Consensus document on frailty: conceptualization, detection, multidisciplinary management and future roadmap

Abstract

BACKGROUND: The lack of a universally accepted definition, a gold-standard assessment tool, and sufficient evidence-based interventions has hindered the integration of frailty into routine clinical practice, particularly outside geriatric medicine. For clinicians, health professionals, policymakers, and aging researchers, a unified framework based on robust evidence has become essential. OBJECTIVES: To provide a consensus on relevant aspects of frailty, including definition, attributes, misunderstandings, pathophysiology, phenotypes, assessment, biomarkers, management, stigmas and future challenges, useful for epidemiological, clinical and research application across Europe. DESIGN: Consensus document. SETTING: 25 research centers on frailty and healthy aging. MEASUREMENTS: Relevant aspects on frailty. RESULTS: In this document we present a consensus regarding what frailty is, what frailty is not, what is aging, which are the most common misunderstandings related to frailty, which is the pathophysiology and which are the biomarkers of frailty, how should frailty be assessed and who should assess frailty, how should frailty be managed, the presence or absence of frailty subphenotypes or subtypes, how is the stigma of been considered frail, which are the gender considerations, and which are the current challenges and future directions. We support that frailty is the expression of an age-associated clinical phenotypic syndrome driven by the biology of aging, life-course environmental exposures, and disease burden. Its physiological basis lies in a heterogeneous decline of functional reserve across organ systems, accompanied by impaired homeostasis and reduced capacity to respond to stressors, ultimately predisposing to adverse health outcomes, mainly disability. CONCLUSIONS: We present a consensus document on frailty, useful for epidemiological, clinical and research application across Europe.