.0 software was used to conduct systematic review and meta-analysis of the prevalence and influencing factors of CF in Chinese patients undergoing MHD.
RESULTS: A total of 16 studies with 5690 Chinese patients undergoing MHD were included. The results of this meta-analysis showed that the prevalence of CF in Chinese patients undergoing MHD was 25%. The results of subgroup analyses showed that the frailty assessment tool (TFI) and education level (≥ College) may be sources of heterogeneity in the prevalence of CF in Chinese patients undergoing MHD. The meta-analysis results indicate that age (> 60, > 75), female, depression (HADS scale), malnutrition, triglycerides, waist circumference, stroke history, fall history, complications, CCI, comorbidities and dialysis age were risk factors for CF. High education level, calf circumference and serum creatinine level were protective factors for CF.
CONCLUSIONS: The prevalence of CF in Chinese patients undergoing MHD is high (25%). Therefore, this patient population necessitates early screening and targeted interventions with influencing factors.
PROSPERO REGISTRATION NUMBER FOR THIS STUDY: CRD42023493122CRD42023475424.
Source: Wei, X. BMC Nephrology, Jul 2025; 26(1): 365-9
Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients
Abstract: This review evaluates the effectiveness of nutritional supplementation combined with exercise training on frailty characteristics, physical function, and health-related quality of life in patients with chronic kidney disease (CKD). A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted, identifying 7 articles (9 trials, 324 patients). Meta-analysis showed that combined interventions improved frailty characteristics, such as walking speed (mean difference: 0.09 m/s, 95% confidence interval (CI): 0.02 to 0.16) and physical functioning, including cardiorespiratory fitness (standardized mean difference: 0.56, 95% CI: 0.20 to 0.93) and lower extremity mobility (Timed Up and Go test: -1.11 s, 95% CI: -1.79 to -0.43). However, effects on body weight, fatigue, and health-related quality of life remain uncertain. Due to study heterogeneity and small sample sizes, findings should be interpreted cautiously. Larger, long-term studies are needed to confirm these results and explore additional health outcomes.
Source: Zhang F. Journal of Renal Nutrition, Mar 2025; 35(2): 259-270
Cognitive frailty in maintenance hemodialysis: a scoping review
Abstract:
Source: Wei, X. BMC Nephrology, Jul 2025; 26(1): 365-9
Investigating the complex relationship and influencing factors of frailty on nutritional status in maintenance hemodialysis patients
Abstract: This review evaluates the effectiveness of nutritional supplementation combined with exercise training on frailty characteristics, physical function, and health-related quality of life in patients with chronic kidney disease (CKD). A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted, identifying 7 articles (9 trials, 324 patients). Meta-analysis showed that combined interventions improved frailty characteristics, such as walking speed (mean difference: 0.09 m/s, 95% confidence interval (CI): 0.02 to 0.16) and physical functioning, including cardiorespiratory fitness (standardized mean difference: 0.56, 95% CI: 0.20 to 0.93) and lower extremity mobility (Timed Up and Go test: -1.11 s, 95% CI: -1.79 to -0.43). However, effects on body weight, fatigue, and health-related quality of life remain uncertain. Due to study heterogeneity and small sample sizes, findings should be interpreted cautiously. Larger, long-term studies are needed to confirm these results and explore additional health outcomes.
Source: Zhang F. Journal of Renal Nutrition, Mar 2025; 35(2): 259-270
Cognitive frailty in maintenance hemodialysis: a scoping review
Abstract:
PURPOSE: To conduct a scoping review of the related research on cognitive frailty (CF) in maintenance hemodialysis (MHD) patients, so as to provide a basis for early diagnosis, treatment and intervention of CF in MHD patients.
METHODS: Utilizing a scoping review approach, we searched PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, the China Biological Medicine Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu (VIP) for literature on CF in MHD patients up to October 20, 2024. Two researchers conducted independent screening and data extraction of the literature's fundamental characteristics. The study is registered in OSF (https://doi.org/10.17605/OSF.IO/H6Q89).
RESULTS: The review included 21 articles, revealing a concerningly high prevalence of CF in MHD patients, ranging from 4.6 to 56.4%. Six diagnostic combinations were identified, with the combination of Frailty Phenotype (FP), Montreal Cognitive Assessment (MOCA), and Clinical Dementia Rating (CDR) scales being the most prevalent. Influencing factors were categorized into demographic and lifestyle, physical condition, disease-related and psychosocial aspects. Interventions included exercise, cognitive therapy combined with exercise, social support and predictive nursing, yet there remains a scarcity of intervention studies.
CONCLUSION: The prevalence of CF in MHD patients is high; however, understanding of CF in MHD patients is insufficient. There are many types of assessment tools, but there is a lack of unified standards and specificity; the influencing factors are complex and diverse; and prevention and intervention studies are scarce.
Source: Zhang K. International Urology and Nephrology, Jul 2025; 57(7): 2159-2169
Source: Zhang K. International Urology and Nephrology, Jul 2025; 57(7): 2159-2169
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Prevalence and Associated Factors of Social Frailty in Older Patients on Maintenance Hemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
Prevalence and Associated Factors of Social Frailty in Older Patients on Maintenance Hemodialysis: A Multi-Centre Cross-Sectional Study
Abstract:
INTRODUCTION: Given that social frailty is closely associated with adverse health outcomes among older maintenance hemodialysis (MHD) patients, this study aimed to investigate the prevalence of social frailty among older MHD patients, with an emphasis on its correlation with factors such as family functioning, self-care ability, depression, and physical frailty. METHODS: A multi-center cross-sectional investigation was conducted to recruit older patients with MHD between September and December 2024 from four hemodialysis centers in four tertiary hospitals in Sichuan Province, China. Self-report scales were employed to collect general information and assess the participants' social frailty, family functioning, depression, and physical frailty. Univariate analysis and binary logistic regression analysis were adopted to determine the predictors of social frailty.
RESULTS: A total of 386 older MHD patients were included in the analysis. Of the participants, 205 (53.1%) were diagnosed with social frailty. Binary logistic regression analyses demonstrated that family functioning (OR = 0.863, 95% CI: 0.776-0.960, p = 0.007), self-care ability (OR = 3.527, 95% CI: 1.958-6.352, p < 0.001), depression (OR = 2.007, 95% CI: 1.180-3.415, p = 0.010), and physical frailty (OR = 2.261, 95% CI: 1.237-4.133, p = 0.008) were significantly associated with social frailty among older MHD patients.
CONCLUSIONS: Social frailty is highly prevalent among older patients with MHD. In addition, family function, self-care ability, depression, and physical frailty were detected to be independently associated with social frailty. These findings could facilitate the refinement of daily care strategies for older patients with MHD to reduce or mitigate the negative effects of social frailty.
Source: Zhang Q. Therapeutic Apheresis and Dialysis, Dec 2025; 29(6): 878-884
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of studies from China
Abstract:
Source: Zhang Q. Therapeutic Apheresis and Dialysis, Dec 2025; 29(6): 878-884
Frailty risk prediction models in maintenance hemodialysis patients: a systematic review and meta-analysis of studies from China
Abstract:
OBJECTIVES: To systematically evaluate and meta-analyze the performance, validity, and influencing factors of frailty risk prediction models specifically developed for patients undergoing maintenance hemodialysis in China.
METHODS: China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, SinoMed, PubMed, Web of Science, Cochrane Library, CINAHL and Embase were searched from inception to October 10, 2024. Two independent reviewers conducted literature screening, data extraction, and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed to pool the incidence rates and identify independent predictors.
RESULTS: Fourteen studies incorporating 16 distinct frailty risk prediction models were included. The predictive accuracy, measured by the area under the receiver operating characteristic curve (AUC), ranged from 0.819 to 0.998. Seven studies performed internal validation, one study executed external validation, and one study conducted both internal and external validation. All studies exhibited a high overall risk of bias. Pooled incidence of frailty among maintenance hemodialysis patients was 32.2% (95% CI: 26.9%-37.6%). Significant predictors of frailty included advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression (p < 0.05).
CONCLUSIONS: The pooled incidence of frailty among maintenance hemodialysis patients was notably high at 32.2%, with advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression emerging as significant predictors. Existing frailty prediction models for maintenance hemodialysis patients demonstrated robust predictive capacity but exhibited substantial methodological limitations, high bias and limited external validation. Future research should prioritize multicenter, large sample, validation studies to enhance applicability and reliability.
Source: Zhang Z. Renal Failure, Dec 2025; 47(1): 2500663
Construction and Evaluation of a Novel Nomogram for Predicting Dual Dimensional Frailty in Older Maintenance Haemodialysis Patients
Abstract:
Source: Zhang Z. Renal Failure, Dec 2025; 47(1): 2500663
Construction and Evaluation of a Novel Nomogram for Predicting Dual Dimensional Frailty in Older Maintenance Haemodialysis Patients
Abstract:
OBJECTIVE: To construct and evaluate a novel nomogram for predicting the risk of dual dimensional frailty (comorbidity between physical frailty and social frailty) in older maintenance haemodialysis.
METHODS: A cross-sectional investigation was conducted. A total of 386 older MHD patients were recruited between September and December 2024 from four haemodialysis centres in four tertiary hospitals in Sichuan Province, China. LASSO regression and binary logistic regression were employed to determine the predictors of dual dimensional frailty. The prediction performance of the model was evaluated by discrimination and calibration. The decision curve was utilised to estimate the clinical utility. Internal validation with 1000 bootstrap samples was conducted to minimise overfitting.
RESULTS: In the overall sample (386 cases), a total of 92 (23.8%) of patients exhibited dual dimensional frailty. Five relevant predictors, including physical activity, self-perceived health status, ADL impairment, malnutrition, and self-perceptions of aging, were identified for constructing the nomogram. Internal validation indicated excellent discriminatory power and calibration of the model, while the clinical decision curve demonstrated its remarkable clinical utility.
CONCLUSIONS: The novel nomogram constructed in this study holds promise for aiding healthcare professionals in identifying physical and social frailty risks among older patients on maintenance haemodialysis, potentially informing early and targeted interventions. RELEVANCE TO CLINICAL PRACTICE: This nomogram enables nurses to efficiently stratify dual-dimensional frailty risk during routine assessments, facilitating early identification of high-risk patients. Its visual output can guide tailored interventions, such as exercise programmes, nutritional support, and counselling, while optimising resource allocation.
PATIENT OR PUBLIC CONTRIBUTION: Data were collected from self-reported conditions and patients' clinical information.
REPORTING METHOD: STROBE checklist was employed.
Source: Zhou X. Journal of Clinical Nursing, Dec 2025; 34(12): 5315-5327
Utilizing Frailty Assessment to Impact Nursing Care for Patients with End Stage Kidney Disease: A Quality Improvement Project
Abstract: Frailty is highly prevalent in patients with end stage kidney disease (ESKD) and predictive of morbidity. Nurses lack frailty education and face practical challenges to assessment, which prevent effective interventions to address frailty. A quality improvement project sought to determine if frailty education and utilization of a renal frailty index tool impacts telephonic case management nursing care of patients by improving knowledge, perception, identification, and assessment of frailty, thereby prompting nursing interventions. Positive impacts were seen across all outcomes influencing outreach and resource utilization by nurses. Limitations included a small sample size, time burden, and manual processes. Findings suggest the importance of embedding frailty care into daily practice, automation of frailty scoring, and expansion into advanced practice to improve quality of care and reduce cost of care.
Source: Zimmerman P. Nephrology Nursing Journal, 2025; 52(4): 373-386
Source: Zhou X. Journal of Clinical Nursing, Dec 2025; 34(12): 5315-5327
Utilizing Frailty Assessment to Impact Nursing Care for Patients with End Stage Kidney Disease: A Quality Improvement Project
Abstract: Frailty is highly prevalent in patients with end stage kidney disease (ESKD) and predictive of morbidity. Nurses lack frailty education and face practical challenges to assessment, which prevent effective interventions to address frailty. A quality improvement project sought to determine if frailty education and utilization of a renal frailty index tool impacts telephonic case management nursing care of patients by improving knowledge, perception, identification, and assessment of frailty, thereby prompting nursing interventions. Positive impacts were seen across all outcomes influencing outreach and resource utilization by nurses. Limitations included a small sample size, time burden, and manual processes. Findings suggest the importance of embedding frailty care into daily practice, automation of frailty scoring, and expansion into advanced practice to improve quality of care and reduce cost of care.
Source: Zimmerman P. Nephrology Nursing Journal, 2025; 52(4): 373-386
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Effects of intradialytic exercise on frailty in maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
Effects of intradialytic exercise on frailty in maintenance hemodialysis patients: a systematic review and meta-analysis
Abstract:
BACKGROUND: The pooled prevalence of frailty in maintenance hemodialysis patients is increasing, and research on the effects of intradialytic exercise to improve frailty remains limited.
OBJECTIVES: To analyze the effects of intradialytic exercise on frailty in maintenance hemodialysis patients through randomized clinical trials and quasi-experimental studies. METHODS: We performed a comprehensive literature search in PubMed, Embase, Web of Science, and Cochrane Library, and English-language publications were indexed from January 2010 to August 2024. Statistical analyses were performed using Review Manager V.5.3 and STATA 15.0. Statistical heterogeneity among studies was quantified using the Chi-square and I-square tests, and publication bias was evaluated using Egger's test and funnel plots. RESULTS: 31 studies involving 1,365 maintenance hemodialysis patients were included. The data from the meta-analysis showed that intradialytic exercise significantly reduced frailty score (MD = -0.98, 95%CI: 1.90 to -0.06, p = 0.04) and fatigue (SMD = -0.47, 95%CI: 0.72 to -0.23, p = 0.0001). Also, intradialytic exercise significantly increased grip strength (MD = 2.42, 95%CI:0.78 to 4.06, p = 0.004), 6-min walking distance (MD = 36.65, 95%CI:24.90 to 48.39, p < 0.0001), and step counts (SMD = 0.32, 95%CI:0.04 to 0.60, p = 0.03). However, no significant effects were found in body weight (MD = 0.71, 95%CI: 1.28 to 2.69, p = 0.48). CONCLUSION: Intradialytic exercise can significantly improve overall frailty and frailty indicators such as grip strength, 6-min walking distance, step counts, and fatigue. Thus, intradialytic exercises might be a viable strategy for frailty in maintenance hemodialysis patients.
SYSTEMATIC REVIEW REGISTRATION: CRD42024576582.
Source: Zou Zhao H. Frontiers in Physiology, Nov 2025; 16: 1600219
A review of the impact of exercise on fall rates among community-dwelling older adults
Abstract:
Source: Zou Zhao H. Frontiers in Physiology, Nov 2025; 16: 1600219
A review of the impact of exercise on fall rates among community-dwelling older adults
Abstract:
Background: The physical decrements of aging predispose older adults to falls and fall-related injuries. Consequences of falling place financial and logistical burdens on the health care system. With an aging population, mitigation of risk and reduction of harm are important objectives. Studies show that exercise can improve balance and build muscle mass. The challenge is prescribing safe and evidence-based exercise regimens to older adults.
Objective(s): The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community.
Objective(s): The objective of this evidence review was to determine if an exercise program can reduce fall rates and prolong functional independence among older adults living in the community.
Data sources: This review included 14 randomized control trials and one quasi-experimental interventional study, all published between 2014 and 2020.
Conclusion(s): The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults.
Conclusion(s): The evidence suggests that a home- or community-based exercise program with formal instruction and health care provider involvement can be an effective fall-prevention and harm reduction strategy for community-dwelling older adults.
Implications for practice: The evidence suggests that a home- or community-based exercise program may be an effective fall-prevention strategy for older adults living independently in the community. Health care providers should educate these patients about the benefits of exercise as a fall-prevention measure and assist patients in increasing participation in exercise programs by making referrals and promoting engagement in evidence-based exercise programs.
Source: Journal of the American Association of Nurse Practitioners, 2022; 34(2): 247-251
Source: Journal of the American Association of Nurse Practitioners, 2022; 34(2): 247-251
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