Journal of the American Medical Directors Association
Special ArticleFrailty: An Emerging Public Health Priority
Section snippets
Prevalence of Frailty
Recently, a systematic review was conducted to estimate the prevalence of frailty in older persons.11 Authors considered data from 21 studies and more than 61,500 community-dwelling older persons. The reported prevalence varied substantially across studies, ranging from 4.0% to 59.1% according to the adopted operational definition of frailty and the characteristics of the studied sample. Nevertheless, when analyses were restricted to studies using the phenotype model proposed by Fried and
The Course and Outcomes of Frailty
The predictive value of frailty for negative outcomes is consistently confirmed across assessment instruments, target populations, and settings. The increased risk of negative health-related events includes falls, hospitalizations, disability, institutionalization, and mortality.8, 9 Nevertheless, the course of frailty varies from individual to individual and it is capable of change. In a study by Gill and colleagues,25 nondisabled individuals aged 70 years or older were followed over time to
Evidence-based Interventions for Targeting Frail Older People
Functional health at old age is the result of the cumulative effects of disease and physiologic changes occurring with ageing.29 The age-related accumulation of deficits is also influenced by the individual's behaviors as well as social and economic factors (eg, access to health care) to which the person is exposed during his or her life. It follows that the health status of an older person should not only be “cross-sectionally” assessed, but also assessed “longitudinally” through a careful
Realigning Health Systems for Frailty Care Programs
As any other preventive strategy, the intervention for frailty should be evaluated after an adequate time period, in particular for appreciating its possible cost-effectiveness.42 It is likely that during the scaling-up phase such activity may lead to an increase in health care costs, for example, due to staff training, screening and assessment procedures, and additional investigations and interventions once a clinical problem is detected. Benefits may be considerable, but would be accrued some
Measurements for Frailty
Multiple instruments have been developed to detect frailty and render it objectively measureable. Overall, the available instruments to measure frailty present a strong predictive value for negative outcomes.48 Unfortunately, the agreement between them is quite modest.48 Analyses conducted by van Iersel and colleagues49 compared the prevalence of frailty using 4 different tools (the frailty phenotype, the Frailty Index, usual gait speed, and handgrip strength). The prevalence of frailty varied
Conclusions
Frailty represents a public health priority for multiple reasons. It is a highly and increasingly prevalent condition in the aging populations. Moreover, frailty is a strong predictor of major negative health-related outcomes in older persons (in particular, disability, hospitalization, institutionalization, death). Besides affecting the quality of life of the individual, frailty also severely threatens the long-term sustainability of health care systems, at least as they are traditionally
Acknowledgments
Special thanks to Ms Alana Officer and Ms Ritu Sadana at the World Health Organization Headquarters, and Ms Constance De Seynes at the International Association of Gerontology and Geriatrics-Global Ageing Research Network for having supported the organization of the experts' group meeting.
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The authors declare no conflicts of interest.
The present work and related activities were supported by the International Association of Gerontology and Geriatrics (IAGG) and the IAGG-Global Aging Research Network (GARN).