Early identification of frailty: Developing an international delphi consensus on pre-frailty

Sezgin, Duygu, O'Donovan, Mark, Woo, Jean, Bandeen-Roche, Karen, Liotta, Giuseppe, Fairhall, Nicola,O'Caoimh, Rónán et al (2022). Early identification of frailty: Developing an international delphi consensus on pre-frailty. Archives of Gerontology and Geriatrics, 99, 104586. doi:https://doi.org/10.1016/j.archger.2021.104586

Abstract

Background Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent intermediate state before frailty becomes established. Despite being widely-used in the literature and increasingly in clinical practice, it is poorly understood. Objective To establish consensus on the construct and approaches to diagnose and manage pre-frailty. Methods We conducted a modified (electronic, two-round) Delphi consensus study. The questionnaire included statements concerning the concept, aspects and causes, types, mechanism, assessment, consequences, prevention and management of pre-frailty. Qualitative and quantitative analysis methods were employed. An agreement level of 70% was applied. Results Twenty-three experts with different backgrounds from 12 countries participated. In total, 70 statements were circulated in Round 1. Of these, 52.8% were accepted. Following comments, 51 statements were re-circulated in Round 2 and 92.1% were accepted. It was agreed that physical and non-physical factors including psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life. Experts considered pre-frailty to be an age-associated multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It can be reversed or attenuated by targeted interventions. Brief, feasible, and validated tools and multidimensional assessment are recommended to identify pre-frailty. Conclusions Consensus suggests that pre-frailty lies along the frailty continuum. It is a multidimensional risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies and socioeconomic disadvantages, predisposing to the development of frailty. More research is needed to agree an operational definition and optimal management strategies.

Funder

European Union's Health Programme

Publisher

Elsevier

Collections

Nursing and Midwifery (Scholarly Articles)