Abstract
Frailty is a clinical condition characterized by the individual's increased vulnerability to endogenous and exogenous stressors. It is determined by the reduction of homeostatic capacities of the organism and responsible for a marked risk of adverse health outcomes (including functional loss and mortality). Frailty originates from the geriatric background and may pave the way toward a model of care centered on the person, deviating from the traditional and obsolete disease-focused approach. Unfortunately, many controversies have affected the field of frailty over the years and ambiguities have been growing. In particular, the common use of frailty as condition to “exclude” from interventions is a worrisome trend. In fact, the detection of frailty should instead represent the entry point for a more in-depth analysis with the aim of identifying the causes of individual's increased vulnerability and implementing a person-tailored intervention plan. With the aim of promoting a more comprehensive and appropriate assessment of the aging population, the World Health Organization introduced the concept of intrinsic capacity (IC), defined as the composite of all physical and mental capacities that an individual can draw upon during his/her life. Frailty and IC are two constructs stemming from the same need of overcoming traditional medical paradigms that negatively impact on the correct way clinical and research practice should be conducted in older persons. In this article, we describe the similarities and differences between the two constructs, highlighting how geriatric medicine contributed to their development and will be crucial for their further integration in future healthcare models.
Highlights
The right to health is applicable to all ages, including the later years of life [1]
The promotion of healthy aging, regarded not as the absence of diseases but as the process for fostering and maintaining the individual’s functional ability, has been set as a priority by the World Health Organization [1]. To achieve this goal it is necessary to change our healthcare systems which are traditionally centered on the concept of diseases in favor of a new paradigm giving value to the person’s functions and values [3, 15, 16]
The development of frailty into something “new” is motivated by multiple reasons as: [1] the need of disseminating the comprehensive approach to the older person beyond the perimeter of geriatric medicine, [2] the necessity to provide a positive connotation to the aging phenomenon, [3] the importance of working on trajectories instead of focusing on arguable cross-sectional cut-points, and [4] the attempt to anticipate as much as possible the self-empowerment of the individual for his/her health status
Summary
The right to health is applicable to all ages, including the later years of life [1]. The development of frailty into something “new” is motivated by multiple reasons as: [1] the need of disseminating the comprehensive approach to the older person beyond the perimeter of geriatric medicine (even in countries where geriatricians are relatively absent), [2] the necessity to provide a positive connotation to the aging phenomenon ( focusing on functions rather than on deficits), [3] the importance of working on trajectories instead of focusing on arguable cross-sectional cut-points, and [4] the attempt to anticipate as much as possible the self-empowerment of the individual for his/her health status ( supporting preventive strategies in the community). It is noteworthy that both frailty and IC are based on the assumption that the aging individual can be adequately assessed and managed only if comprehensively evaluated and followed in a novel healthcare model based on integration and mutidisciplinarity of services
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