Frailty: implications for clinical practice and public health

Emiel O. Hoogendijk, Jonathan Afilalo, Kristine E. Ensrud, Paul Kowal, Graziano Onder, Linda P. Fried

Research output: Contribution to journalReview articlepeer-review

101 Scopus citations


Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.

Original languageEnglish (US)
Pages (from-to)1365-1375
Number of pages11
JournalThe Lancet
Issue number10206
StatePublished - Oct 12 2019

Bibliographical note

Funding Information:
EH is supported by an NWO/ZonMw Veni fellowship [grant number 91618067]. The data collection of the Longitudinal Aging Study Amsterdam ( figure 1 ) is largely supported by a grant from the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. We thank Elsa Dent for her valuable comments on earlier versions of the manuscript.

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