Special Article
Frailty: An Emerging Public Health Priority

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Abstract

The absolute and relative increases in the number of older persons are evident worldwide, from the most developed countries to the lowest-income regions. Multimorbidity and need for social support increase with age. Age-related conditions and, in particular, disabilities are a significant burden for the person, his or her family, and public health care systems. To guarantee the sustainability of public health systems and improve the quality of care provided, it is becoming urgent to act to prevent and delay the disabling cascade. Current evidence shows that too large a proportion of community-dwelling older people present risk factors for major health-related events and unmet clinical needs. In this scenario, the “frailty syndrome” is a condition of special interest. Frailty is a status of extreme vulnerability to endogenous and exogenous stressors exposing the individual to a higher risk of negative health-related outcomes. Frailty may represent a transition phase between successful aging and disability, and a condition to target for restoring robustness in the individual at risk. Given its syndromic nature, targeting frailty requires a comprehensive approach. The identification of frailty as a target for implementing preventive interventions against age-related conditions is pivotal. Every effort should be made by health care authorities to maximize efforts in this field, balancing priorities, needs, and resources. Raising awareness about frailty and age-related conditions in the population is important for effective prevention, and should lead to the promotion of lifelong healthy behaviors and lifestyle.

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).

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