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This scoping review synthesized perceptions of frailty language, classification, the meaning of the term frailty and potential implications amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: 1) understanding frailty as a multi-dimensional concept and inevitable consequence of aging; 2) perceiving frailty as a generalizing and harmful label; and 3) resisting and responding to frailty. Recommendations include using person-centered language, discussing the term ‘frailty’ with caution, maintaining a holistic view of frailty as a multidimensional concept, and being aware of the potential consequences of labelling persons as frail.
Running Head: Perceptions of Frailty Language
Long Title: Older Adults’ Perceptions of Frailty Language: A Scoping Review
Durepos, P., PhD Student1,2,
Sakamoto, M., PhD Student1,3,
Alsbury, K., PhD Student1,4.,
Hewston, P., PhD1,5.,
Borges, J., MSc1,6.,
Takaoka, A., MSc1,7.
1 Canadian Frailty Network Interdisciplinary Fellowship Program
2 McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, ON
3 University of British Columbia, School of Nursing, T201-2211 Westbrook Mall, Vancouver,
BC, V6T 2B5
4 University of Toronto, Faculty of Medicine, Rehabilitation Sciences Institute, Toronto, ON
5 McMaster University, Geriatrics Education Research and Aging Sciences Center, Hamilton,
6 Memorial University, Health Ethics, St. John’s, NFLD
7 McMaster University, Faculty of Health Sciences, Health Research Methods, Evidence and
Impact, Hamilton, ON
Corresponding Author:
Pamela Durepos
HSC 3H48C, 1280 Main St. W.
Hamilton, ON, L8S 4K1
Acknowledgements: The authors are grateful for funding in the way of grants and scholarships
including: Alzheimer Society of Canada Brant, Haldimand-Norfolk, Hamilton-Halton Branch;
Canadian Frailty Network Interdisciplinary Fellowship 2018-19; Canadian Institutes of Health
Research 159269; Canadian Nurses Foundation; Registered Nurses Foundation of Ontario,
Mental Health Interest Group.
Disclosure Statement: The authors have no conflicts of interest to report.
There is growing interest in conceptualizing and diagnosing frailty amongst researchers,
health care professionals and policy-makers. Little is known however, about older adults’
perceptions of the term “frail” and the implications of being classified as frail. The purpose of
this scoping review was to map the breadth of primary studies and synthesize findings describing
community-dwelling older adults’ perceptions of frailty language, classification, the meaning of
the term frailty and potential implications. Eight studies were included in the review and three
core themes were identified: 1) understanding frailty as a multi-dimensional concept and
inevitable consequence of aging; 2) perceiving frailty as a generalizing and harmful label; and 3)
resisting and responding to frailty. Recommendations include using person-centered language,
discussing the term ‘frailty’ with caution, maintaining a holistic view of frailty as a
multidimensional concept, and being aware of the potential consequences of labelling persons as
Keywords: Frailty, perception, stigma, healthcare implications, language
Older adults (over 65 years) are a growing segment of the Canadian population
(Canadian Institute for Health Information, 2011). Amongst older adults, frailty has emerged as a
characteristic with important implications for health and the Canadian healthcare system.
Worldwide, 10.7% of community-dwelling older adults are considered frail, and in Canada the
prevalence of frailty for those over 65 is greater at 23% (Collard, Boter, Schoever & Voshaar,
2012; Song, Mitnitski & Rockwood, 2010). While the term frailty has been used for decades,
there remains a lack of consensus regarding the meaning of frailty and criteria for diagnosis
(Fisher, 2005). Broadly, the term frailty has been used to describe a person’s vulnerability and
susceptibility to health problems, and is commonly associated with aging (Theou, Walston &
Rockwood, 2015). Amongst health care professionals, frailty is increasingly being used as a
biomedical term and medical diagnosis, with evidence for decline in physiological and physical
functioning (Cosco, Armstrong, Stephan & Brayne, 2015). Contrasting definitions are being used
to operationalize frailty, which influences the diagnostic or assessment tools and language that
health care professionals are using to discuss frailty with older adults. Frailty has been defined as
an accumulation of deficits related to aging in multiple body systems, which results in a dynamic
risk ‘state’ (Maxwell & Wang, 2017; Rockwood & Mitnitski, 2011). Hence, an index of deficits
can be used to assess an individual’s state of frailty (Theou et al., 2015). In contrast, frailty has
also been described as a phenotype, and defined as a clinical syndrome (Fried et al., 2001). The
presence of at least three of the following criteria: physical activity, self-reported exhaustion,
unintentional weight loss, slow walking speed, weakness in grip strength, slow walking speed,
and low physical activity, therefore suggests a syndrome of frailty within individuals.
Frailty, when objectively diagnosed or measured, can inform healthcare and support
clinical decision-making (McNally, 2017). As a significant predictor of health outcomes, frailty
measures can also predict outcomes such as falls, reduced mobility, hospitalization and death,
more accurately than other measurable phenomena like advanced age or comorbidity status
(Fried et al., 2001; Maxwell & Wang, 2017). Certainly, recognizing and addressing frailty may
be advantageous and may support older adults to maintain, improve or avoid negative health
outcomes, and live in their preferred place for longer (Ofori-Asenso et al., 2019; Theou et al.,
2015). Nevertheless, there is also concern that frailty is a pejorative term that emphasizes the
challenging aspects of later life (McNally & Lahey, 2015).
Discourse around the ‘fourth age’ generalizes older adults and the last stage of life as a
period of decline (Gilleard & Higgs, 2010a). As such, classifying or labelling persons as frail
could be associated with negative connotations, contributing to age-related discrimination. There
is also evidence that negative perceptions of aging predict individuals’ mortality and poor health
outcomes (Warmoth, Tarrant, Abraham & Lang, 2016). According to stereotype embodiment
theory, stereotypes can become embodied and negatively influence health and overall
functioning (Levy, 2009). Internalizing a label of frailty has potential to bring about feelings of
guilt or inferiority (Ebrahimi, Wilhelmson, Ekland, Moore, & Jakobsson, 2013) and also to
influence health and healthcare utilization.
Research into frailty and related health care interventions is growing and researchers,
health care professionals and policy-makers are looking to frailty as a diagnostic and outcome
measure, significant to the well-being and independence of older adults (D’Avanzo et al., 2017).
Understanding the perceptions of older adults regarding frailty and classification (i.e., diagnosis,
labelling) is therefore essential when planning research and interventions, to ensure that frailty
language and practices are acceptable, and that classifying persons as frail does not act as a
stigmatizing or discriminatory label. To date, research examining older adults’ perceptions and
understanding of the term ‘frail’ and frailty classification is limited, and findings have not been
synthesized. The purpose of this scoping review was therefore to: 1) map the breadth of primary
studies describing community-dwelling older adults and frailty language; 2) explore and
summarize perceptions of the term ‘frail’, the meaning of frailty and potential implications of
being classified as frail; and 3) contribute recommendations for the use of frailty language by
The authors conducted a scoping review to describe the current state of research
exploring older adults’ perceptions and the meaning of the term ‘frail’. A methodological
framework defined by Arksey & O’Malley (2005) with refinements by Levac, Colquhoun &
O’Brien (2010) was used to inform the study. A scoping review was appropriate to explore the
breadth of research on this topic, synthesize findings from a variety of disciplines/study designs
and to produce recommendations relevant to multiple stakeholders.
Search strategy
Together with a university librarian, the authors developed a comprehensive search
strategy with keywords and MeSH terms. Healthcare databases MEDLINE, CINAHL,
EMBASE, Ageline, and PsychInfo were searched, and hand-searching was conducted for
additional articles within reference lists of included studies, existing networks, GoogleScholar
and relevant organizations (e.g., International Federation on Aging). Diverse sources of literature
representing research from an array of disciplines (including social sciences, biology, law,
medicine, nursing) were searched to explore frailty beyond a strictly biomedical definition
(Arksey & O’Malley, 2005).
Inclusion and exclusion criteria
Included articles were: 1) primary qualitative, quantitative or mixed methods research
studies; 2) published in English, with full text available between January 1994 and February
2019; 3) describing the perceptions, meaning and perceived implications of frailty language (i.e.,
the term/word ‘frail’ or ‘frailty’), diagnosis (i.e., labelling, classifying or identifying); 4) of
community-dwelling (i.e., not living in long-term care), older adults’ (i.e., aged, frail, elderly, or
seniors). The authors elected to begin their search in 1994 because a seminal article
conceptualizing frailty was published at that timepoint (Rockwood, Fox, Stolee, Robertson &
Beattie, 1994). Articles were excluded if they were: 1) unavailable in English; 2) without full
text; 3) commentaries, editorials, opinion papers, or conference proceedings; 4) not sampling the
target population (i.e., older adults); or 5) not focused on the perceptions of frailty language.
Study selection and analysis
Titles and abstracts were initially screened for inclusion by single authors in DistillerSR
(Evidence Partners, Ottawa, Canada). The full text of selected articles was reviewed
independently by two authors for inclusion in the final sample. Disagreements were resolved
through discussion or consultation with a third author. Study descriptives (e.g., author, year,
method) were extracted and charted in Microsoft Excel in duplicate by two authors for rigour.
Data was analyzed through content analysis, meaning that authors read and re-read each article,
identified codes (i.e., meaningful units of data), classified data according to an agreed upon
coding framework, and then discerned common themes and patterns within and across articles to
address the study purpose. As a method of researcher triangulation and trustworthiness, each
author independently developed a coding framework, categorized the content of three articles
and met to reach consensus regarding a final coding framework through discussion. The
remaining articles were then each coded by two authors, with data extracted into an Excel
spreadsheet. New codes and themes identified subsequently by authors were added to the coding
framework if agreed upon (Arksey & O’Malley, 2005; Levac et al., 2010; Patton, 2015).
Sample descriptives
The initial search generated 4639 articles from online databases and hand searching of
reference lists. The authors reviewed n=73 full text articles in duplicate and included 10 articles,
representing N=8 unique studies in the final qualitative synthesis (see Figure 1). Included studies
were conducted in the United Kingdom (n=3), in Canada (n=1), the United States of America
(n=2), France (n=1) and the Netherlands (n=1) and were published most often in the Journal of
Aging Studies (n=2) and Ageing & Society (n=2). A qualitative (n=7) or mixed methods design
(n=1) was used for each study, with data was collected through interviews (n=8), observations
(n=2) and/or focus groups (n=1). Participants ranged in age from 55 to 98, with various cut-offs
used to define older adults, including over 55, 65, 75 or 80 years old. The proportion of female
participants (ranging from 44-100%) was greater than males on average. Study authors most
commonly defined frailty as a phenotype (n=4) according to Fried et al. (2001)’s definition, or as
an accumulation of deficits (n=2), based on the model by Rockwood & Mitnitski (2011). See
Table 1 for a description of the included studies.
Qualitative findings
Three core themes were identified through content analysis: 1) understanding frailty as a
multi-dimensional concept and inevitable consequence of aging; 2) perceiving frailty as a
generalizing and harmful label; and 3) resisting and responding to frailty.
Theme 1: Understanding frailty as a multi-dimensional concept and inevitable
consequence of aging. In general, frailty was described and understood by participants as a
quality or state of being (Warmoth et al., 2016), and as a binary or dichotomous classification,
meaning that persons were either frail or not (Age UK, 2015). Participants commonly described
a pattern of events of ‘becoming frail’, whereby persons experienced a gradual decrease in their
abilities over time (Age UK, 2015; Becker, 1994; Skilbeck, Arthur & Seymour, 2018; Warmoth
et al., 2016). Some participants described a specific health event or a turning point, which caused
them to cross a threshold and become frail (Escourrou et al., 2017, 2019; Skilbeck et al., 2018).
Once frail, individuals were perceived as likely to experience serious illness and decline
(Grenier, 2006).
The process of becoming frail was commonly perceived as out of one’s control and an
inevitable part of the aging process (Age UK, 2015; Escourrou et al., 2019; Escourrou et al.,
2017; Grenier, 2006, 2007; Puts et al., 2009; Schoenborn et al., 2018; Warmoth et al., 2016). A
participant explained, “Frailty is not something that you can prevent, you cannot do anything, it
just happens when you get older" (Puts et al., 2009, p. 264). In contrast, participants classified as
not frail or pre-frail tended to describe frailty as something that could be delayed or reversed
through strategies or “doing things” (Warmoth et al., 2016. p. 1494), like physical or social
Across all studies, participants described and understood the concept of frailty as having
several dimensions including physical, psychological/cognitive and social domains. The domains
were often understood as interrelated, whereby decline in one domain of function resulted in
losses in another domain (Escourrou et al., 2017, 2019; Grenier, 2006, 2007; Skilbeck et al.,
2018; Warmoth et al., 2016). In a single study, female participants emphasized the social and
psychological aspects of frailty as opposed to males, who limited descriptions of frailty to
physical, chronic, and co-morbid impairments (Puts et al., 2009).
‘Physical frailty’ figured prominently within persons’ descriptions of frailty and older
age. Physical frailty was often described as a loss of mobility and requirement of assistive
devices, such as canes, walkers, and wheelchairs (Age UK, 2015; Escourrou et al., 2017, 2019;
Grenier, 2006, 2007; Puts et al., 2009; Schoenborn et al., 2018; Warmoth et al., 2016).
Participants often described individuals they perceived as frail as persons who are fragile, fall
often and easily sustain fractures (Age UK, 2015; Puts et al., 2009). The presence of
comorbidities (Puts et al., 2009) and appearance-related descriptors, including low body weight
and pale skin, were also used to describe individuals perceived as frail (Grenier, 2006, 2007; Puts
et al., 2009; Warmoth et al., 2016). A participant explained their understanding of frailty:
Frailty is frailty physically, I think frailty is someone whose bones may crack, …
someone who is slightly bent over and they, when they walk, it’s as though they’re not
sure their feet are going to find that solid ground there … [a person has] pallid
complexion [and is] withdrawn … not want[ing] to be a bother yet here I am. I am no
longer able to take care of myself…. (Grenier, 2007, p. 433).
‘Psychological frailty’ was described as referring to a person’s mood, attitude, self-
esteem and cognitive function. Having depressive thoughts, anxiety, fear, a negative attitude,
being unable to cope, and as having one’s identity threatened were examples of psychological
frailty described by participants (Becker, 19954; Grenier, 2006, 2007; Puts et al., 2009; Skilbeck
et al., 2018; Warmoth et al., 2016). As such, having a frail state of mind was perceived as being
dependent on, and reflective of a person’s personality, attitude and outlook on life (Age UK,
2015; Schoenborn et al., 2018). Additionally, cognitive losses, such as forgetfulness or difficulty
concentrating, were perceived as characterizing psychological frailty (Escourrou et al., 2017,
2019; Puts et al., 2009). Decline and losses in psychological status were perceived as ultimately
contributing to an emotional experience that led to classification and self-identification as frail
(Grenier, 2006, 2007).
‘Social frailty’ was described as loneliness, infrequent interactions (Puts et al., 2009),
and disengagement behaviours (Age UK, 2015; Warmoth et al., 2016), which compounded the
losses that can accompany later life. Individuals with frailty were described as withdrawing from
participation in social events, while at the same time being excluded from invitations to social
activities because of functional limitations (Warmoth et al., 2016). As such, social isolation was
described as both a cause and a result of frailty. Being excluded from social gatherings was
perceived as reducing motivation for participation in future social events, and as eliciting a
perpetuating pattern which led to further isolation (Warmoth et al., 2016). Participants explained
that social frailty was exacerbated by environmental constraints, including limited access to
transportation, poor building accessibility, and financial concerns (Age UK, 2015; Escourrou et
al., 2017, 2019). Facilities without wheelchair ramps, for example, were described as preventing
adults with immobility from attending social events and leading to social disconnection.
Regardless of the domain of frailty, whether physical, psychological or social, feelings of
loss were often associated with the sense of being frail. Examples of loss were linked to deficits
in function, mood and identity. The multiplicity of losses was perceived as accumulating, and
ultimately translating into the overall loss of independence, control, dignity, certainty,
confidence and one’s sense of personhood (Age UK, 2015; Grenier, 2006, 2007; Puts et al.,
2009; Warmoth et al., 2016).
Theme 2: Perceiving frailty as a generalizing and harmful label. Across all studies,
participants associated the terms ‘frail’ and ‘frailty’ with similar, negative age-related stereotypes
related to all domains (Schoenborn et al., 2018; Warmoth et al., 2016). In the Age UK report
(2015), a collage of words taken from interviews graphically illustrated the concept of frailty,
emphasizing an array of negative terms, representing participants’ views (p. 12). Physical
stereotypes assumed that persons’ with frailty were all, “grey-haired, hunched, wobbly”
(Warmoth et al., 2016, p. 1490), using mobility and sensory aids, and were predominantly female
(Age UK, 2015; Puts et al., 2009; Schoenborn et al., 2018). Psychological stereotypes included
assumptions that persons with frailty all had poor cognitive functioning, memory loss, or
dementia (Warmoth et al., 2016). Overall, frailty was viewed as a term that homogenized unique
experiences of change and aging, and most participants viewed labeling or classifying persons as
frail as problematic. A participant explained:
Frailty is a generalization and I don’t think it has really any place in the medical
conversation…whatever the element that goes into making up frailty ought to be
discussed, but the generalization of frailty I don’t think is helpful at all (Schoenborn et
al., 2018, p. 3).
Participants also perceived that others (and even they themselves) held negative attitudes towards
frailty, which led to de-valuing persons with frailty as members of society and undermining these
persons’ opinions, capabilities or contributions. For example, a participant described that persons
were always, “thinking you weren’t good enough to do something” (Warmoth et al., 2016, p.
Participants were reported across the included studies as having strong negative
emotional reactions to discussions around frailty, and there was strong agreement that frailty was
an unwanted label. In some studies, it was explicitly noted that participants completely avoided
the use of the word frailty in describing their state of health, despite being classified as frail
according to validated tools (Age UK, 2015; Becker, 1994; Escourrou et al., 2017, 2019;
Grenier, 2006, 2007; Warmoth et al., 2016). Being referred to as frail met with considerable
offense, resistance and strong emotional reactions from participants (Age UK, 2015; Becker,
1994; Grenier, 2006, 2007; Puts et al., 2009; Schoenborn et al., 2018; Warmoth et al., 2016).
Schoenborn et al. (2018) reported that emotional reactions occurred more often in participants
who were not frail, when compared to persons considered frail. For example, a participant who
was assessed as non-frail, fiercely rejected the idea of being labelled as frail, denoted by
exclamatory punctuation:
I am never sick, fortunately, my wife neither. I don't even know what it is like being in
bed sick. I have had the flu occasionally but that is not frailty. No, I am definitely not
frail, definitely not! (Puts et al., 2009, p. 263).
Similarly, another participant cautioned against applying the label because of its associated
I don’t think you should label people as being frail um no, no I wouldn’t, wouldn’t want
to stigmatise people by saying ya know I think you’re frail um know you are getting older
and you can’t do as much as you perhaps would like to do (Warmoth et al., 2016, p.
Only a small subset of participants from the study by Schoenborn et al., (2018) did not find
anything wrong with the word frailty.
The term frail was also perceived as an identity faced by older adults and linked to
functional impairments (Becker, 1994). Self-identifying as frail or adopting an identity of frailty
was perceived as succumbing to a permanent loss of independence, control, and dignity (Age
UK, 2015; Becker, 1994; Escourrou et al., 2017, 2019; Skilbeck et al., 2018; Warmoth et al.,
2016). Warmoth et al. (2016) explained that self-identifying as frail meant to, “incorporate the
negative, and feared, views about older people as feeble, dependent and vulnerable” (p.1490). As
such, individuals avoided adopting the frailty identity. However, some participants did describe
adopting or accepting a frailty identity:
I’m frail in every sense of the word because of my incapacity, my lack of balance, my
inability to walk, to stand up, um no, no, I’m frail because I am. (Warmoth et al, 2016,
p. 1491).
Self-identifying and being classified as frail were described as altering and lowering self-
perceptions, decreasing self-esteem, and affecting confidence in one’s abilities, strengths and
self-value (Escourrou et al., 2017, 2019; Warmoth et al., 2016). Developing a ‘fixed identity’ of
frailty (i.e., labelling oneself as frail) and ‘acting frail’ were perceived as carrying a negative risk
(Grenier, 2006; 2007; Schoenborn et al., 2018). In addition, altered self-perception and fixed
identity were perceived as leading to deterioration in health status (Puts et al., 2009; Schoenborn
et al., 2018). Across studies, tensions between changes to the physical body (i.e., external
identity) and perceptions of one’s self and personhood (i.e., internal identity) were highlighted
(Grenier, 2006, 2007; Puts et al., 2009). This was exemplified in Puts et al. (2009) where 6 out of
8 adults perceived themselves as less frail than their measured level or classification of frailty. A
participant justified that she should not be classified as frail, although others perceived her as
frail. She explained:
Even though I have a heart problem, I do what I want to do, all my own work and
everything. So, I don’t consider myself frail. I don’t want to consider myself frail
(Grenier, 2007, p. 7).
Theme 3: Resisting and responding to frailty. Participants described using coping
techniques, health behaviours and seeking or avoiding healthcare services as ways they resisted
and responded to becoming or being labelled as frail. A variety of coping techniques were
perceived as allowing participants to maintain a sense of control over their health and avoid
becoming frail when facing an uncertain and unpredictable future (Puts et al., 2009; Warmoth et
al., 2016). Strategies included engaging in predictable routines (Skilbeck et al., 2018), hiding
frailty by ‘keeping up appearances’ (Age UK, 2015), associating with younger people (Grenier,
2006, 2007), or conversely, exaggerating their limitations to acquire services which would
support their health (Warmoth et al., 2016).
Coping strategies employed to facilitate adaptation to changing health included reshaping
perceptions of independence, for example, by comparing oneself to others with worse
impairments (Skilbeck et al., 2018; Warmoth et al., 2016), adjusting expectations of capabilities,
and finding creative ways to manage new impairments (Skilbeck et al., 2018). Some older adults
chose to form new supportive connections and relationships in their lives, focused on ‘keeping
busy or maintaining a strong mindset (Grenier, 2006, 2007). Others were interested in
discussing the concept of frailty, but wanted to avoid using the terms frail or frailty (Schoenborn
et al., 2018).
Some participants perceived that frailty could be a useful or motivating label or
diagnosis, bringing a person’s attention to vulnerabilities that they were previously unaware of
and encouraging them to seek healthcare and supportive services (Warmoth et al., 2016). A
single study reported that participants who self-identified as frail, and accepted a frailty identity
tended to be more open to discussing frailty than others (Schoenborn et al., 2018). In contrast,
participants who vehemently resisted discussing frailty were described as more likely to refuse
assistance like mobility aids (Skilbeck et al., 2018). Similarly, participants described as not frail
or pre-frail in a single study expressed that they would avoid health care professionals if the topic
of frailty and their frailty status was introduced (Schoeneborn et al., 2018). A participant
explained, [I would] get another doctor. I’m dead serious” (Schoenborn et al., 2018, p. 4). Self-
identifying as frail and having fewer social interactions were also perceived as causing people to
reduce their use of healthcare services, to decrease healthy behaviours, amidst beliefs that
advancing frailty was inevitable and services/activities would not be beneficial (Puts et al.,
2009). As one participant in the Schoenborn et al. (2018) study explained:
When a physician would say to somebody [that he or she is frail]…would that have any
detrimental effect on the individual of start becoming more frail and start acting more
frail?… Because psychologically that seeds been planted…, [the individual may think]:
‘I’m frail so I guess I’m just gonna have to sit in this chair and watch television 24 hours
a day (p. 4).
To the authors’ knowledge, this is the first scoping review to map the breadth of primary
studies exploring perceptions of the word frailty amongst older community-dwelling adults. In
general, the articles in this scoping review demonstrate that perceptions, understandings and
experiences of the word and/or label ‘frail’ are closely aligned across sociological and
biomedical fields. Perceived as a generalizing term, frailty is described within the included
studies as reflecting negative stereotypes across domains of physical, psychological, cognitive,
and social function. While frailty is discussed as a multi-dimensional construct in all of the
studies, it is clear that increased emphasis on the social domain, particularly when it comes to
how frailty is measured, is required in the field of frailty studies.
Breadth of primary studies
Studies included in this scoping review were from a select number of Western countries,
which could be related to both aging trends in these locations and interest/specializations in
frailty research and measures within the United States, Canada and the UK. The scoping review
was also limited to studies published in English, and as such there is potential studies from
additional countries could have been excluded.
The few primary studies which were identified in this scoping review (n=8) suggests that
little research has been completed to explore the perceptions of older adults around frailty
language, the meaning of frailty and being classified as frail. This is concerning because research
into the science of frailty diagnosis and measurement is quickly advancing and assessing frailty
can provide valuable insight into the current and future well-being of older adults (Cosco et al.,
2015). If the voices of older adults are not included in the discussion on frailty, there may be
limited uptake and interest in utilizing services or measures that are not perceived as aligning
with preferred language and priorities. Older adults in particular are often excluded from
participating in research due to barriers such as transportation, cognitive function, immobility
(Velzke & Baumann, 2017). However, research-funding bodies are cognizant of the benefits of
citizen engagement, and methods such as co-design, co-production and participation are
becoming expected elements of study design (Doolan-Noble, Mehta, Waters & Baxter, 2019).
Engaging citizens (in this case older adults) in research is necessary to support the development
of acceptable interventions, inform the use of preferred language, and promote the uptake of
services once publicly available (Velzke & Baumann, 2017).
Exploring the social domain of frailty
Participants across studies consistently described frailty as having social and
psychological domains and viewed symptoms of ‘social or psychological’ frailty as potent
indicators of overall frailty and wellbeing. Despite the importance placed on these domains of
frailty, the nine tools used to assess frailty within eight of the included studies sampled content
based on a variety of frailty models, domains and definitions and did not all address
psychological or social frailty. The most commonly used tools were the Frailty Index (n=2)
based on the accumulation of deficits model (Rockwood & Mitnitski, 2011), which does include
items sampling social frailty, and the Fried Frailty Phenotype (n=2), which focuses on primarily
physical criteria for frailty, without social or psychological items (Fried et al., 2001).
Assessing frailty solely based on physical criteria remains commonplace both in research
and clinical practice, with most of the content in frailty instruments sampling physical
characteristics and limiting or neglecting social or psychological factors (Sutton et al., 2016).
Participants’ personal experiences and the perceived importance of social frailty in our study
findings support a conceptual model of social frailty (Bunt, Steverink, Olthof, van der Schans &
Hobbelen, 2017). Social frailty is defined as a continuum of being at risk of losing or having
lost resources to fulfill social needs” (Bunt et al., 2017, p. 323). Factors described as contributing
to needs fulfillment including social or general resources, social behaviours and activities and
self-management abilities, are likely indicators for social frailty that can and should be
incorporated in frailty tools (Bunt et al., 2017), such as the recently published Fit-Frail Scale
(Theou et al., 2019) which incorporates several dimensions of frailty including the social and
psychological aspects of frailty mentioned by the participants of the studies in our review.
Critical perceptions of language and social meaning
Apart from social understandings of frailty, there are also culturally specific
understandings of frailty that should be explored. Variations exist in linguistic equivalencies, as
revealed in the Puts et al. (2009) article, where the word frailty does not exist in the Dutch
language and terms such as vulnerability and fragility are used instead. In fact, several languages
have variations of the term, which can be accompanied by slight differences in meaning
(Grenier, 2007). Interestingly, in French-speaking Québec, frailty has been discussed as perte
d’autonomie or loss of autonomy, and not frêle, which would be the direct translation (Grenier,
2007). Overall, these subtle differences highlight the tendency for frailty to be conceptualized as
a negative experience and demonstrate how easily it is associated with loss, regardless of
linguistic or cultural variations.
The primarily negative perceptions of aging and living with frailty described in the
articles included in this review contrasts findings from other research where older people who
are considered frail can “enjoy positive aspects of embodiment and maintain objective strengths”
(Pickard, 2018, p. 25). While some older adults may report this experience, the negative
connotations and understandings of a designation of frailty reported in this review are hard to
ignore, a perspective that has been similarly described in disability studies, where social forces
are perceived as shaping the experience of disability, in ways that highlight fragility and
vulnerability, and which are not adequately deconstructed or challenged (Burghardt, 2013). As
such, additional research on how to positively influence society’s shared views of aging and
frailty is needed, along with a critical examination of the unintended effects of frailty discourse
and assessment (Pickard et al., 2019).
Frailty as an imposed and generalizing label
By bringing older adults’ understandings and perceptions of frailty to the fore within this
review, it is evident that the term frailty is a label most often imposed on older people by others,
usually by healthcare providers. Frailty is described as an imposed identity and label by Higgs
and Gilleard (2014) who state that frailty “is made manifest through third party actions, not
through first person accounts” (p. 15). While effort is being made to use person-first language in
frailty research, the term itself remains a powerful designation that may not only serve to other
persons classified as frail, but also promulgates fourth age discourse and a negative social image
of later life (Gilleard & Higgs, 2010a; Higgs & Gilleard, 2014). Some scholars have argued that
frailty is a socially constructed label that is imposed on older adults (Gilleard & Higgs, 2010b),
highlighting the need to explore societal understandings of later life and the effect that these
perspectives can have on older adults’ experiences, especially those who are labelled or
diagnosed as frail. Hence, persons perceived or labelled as frail may be symbolically reduced to
this label, and frailty as a construct of the fourth age may diminish understandings of the
spectrum of diverse aging experiences that can exist (Grenier, Lloyd & Phillipson, 2017).
Based on the results of this review, older adults do not in general identify with the
imposed identity of ‘frailty’ and generalizations are described as having harmful implications,
including avoidance of healthcare services which aim to support independence and well-being.
Although older adults can employ coping mechanisms to avoid becoming or being labelled as
frail and participants in the included studies perceived that frailty could be useful for risk
stratification and resource access as related to healthcare, the all-encompassing term was seen as
harmful when, for example, an individual had impaired function in only one of these domains,
but was labelled as frail implying impairment across all domains. As an all-encompassing term,
there is the potential that labelling someone as frail can lead to self-fulfilling negative beliefs
about the self, as well further self-identification with failing health, which could in turn lead to
increased frailty in other domains. In this sense, self-perceived or diagnosed frailty was viewed
as having the potential to cause harm, including stimulating additional decline (Schoenborn et
al., 2018; Puts et al., 2009). Overall, the imposed identity of ‘being frail’ was discordant with
many older adults’ self-views and as a result, people within the included studies resisted self-
identification and the generalizations that accompany the label of frailty. Importantly, denial of
one’s functional status or limitations was perceived as leading to the avoidance of the very
healthcare services which aimed to support an individual with adaptive strategies for
independence and health.
Overall, recommendations based on this review propose that health care professionals
and researchers should: 1) employ a holistic view and understand frailty as a multidimensional
concept; 2) use the terms ‘frail’ and ‘frailty’ with caution and sensitivity, focusing on person-
centered language and finding mutual understanding; and 3) be aware of the potential
consequences that frailty language and labelling may have on persons’ well-being and use of
healthcare services.
1) A holistic view of frailty includes valuing domains of psychological, social, and
physical well-being equally. Frailty was perceived as a multidimensional concept, and as such,
cannot be reduced and based only on indicators of physical health. Complex factors indicating
the social determinants of health (e.g., housing, financial status, social support, culture,
education) are linked to frailty, and must therefore be considered part of the comprehensive
assessment and sensitive discussion of frailty with older adults, or factors critical to the
prevention or treatment of frailty will be neglected.
Research has shown that healthcare professionals in general support a holistic view of
frailty (Gustaffson, Edberg & Dahlin-Ivanoff, 2012; Coker, Martin, Simpson & Lafortune,
2019). However, interdisciplinary training and education is required to ensure that perspectives
of frailty (and all diagnoses) extend beyond a biomedical model (Coker et al., 2019). The
perceptions and meaning of frailty amongst researchers have not been explored to the authors’
knowledge, and researchers leading the development and use of frailty measures should aim to
adequately represent all domains of frailty in diagnostic tools. As such, interdisciplinary training
and education relative to the concept of frailty and influencing factors (i.e., social determinants
of health) may be beneficial to health care professionals and researchers.
2) Using frailty language, including the terms frailor frailty is cautioned, as many
older adults do not use these words to describe themselves, and labelling persons as frail may
contribute to stereotypes or discrimination (Age UK, 2015; Becker, 1994; Grenier, 2007).
Person-centered, ‘person-first’ or ‘ableist’ language such as ‘a person living with frailty’ is
recommended to emphasize personhood and avoid replacing a person with a diagnosis (Puts et
al., 2009). Acknowledging and valuing the individual, unique identity of older adults is essential
to providing high-quality care and building trusting relationships (Becker, 1994).
Communicating with older adults about individual, specific health challenges or age-related
changes is preferred, rather than using the term frail as an all-encompassing description of health.
Seeking shared-understanding of frailty and educating older adults to understand frailty as a
dynamic, reversible and avoidable concept by sharing specific examples of ‘living with frailty’
may also promote acceptance of the term (Age UK, 2015; Schoenborn et al., 2018). Overall,
avoiding labelling persons facilitates communication, leads to better care plans and improves
outcomes (Escourrou et al., 2019; Grenier, 2006; Skilbeck et al., 2018).
3. Healthcare professionals and researchers must be aware of the potential consequences
of labelling or diagnosing persons as frail, so as to avoid causing harm and reducing healthcare
service use. Findings from this scoping review illustrated that being diagnosed or self-identifying
as frail may generate a ‘cycle of decline’, result in ‘hiding health problems’, or avoiding
healthcare services, and contribute to further health concerns. Interdisciplinary training and
education surrounding the connection between self-perception and realized health (i.e., mind-
body) may assist health care professionals and researchers to recognize the serious potential for
harm of labelling. In addition, gauging people’s preferences for communication (i.e., the level
and type of information) and language (i.e., what words does the individual use) may assist
health care professionals to avoid offending persons’ identity. Future research may consider
investigating knowledge translation strategies to educate all stakeholders on the meanings,
understandings and implications of frailty, in order to better meet the needs of older adults.
In summary, the ongoing critique of frailty, in terms of “its perpetuation of decline
narratives and ultimately its potentially (albeit unintentionally) harmful impact on older people
who are labelled ‘frail’ (Pickard et al., 2019, p. 457), raises the question as to whether new
terminology is required, or whether a more holistic perspective of the changes that can
accompany aging is needed? The World Health Organization’s World Report on Ageing and
Health (2015) uses the term “intrinsic capacity” when discussing the potential for healthy aging,
in terms of individuals’ physical and cognitive health, overall functional ability and the ongoing
influence of the social environment. Such conceptualizations of the aging experience, that are
less disease and limitation-focused and that positively support older adults in their health in ways
that are meaningful to them, are increasingly being called for (Pickard et al, 2019). Importantly,
exploring, engaging, and valuing older adults in the discourse on frailty does not require setting
“aside the progress made in a formal quantitative understanding of frailty in order to engage in a
debate about semantics” (Rockwood & Howlett, 2018, p.3). Grenier (2019), a primary author
included in this review from the field of critical gerontology, has argued that it is crucial to
explore the semantics or meaning attributed to the term frailty and the language associated with
being frail’, especially as research is consistently demonstrating that older people do not ascribe
to a frailty lens, or see themselves as frail.
The authors restricted inclusion criteria to include only English language articles,
therefore additional unpublished articles, or findings from non-English languages may suggest
alternative perceptions of frailty. In addition, when translated to other languages, the word ‘frail’
may not have a direct translation or may hold different cultural associations making it difficult to
synthesize findings. Within some databases (i.e. CINAHL) use of the keyword ‘frail’ limited
search results, however concurrent searches in other databases and hand-searches support the
comprehensiveness of the search. The protocol and findings from this review were not registered
in a review database due to the iterative nature and timeline of this project, but the authors are
confident that the methods have been reported transparently and were guided by PRISMA
reporting guidelines (Moher et al., 2009).
The authors of this scoping review are individuals from rehabilitation sciences,
nursing, ethics, and kinesiology disciplines. Diversity as an interdisciplinary team and the mix of
both research skills and clinical work with older adults added a variety of perspectives to this
review. The authors screened titles, abstracts and full texts in duplicate, adding rigour to our
study selection process. Extracting and the coding of data were also performed in duplicate to
enhance reliability, and three articles were analyzed by all authors to enhance trustworthiness
and to avoid researcher bias.
Overall, critical work has been done in operationalizing and quantifying frailty
(Rockwood & Howlett, 2018), particularly in terms of the tools and measurements that have
been developed. Frailty certainly exists and is often experienced by people as they age, therefore
use of the term cannot be dismissed altogether, especially in healthcare practice and research
(Pickard et al., 2019). However, ongoing examination of the term frailty, and guidelines for
person-centered language are necessary. The recommendations summarized can inform next
steps for frailty research and the formulation of guidelines for healthcare professionals,
policymakers, and interdisciplinary researchers, around the use of frailty language. These
recommendations may ultimately help stakeholders to avoid inadvertent stigmatization and
promote the inclusion of older adults in conversations about frailty.
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Figure 1. Search flow.
Note from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting Iiems
for systematic reviews and Meta-analyses: The PRISMA statement. PLoS Med 6(7): e1000097.
Records identified through
database searching
(n = 8528)
Additional records identified
through other sources
(n = 8)
Records after duplicates removed
(n = 4639)
Records screened
(n = 4639)
Records excluded
(n = 4566)
Full-text articles assessed
for eligibility
(n = 73)
Full-text articles excluded,
with reasons (N = 63)
Study type (n=7)
Population (n=13)
Study Focus
Articles included
(n = 10)
Primary studies included
in qualitative synthesis
(n =8)
Table 1. Included studies
Design and
Sample Descriptives
Study Aim
Age UK,
on behalf of
Age UK and
the British
Interviews and
focus groups
Manchester and
*Age & gender not reported
With frailty: (n=12),
Non-frail: (n=6),
Family carers: (n=5),
Hospital managers: (n=4),
Nurses: (n=6),
Non-specialist health care
professionals: (n=6)
Identify ways of supporting
older people to: identify with
the concept of frailty,
engage with preventative
strategies and access services
for frailty
Journal of
Aging Studies
San Francisco
Long-term care
Over 80 years;
With frailty: (n=19)
Pre-frail: (n=4)
57% Female
Explore the meaning of
autonomy and decreases in
functional ability to older
The Journal of
Frailty &
Interviews and
Hospital day
Over 65 years,
Over 75 years,
With frailty &
risk of losing independence:
60% Female
Explore the perceptions of
older adults of the term and
concept of frailty;
Explore perceived risk of
losing of independence
Journal of
Social Work
Ageing &
*Age not reported
Older, diverse, English-
speaking women
100% Female
Explore the distinctions
between 'being and 'feeling'
frail, the emotional feelings
that accompany aging and
what is defined as ‘frailty’;
Explore older women’s
understanding and use of the
word frail.
Puts, 2009
Journal of
Aging Studies
67-90 years,
With frailty: (n=11)
Non-frail: (n=14)
44% Female
Explore the meaning that
older adults attach to frailty;
Compare perceptions of
frailty amongst men and
women who are frail and not-
frail of frailty
Mixed Methods;
and Interviews
Mean age 76,
With frailty: (n=12)
Pre-frail: (n=8)
Non-frail: (n=9)
72% Female
Explore perceptions and
informational needs about
frailty among older adults
Journal of
Older People
Interviews and
North England
Over 75 years,
With frailty,
Living alone
70% Female
Explore how older people
with complex health
problems experience and
understand frailty in their
daily lives
Ageing &
dwellings and
Long-term care
Over 66 years,
59% Female
Explore older peoples’
perceptions and
understandings of frailty;
Explore if frailty is
considered an inevitable
consequence of ageing or can
be actively managed or
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Importance Frailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level. Objective To estimate the global incidence of frailty and prefrailty among community-dwelling adults 60 years or older. Data Sources MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Plus, and AMED (Allied and Complementary Medicine Database) were searched from inception to January 2019 without language restrictions using combinations of the keywords frailty, older adults, and incidence. The reference lists of eligible studies were hand searched. Study Selection In the systematic review, 2 authors undertook the search, article screening, and study selection. Cohort studies that reported or had sufficient data to compute incidence of frailty or prefrailty among community-dwelling adults 60 years or older at baseline were eligible. Data Extraction and Synthesis The methodological quality of included studies was assessed using The Joanna Briggs Institute’s Critical Appraisal Checklist for Prevalence and Incidence Studies. Meta-analysis was conducted using a random-effects (DerSimonian and Laird) model. Main Outcomes and Measures Incidence of frailty (defined as new cases of frailty among robust or prefrail individuals) and incidence of prefrailty (defined as new cases of prefrailty among robust individuals), both over a specified duration. Results Of 15 176 retrieved references, 46 observational studies involving 120 805 nonfrail (robust or prefrail) participants from 28 countries were included in this systematic review. Among the nonfrail individuals who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail, with the pooled incidence rate being 43.4 (95% CI, 37.3-50.4; I² = 98.5%) cases per 1000 person-years. The incidence of frailty was significantly higher in prefrail individuals than robust individuals (pooled incidence rates, 62.7 [95% CI, 49.2-79.8; I² = 97.8%] vs 12.0 [95% CI, 8.2-17.5; I² = 94.9%] cases per 1000 person-years, respectively; P for difference < .001). Among robust individuals in 21 studies who survived a median follow-up of 2.5 (range, 1.0-10.0) years, 30.9% (9974 of 32 268) became prefrail, with the pooled incidence rate being 150.6 (95% CI, 123.3-184.1; I² = 98.9%) cases per 1000 person-years. The frailty and prefrailty incidence rates were significantly higher in women than men (frailty: 44.8 [95% CI, 36.7-61.3; I² = 97.9%] vs 24.3 [95% CI, 19.6-30.1; I² = 8.94%] cases per 1000 person-years; prefrailty: 173.2 [95% CI, 87.9-341.2; I² = 99.1%] vs 129.0 [95% CI, 73.8-225.0; I² = 98.5%] cases per 1000 person-years). The incidence rates varied by diagnostic criteria and country income level. The frailty and prefrailty incidence rates were significantly reduced when accounting for the risk of death. Conclusions and Relevance Results of this study suggest that community-dwelling older adults are prone to developing frailty. Increased awareness of the factors that confer high risk of frailty in this population subgroup is vital to inform the design of interventions to prevent frailty and to minimize its consequences.
Full-text available
Background: Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity. Methods: In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. In Phase 2, feedback was sought from health professionals and the general public. In Phase 3, 366 participants completed preliminary testing on the revised draft, including 162 UK paramedics, and rated the scale on feasibility and usability. In Phase 4, following translation into Malay, the final prototype was tested in 95 participants in Peninsular Malaysia and Borneo. Results: The final scale incorporated 14 domains, each conceptualized with 3-6 response levels. All domains were rated as "understood well" by most participants (range 64-94%). Percentage agreement with positive statements regarding appearance, feasibility, and usefulness ranged from 66% to 95%. Overall feedback from health-care professionals supported its content validity. Conclusions: The PFFS is comprehensive, feasible, and appears generalizable across countries, and has face and content validity. Investigation into the reliability and predictive validity of the scale is currently underway.
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In the past decade, frailty research has focused on refinement of biomedical tools and operationalisations, potentially introducing a reductionist approach. This article suggests that a new horizon in frailty lies in a more holistic approach to health and illness in old age. This would build on approaches that view healthy ageing in terms of functionality, in the sense of intrinsic capacity in interplay with social environment, whilst also emphasising positive attributes. Within this framework, frailty is conceptualised as originating as much in the social as in the biological domain; as co-existing with positive attributes and resilience, and as situated on a continuum with health and illness. Relatedly, social science-based studies involving interviews with, and observations of, frail, older people indicate that the social and biographical context in which frailty arises might be more impactful on the subsequent frailty trajectory than the health crisis which precipitates it. For these reasons, the article suggests that interpretive methodologies, derived from the social sciences and humanities, will be of particular use to the geriatrician in understanding health, illness and frailty from the perspective of the older person. These may be included in a toolkit with the purpose of identifying how biological and social factors jointly underpin the fluctuations of frailty and in designing interventions accordingly. Such an approach will bring clinical approaches closer to the views and experiences of older people who live with frailty, as well as to the holistic traditions of geriatric medicine itself.
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Background: The frailty concept requires that practices should be adapted to meet the challenge of dependence. The GP is in the front line of management of frail elderly patients. Objectives: To explore the perception of elderly persons of the term and concept of frailty and to understand their perception of the risk of loss of independence. Methods: Two qualitative studies by individual interviews in the homes of elderly persons identified as potentially frail by their GP, or diagnosed as frail and at risk of loss of independence. The sampling was theoretical. The analysis was carried out using an inductive approach following the phases of thematic analysis. The researchers used triangulation and collection was concluded when theoretical saturation had been reached. Results: The concept of frailty was seen as forming an integral part of physiological ageing and appeared to be irreversible. The term of frailty had a negative connotation. The physical, cognitive and psychological components of frailty were present in the participants' discourse. Nutritional and sensory components were less present. Frailty due to inappropriate medication was not cited. Seven risk factors for loss of independence were identified: social isolation, poor physical health, poor mental health, loss of mobility, unsuitable living conditions, unsuitable environment, and low resources. Conclusions: Becoming frail is a major turning point in patients' life course. Coordinated multiprofessional management that takes account of patients' perceptions could help in negotiating a feasible care plan adapted to the patient's needs.
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Background: Frailty is seen across various health and social care settings. However, little is known about how healthcare professionals, particularly those who provide care for older adults living in the community view frailty. There is also a dearth of information about the extent to which a shared understanding of frailty exists across the various disciplines of care. Such an understanding is crucial across care professionals as it ensures consistent assessment of frailty and facilitates interdisciplinary working/collaboration which is a key component in the management of frailty. This study aimed to explore: (i) how community care staff from various specialties viewed frailty; (ii) whether they had a shared understanding; and (iii) how they assessed frailty in everyday practice. Methods: Semi-structured interviews were conducted with a purposive sample of 22 community care staff from seven specialties, namely: healthcare assistants, therapy assistants, psychiatric nurses, general nurses, occupational therapists, physiotherapists and social workers, recruited from four neighbourhood teams across Cambridgeshire, England. Interviews were analysed thematically. Results: There was a shared narrative among participants that frailty is an umbrella term that encompasses interacting physical, mental health and psychological, social, environmental, and economic factors. However, various specialities emphasised the role of specific facets of the frailty umbrella. The assessment and management of frailty was said to require a holistic approach facilitated by interdisciplinary working. Participants voiced a need for interdisciplinary training on frailty, and frailty tools that facilitate peer-learning, a shared understanding of frailty, and consistent assessment of frailty within and across specialities. Conclusions: These findings underscore the need to: (i) move beyond biomedical descriptions of frailty; (ii) further explore the interacting nature of the various components of the frailty umbrella, particularly the role of modifiable factors such as psychological and socioeconomic resilience; (iii) care for frail older adults using holistic, interdisciplinary approaches; and (iv) promote interdisciplinary training around frailty and frailty tools to facilitate a shared understanding and consistent assessment of frailty within and across specialities.
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The aim of this paper is to subject the clinical classification of frailty to scrutiny through exploring, via a phenomenological lens, the lived experiences of older people who meet the objective, or clinical, criteria of frailty. Drawing on a range of published research that explores the heterogeneous experiences of embodied ageing, the paper highlights the continuity of phenomenological structures of experience across successful ageing, normal ageing and frailty, suggesting the permeability and contestability of the boundaries between them and highlighting the complexity of health and illness in old age. Such data suggests a need to question the perception of frailty as something both apart from ‘normal’ ageing, and constitutive of frailed or failed ageing, and challenges the construction of the third age/fourth age polarity that underpins much of the meaning accorded to old age today.
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Abstract The notion of frailty has evolved for more than 15 years. Although there is no consensus definition, frailty reflects a state of increased vulnerability to adverse health outcomes for individuals of the same chronological age. Two commonly used clinical tools, the frailty index and the frailty phenotype, both measure health-related deficits. The frailty index is a ratio of the number of deficits that an individual has accumulated divided by all deficits measured, whereas the phenotype specifies frailty as represented by poor performance in three of five criteria (i.e., weight loss, exhaustion, weakness, slowness, lack of activity). From human studies, animal models of both approaches have been developed and are beginning to shed light on mechanisms underlying frailty, the influence of frailty on disease expression, and new interventions to attenuate frailty. Currently, back-translation to humans is occurring. As we start to understand subcellular mechanisms involved in damage and repair as well as their response to treatment, we will begin to understand the molecular basis of aging and, thus, of frailty.
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Background: Since 2004, the definition of the frailty syndrome has shifted from purely physical criteria to a more comprehensive consideration of the individual, including their psychosocial criteria. In this study, qualitative research methods were used as a complementary approach in order to enrich the existing quantitative results in this area. Objective: To understand the views of older persons on the risk of loss of independence. Methods: The study population comprised people over 75 years of age who were living at home in the south-west of France and were considered to be at risk of losing their independence. Data were collected using individual semi-structured in-depth interviews, accompanied by observations. Inductive analysis was carried out according to grounded theory methods. Results: Fifteen individual interviews were conducted to achieve theoretical data saturation. Analysis of the content of the interviews revealed seven risk factors for the loss of independence: poor mental health, poor physical health, social isolation, no longer leaving the home, an unsuitable environment, unsuitable living conditions, and few resources. Conclusions: These results complement the purely physical approach to screening for the frailty syndrome and lead us to reconsider our screening approach to include a more holistic view of the older person and their circumstances.
Over the last 15 years, frailty has become a dominant discourse on late life. Taken-for-granted knowledge and practice can be seen in initiatives such as the International Association of Gerontology and Geriatrics’ White Book on Frailty . This paper begins with an overview of key themes on frailty from the biomedical literature, followed by critical literature in the social sciences and humanities. It discusses the tensions within the biomedical field, frailty as a social construction and ‘social imaginary’, practices of frailty as historically linked to political systems of care, and frailty as an emotional and relational experience. It then draws on a critical discourse analysis to assess the 2016 White Book on Frailty . Drawing on the idea of ‘significant absences’, the paper highlights the gaps that exist where the social and emotional understandings and political readings of frailty are concerned. The paper concludes by outlining the need to recognise the ‘politics of frailty’ including the power relations that are deeply embedded in the knowledge and practices surrounding frailty, and to incorporate older people's experience and ideas of vulnerability into research, policy and care practice.
Objective This paper describes a workshop process conducted to guide funding priorities for the Ageing Well National Science Challenge in New Zealand (NZ). Methods Based on the Checklist for Health Research Priority Setting, stakeholders networking workshops were conducted in five main cities in NZ (n = 133 attendees). Each workshop involved an introductory presentation; small group work exploring the a priori areas of: mind health, social well‐being, health services and age‐friendly environments; capturing key ideas on flip charts; feedback; and discussion of documented content. Results Suggested strategies to address these issues incorporated reduction in segregated “villages,” delivery of integrated care and provision of age‐friendly transport. Proposed examples of monitoring impact included increased tertiary participation by older people and presence of more housing options. Conclusion Actively engaging older adults and community stakeholders in setting research priorities provided a unique opportunity to understand the key areas older adults think important for future research.