The Conceptual and Practical Definitions of Frailty in Older Adults: a Systematic Review

Overview

Journal J Diabetes Metab Disord

Specialty Endocrinology

Date 2021 Dec 13

PMID 34900836

Citations 13

Authors

Ameneh Sobhani

Reza Fadayevatan

Farshad Sharifi

Ahmadali Akbari Kamrani

Hanieh-Sadat Ejtahed

Raziye Sadat Hosseini

Shamaneh Mohamadi

Alireza Fadayevatan

Sara Mortazavi

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to review and extract all publications containing concepts related to definitions of frailty and categorize them.

Methods: A total of six electronic databases (PubMed, Ovid web, Web of Science, Scopus, Embase, Cochrane Library, and ProQuest) were searched to identify studies that introduced a definition of frailty up to October 2018. No language restrictions were imposed.

Results: Totally, 104,370 papers were found in the initial search and finally 68 papers were included. Of these, 21 studies provided a conceptual definition and 50 original articles also 9 review articles provided a practical definition. Moreover, 12 papers had both definitions of frailty. Of them, 62 were published in English, 2 in Portuguese, 1 in Japanese, 2 in Korean, and 1 in German languages.

Conclusion: Many screening tools have been developed but neither of them can cover a wide range of parameters at the same time, nor do they have simplicity in the execution. It is important to note that although a more or less general consensus on one single definition might be expected, we believe that the elderly population is too heterogeneous to allow a tool to address it as a whole, and such a definition may even be impossible. Therefore, in the absence of a "Gold Standard" definition, it is suggested to seek accurate knowledge of the strengths and weaknesses of each definition and choose the most appropriate definition and the most effective evaluation tool according to the purpose of the research and the characteristics of the older population.

Citing Articles

Integrating frailty interventions into existing care models: a comprehensive approach to enhancing patient outcomes in chronic disease management.

Uchmanowicz I, Faulkner K, Iovino P, Kwasny A, Surma S, Magi C Front Public Health. 2025; 12:1518774.

PMID: 39906402 PMC: 11790414. DOI: 10.3389/fpubh.2024.1518774.

Association between frailty and adverse outcomes after cardiac resynchronization therapy: a systematic review and meta-analysis.

Li X, Fang F Eur Geriatr Med. 2024; 16(1):165-177.

PMID: 39630191 PMC: 11850548. DOI: 10.1007/s41999-024-01112-9.

Understanding frailty and its opposites from community-dwelling older peoples' perspectives: A phenomenological qualitative study.

Golbach R, Kleinenberg-Talsma N, van der Lucht F, Hobbelen J, Jager-Wittenaar H, Finnema E Int J Nurs Stud Adv. 2024; 7:100238.

PMID: 39310677 PMC: 11416217. DOI: 10.1016/j.ijnsa.2024.100238.

Identifying Frailty in Older Adults Receiving Home Care Assessment Using Machine Learning: Longitudinal Observational Study on the Role of Classifier, Feature Selection, and Sample Size.

Pan C, Luo H, Cheung G, Zhou H, Cheng R, Cullum S JMIR AI. 2024; 3:e44185.

PMID: 38875533 PMC: 11041467. DOI: 10.2196/44185.

Accelerated Aging in Cancer Survivors: Cellular Senescence, Frailty, and Possible Opportunities for Interventions.

Wang S, Jurdi N, Thyagarajan B, Prizment A, Blaes A Int J Mol Sci. 2024; 25(6).

PMID: 38542292 PMC: 10970400. DOI: 10.3390/ijms25063319.

References

Ravaglia G, Forti P, Lucicesare A, Pisacane N, Rietti E, Patterson C . Development of an easy prognostic score for frailty outcomes in the aged. Age Ageing. 2008; 37(2):161-6. DOI: 10.1093/ageing/afm195. View

Ma L, Zhang L, Tang Z, Sun F, Diao L, Wang J . Use of the frailty index in evaluating the prognosis of older people in Beijing: A cohort study with an 8-year follow-up. Arch Gerontol Geriatr. 2016; 64:172-7. DOI: 10.1016/j.archger.2015.11.002. View

Kajsa E, Katarina W, Sten L, Synneve I . Screening for frailty among older emergency department visitors: Validation of the new FRESH-screening instrument. BMC Emerg Med. 2016; 16(1):27. PMC: 4957482. DOI: 10.1186/s12873-016-0087-0. View

Lorenzo-Lopez L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodriguez-Villamil J, Millan-Calenti J . Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr. 2017; 17(1):108. PMC: 5433026. DOI: 10.1186/s12877-017-0496-2. View

Bunt S, Steverink N, Olthof J, van der Schans C, Hobbelen J . Social frailty in older adults: a scoping review. Eur J Ageing. 2017; 14(3):323-334. PMC: 5587459. DOI: 10.1007/s10433-017-0414-7. View

Goldstein J, Hubbard R, Moorhouse P, Andrew M, Mitnitski A, Rockwood K . The validation of a care partner-derived frailty index based upon comprehensive geriatric assessment (CP-FI-CGA) in emergency medical services and geriatric ambulatory care. Age Ageing. 2014; 44(2):327-30. DOI: 10.1093/ageing/afu161. View

Puts M, Lips P, Deeg D . Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning. J Clin Epidemiol. 2005; 58(11):1188-98. DOI: 10.1016/j.jclinepi.2005.03.008. View

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

Lachs M, Feinstein A, Cooney Jr L, Drickamer M, Marottoli R, Pannill F . A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med. 1990; 112(9):699-706. DOI: 10.7326/0003-4819-112-9-699. View

10.

Robinson T, Eiseman B, Wallace J, Church S, McFann K, Pfister S . Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg. 2009; 250(3):449-55. DOI: 10.1097/SLA.0b013e3181b45598. View

11.

Gobbens R, Luijkx K, Wijnen-Sponselee M, Schols J . Toward a conceptual definition of frail community dwelling older people. Nurs Outlook. 2010; 58(2):76-86. DOI: 10.1016/j.outlook.2009.09.005. View

12.

Kojima G, Iliffe S, Walters K . Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing. 2017; 47(2):193-200. DOI: 10.1093/ageing/afx162. View

13.

Cesari M, Calvani R, Marzetti E . Frailty in Older Persons. Clin Geriatr Med. 2017; 33(3):293-303. DOI: 10.1016/j.cger.2017.02.002. View

14.

Villacampa-Fernandez P, Navarro-Pardo E, Tarin J, Cano A . Frailty and multimorbidity: Two related yet different concepts. Maturitas. 2016; 95:31-35. DOI: 10.1016/j.maturitas.2016.10.008. View

15.

Ensrud K, Ewing S, Taylor B, Fink H, Cawthon P, Stone K . Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med. 2008; 168(4):382-9. DOI: 10.1001/archinternmed.2007.113. View

16.

Dapp U, Anders J, Golgert S, von Renteln-Kruse W, Minder C . [Resources and risks in old age: the LUCAS-I marker set for a classification of elderly people as fit, pre-frail and frail. First results on validity from the Longitudinal Urban Cohort Ageing Study (LUCAS), Hamburg]. Z Gerontol Geriatr. 2012; 45(4):262-70. DOI: 10.1007/s00391-012-0311-9. View

17.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan D, McDowell I . A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5):489-95. PMC: 1188185. DOI: 10.1503/cmaj.050051. View

18.

Campbell A, Buchner D . Unstable disability and the fluctuations of frailty. Age Ageing. 1997; 26(4):315-8. DOI: 10.1093/ageing/26.4.315. View

19.

Sewo Sampaio P, Sampaio R, Yamada M, Arai H . Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty?. Geriatr Gerontol Int. 2016; 16(8):893-902. DOI: 10.1111/ggi.12833. View

20.

Mitnitski A, Graham J, Mogilner A, Rockwood K . Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002; 2:1. PMC: 88955. DOI: 10.1186/1471-2318-2-1. View