Prevalence and associated factors of hospitalisation-associated disability in older adults: a systematic review and meta-analysis.

INTRODUCTION: Hospitalisation-associated disability (HAD) is a significant adverse outcome in older adults, leading to increased healthcare burden. This systematic review aimed to ascertain the prevalence and associated factors of HAD in older adults. METHODS: Eight databases, including PubMed, CINAHL, Embase, the Cochrane Library, Chinese Biomedical, China National Knowledge Infrastructure, WanFang and VIP Chinese Journal Database (VIP), were searched from inception to November, 2025. Data were extracted using a predefined form, and study quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. A meta-analysis was used to estimate the pooled prevalence of HAD. RESULTS: Forty-six studies comprising 439 406 older adults from 15 regions were included. Individual study HAD prevalence ranged from 5% to 57%. The pooled prevalence was 27% (95% confidence interval: 24%-31%). The 95% prediction interval was 7%-48%. Subgroup analyses revealed that the number of HAD publications increased over the years, while the prevalence demonstrated a rebound after a decline. Moreover, a higher prevalence was observed in randomised controlled trials, among patients with lower respiratory tract infections, those aged 75-89 years, in using pre-admission baseline, and when the modified Barthel index was used for assessment. CONCLUSIONS: HAD affects a substantial proportion of older inpatients, while a wide prediction interval. The prevalence may be associated with differences in collection period, study design, patient characteristics and assessment methods. In clinical practice, early identification of high-risk groups and the use of standardised prospective assessments with pre-admission baseline may be considered. These suggestions require confirmation in well-designed prospective studies.