Frailty: Pathophysiology, Theoretical and Operational Definition(s), Impact, Prevalence, Management and Prevention, in an Increasingly Economically Developed and Ageing World

Abstract

The world's population is ageing, and most older adults experience a later life burdened with disease and disability. Frailty is a multidimensional and dynamic condition characterized by declines in reserve and function across multiple physiological systems, such that the ability to cope with every day or acute stressors becomes compromised. It is projected to become one of the most serious public health challenges economically developed societies will face in the coming century. This review provides a comprehensive overview of frailty, exploring its pathophysiology, theoretical and operational definition(s), impact, prevalence, management, and prevention, within the context of its emergence as a major public health challenge, in an increasingly economically developed and ageing world. Further, this review discusses the major limitations, deficiencies, and knowledge gaps presently within the field, and future research directions pertinent to the advancement of frailty research and the promotion of healthy longevity among the increasing global population of older adults.

Keywords: Ageing; Demography; Exercise; Frailty; Rehabilitation.

Fig. 1.

Estimated life expectancy (LE) by age in the UK and Wales (1841–2016); Human Mortality Database; University of CA, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany). Data available at www.mortality.org; raw data downloaded on February 22, 2020; adapted from [8].

Fig. 2.

Illustration of the multidimensional nature of frailty as a loss of physiological reserve across multiple systems, such that resilience and homeostatic response to stressors become compromised (adapted from [20]).

Fig. 3.

Risk factors associated with the development and progression of frailty. Derived and adapted from [19, 32, 33, 34, 35, 36], and [37] respectively.