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 applications across Europe.

Design: Consensus document.

Setting: Twenty-five research centers on frailty and healthy aging.

Measurements: Relevant aspects of frailty.

Results: This document presents a consensus regarding what frailty is and what it is not, the relationship between frailty and aging, common misunderstandings associated with frailty, its pathophysiology, and the biomarkers involved. It also addresses how frailty should be assessed and by whom, how it should be managed, the existence of frailty subphenotypes or subtypes, the stigma associated with being considered frail, gender-related considerations, and the current challenges and future directions in the field. Frailty is defined as 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 individuals to adverse health outcomes, mainly disability.

Conclusions: This consensus document on frailty provides a comprehensive framework useful for epidemiological, clinical, and research applications across Europe.