TY - JOUR

T1 - Early identification of frailty

T2 - Developing an international delphi consensus on pre-frailty

AU - Sezgin, D.

AU - O'Donovan, M.

AU - Woo, J.

AU - Bandeen-Roche, K.

AU - Liotta, G.

AU - Fairhall, N.

AU - Rodríguez-Laso, A.

AU - Apóstolo, J.

AU - Clarnette, R.

AU - Holland, C.

AU - Roller-Wirnsberger, R.

AU - Illario, M.

AU - Mañas, L.R.

AU - Vollenbroek-Hutten, M.

AU - Doğu, B.B.

AU - Balci, C.

AU - Pernas, F.O.

AU - Paul, C.

AU - Ahern, E.

AU - Romero-Ortuno, R.

AU - Molloy, W.

AU - Cooney, M.T.

AU - O'Shea, D.

AU - Cooke, J.

AU - Lang, D.

AU - Hendry, A.

AU - Kennelly, S.

AU - Rockwood, K.

AU - Clegg, A.

AU - Liew, A.

AU - O'Caoimh, R.

N1 - This is the author’s version of a work that was accepted for publication in Archives of Gerontology and Geriatrics. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Archives of Gerontology and Geriatrics, 99, 2021 DOI: 10.1016/j.archger.2021.104586

PY - 2022/3/31

Y1 - 2022/3/31

N2 - 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.

AB - 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.

KW - Consensus

KW - Definition

KW - Delphi

KW - Frailty

KW - Geriatric assessment

KW - Older people

KW - Pre-frailty

U2 - 10.1016/j.archger.2021.104586

DO - 10.1016/j.archger.2021.104586

M3 - Journal article

VL - 99

JO - Archives of Gerontology and Geriatrics

JF - Archives of Gerontology and Geriatrics

SN - 0167-4943

M1 - 104586

ER -