A CONCEPTUAL MODEL OF FRAILTY IN OLDER ADULTS: A LITERATURE REVIEW

Received 2024-01-28; Accepted 2024-06-06; Published 2025-01-02

Abstract

This review employed several key procedures to synthesize the current evidence on frailty. An extensive literature search was conducted across major databases to identify relevant studies on frailty definitions, epidemiology, assessment tools, interventions, and conceptual models. The search results were analyzed using bibliometric techniques including thematic mapping with Biblioshiny and co-occurrence network visualization with VOSviewer. These bibliometric analyses identified core research themes, emerging topic clusters, and connections across the frailty literature. The main findings highlighted frailty's multidimensional nature spanning physical, cognitive, psychological, and social domains. While the frailty phenotype by Fried et al. (2) provided an initial operational definition, subsequent models increasingly encompassed a broader biopsychosocial frailty construct. Globally, over 10% of community-dwelling older adults were estimated as frail, with rates exceeding 40% in those over 90 years old. Frailty was associated with numerous adverse outcomes like disability, falls, hospitalization and mortality. Current assessment approaches included the frailty phenotype, frailty index, and various clinical performance tests, though no single comprehensive tool existed. Evidence supported tailoring multimodal interventions combining physical, nutritional, cognitive, psychological and social strategies to individual risk profiles. The principal conclusion was the critical need for a unified, holistic conceptual model elucidating the complex interplay of factors driving frailty's development and progression. Integrating the findings, a biopsychosocial framework was proposed conceptualizing frailty as a multifactorial health state arising from the cumulative impact of interconnected physical, cognitive, psychological, social and environmental determinants over the life course. Such models are essential for advancing frailty science, shaping clinical practices, and informing policies to promote healthy, resilient aging amid rapidly aging populations worldwide.