Frailty and Intrinsic Capacity: Two Distinct but Related Constructs

Giulia Belloni, Matteo Cesari, Giulia Belloni, Matteo Cesari

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.

Keywords: comprehensive geriatric assessment; disability; healthy aging; older people; person-centered care; public health.

References

    1. Global Strategy and Action Plan on Ageing and Health. Geneva: World Health Organization, (2017).
    1. Scheidt RJ, Humpherys DR, Yorgason JB. Successful aging: what's not to like? J Appl Gerontol. (1999) 18:277–82. 10.1177/073346489901800301
    1. World Health Organization World Report on Ageing and Health. Geneva: World Health Organization, (2015).
    1. WHO . What is Healthy Ageing? WHO. Available online at: (accessed May 20, 2019).
    1. WHO . Active Aging: A Policy Framework. Geneva: WHO, (2002).
    1. Martin P, Kelly N, Kahana B, Kahana E, Willcox BJ, Willcox DC, et al. Defining successful aging: a tangible or elusive concept? Gerontologist. (2015) 55:14–25. 10.1093/geront/gnu044
    1. Depp CA, Jeste DV. Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry Off J Am Assoc Geriatr Psychiatry. (2006) 14:6–20. 10.1097/01.JGP.0000192501.03069.bc
    1. Cosco TD, Prina AM, Perales J, Stephan BCM, Brayne C. Operational definitions of successful aging: a systematic review. Int Psychogeriatr. (2014) 26:373–81. 10.1017/S1041610213002287
    1. Rowe JW, Kahn RL. Successful aging. Gerontologist. (1997) 37:433–440. 10.1093/geront/37.4.433
    1. Baltes PB. On the incomplete architecture of human ontogeny. Selection, optimization, and compensation as foundation of developmental theory. Am Psychol. (1997) 52:366–380.
    1. Kahana E, Kahana B. Conceptual and empirical advances in understanding aging well through proactive adaptation. In: Adulthood and Aging: Research on Continuities and Discontinuities. New York, NY: Springer Publishing Co, (1996) p. 18–40.
    1. Phelan EA, Anderson LA, LaCroix AZ, Larson EB. Older adults' views of “successful aging”–how do they compare with researchers' definitions? J Am Geriatr Soc. (2004) 52:211–6. 10.1111/j.1532-5415.2004.52056.x
    1. Pruchno RA, Wilson-Genderson M, Rose M, Cartwright F. Successful aging: early influences and contemporary characteristics. Gerontologist. (2010) 50:821–33. 10.1093/geront/gnq041
    1. Bowling A, Dieppe P. What is successful ageing and who should define it? BMJ. (2005) 331:1548–51. 10.1136/bmj.331.7531.1548
    1. Low L-F, Yap M, Brodaty H. A systematic review of different models of home and community care services for older persons. BMC Health Serv Res. (2011) 11:93. 10.1186/1472-6963-11-93
    1. Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trials. Health Soc Care Community. (2009) 17:447–58. 10.1111/j.1365-2524.2009.00844.x
    1. Woo J. Combating frailty and sarcopenia in aging populations: switching to a more positive paradigm. Aging Med. (2019) 2:7–10. 10.1002/agm2.12052
    1. Vermeiren S, Vella-Azzopardi R, Beckwée D, Habbig AK, Scafoglieri A, Jansen B, et al. . Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc. (2016) 17:1163.e1–17. 10.1016/j.jamda.2016.09.010
    1. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. . Frailty consensus: a call to action. J Am Med Dir Assoc. (2013) 14:392–7. 10.1016/j.jamda.2013.03.022
    1. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. (2016) 31:3–10. 10.1016/j.ejim.2016.03.007
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. (2001) 56:M146–156. 10.1093/gerona/56.3.m146
    1. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. . A global clinical measure of fitness and frailty in elderly people. CMAJ Can Med Assoc J J Assoc Medicale Can. (2005) 173:489–95. 10.1503/cmaj.050051
    1. Cesari M, Gambassi G, van Kan GA, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing. (2014) 43:10–12. 10.1093/ageing/aft160
    1. Cesari M, Landi F, Calvani R, Cherubini A, Di Bari M, Kortebein P, et al. . Rationale for a preliminary operational definition of physical frailty and sarcopenia in the SPRINTT trial. Aging Clin Exp Res. (2017) 29:81–8. 10.1007/s40520-016-0716-1
    1. Turner G, Clegg A, British Geriatrics Society Age UK Royal College of General Practioners . Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing. (2014) 43:744–7. 10.1093/ageing/afu138
    1. Woo J. Challenges of population ageing: putting frailty as a cornerstone of health and social care systems. Eur Geriatr Med. (2018) 9:273–6. 10.1007/s41999-018-0056-0
    1. Lim WS, Wong CH, Ding YY, Rockwood K, Lien C. Translating the science of frailty in singapore: results from the national frailty consensus discussion. Ann Acad Med Singapore. (2019) 48:25–31.
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet Lond Engl. (2013) 381:752–62. 10.1016/S0140-6736(12)62167-9
    1. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Sci. World J. (2001) 1:323–36. 10.1100/tsw.2001.58
    1. Jylhävä J, Jiang M, Foebel AD, Pedersen NL, Hägg S. Can markers of biological age predict dependency in old age? Biogerontology. (2019) 20:321–29. 10.1007/s10522-019-09795-5
    1. Jazwinski SM, Kim S. Metabolic and Genetic Markers of Biological Age. Front Genet. (2017) 8:64. 10.3389/fgene.2017.00064
    1. WHO Clinical Consortium on Healthy Ageing Report of consortium meeting 1–2 December 2016 in Geneva, Switzerland. Geneva: World Health Organization, (2017).
    1. Althoff T, Sosič R, Hicks JL, King AC, Delp SL, Leskovec J. Large-scale physical activity data reveal worldwide activity inequality. Nature. (2017) 547:336–9. 10.1038/nature23018
    1. Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, et al. . Evidence for the domains supporting the construct of intrinsic capacity. J Gerontol A Biol Sci Med Sci. (2018) 73:1653–60. 10.1093/gerona/gly011
    1. WHO Clinical Consortium on Healthy Ageing 2017 – Report of Consortium Meeting 21–22 November 2017 in Geneva Switzerland. Geneva: World Health Organization, (2018).
    1. Integrated Care for Older People: Guidelines on Community-Level Interventions to Manage Declines in Intrinsic Capacity. Geneva: World Health Organization, (2017).
    1. Woo J. Frailty, Successful aging, resilience, and intrinsic capacity: a cross-disciplinary discourse of the aging process. Curr Geriatr Rep. (2019) 8:67–71. 10.1007/s13670-019-0276-2

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe