The European Union Geriatric Medicine Society (EUGMS) Working Group on "Frailty in older persons".

Abstract

The concept of frailty was introduced in literature to help at clinically depicting the transition of a robust older individual into a different clinical phenotype of risk. Frailty is generally described as a multisystemic impairment responsible for a state of increased vulnerability to endogenous and exogenous stressors. This syndrome may represent the first step towards the evident and clinically relevant functional disability (a cornerstone outcome for geriatric medicine)8, and has shown to be predictive of major negative health-related events, including hospitalization, institutionalization, and mortality.

Full text

The concept of frailty was introduced in literature to help at
clinically depicting the transition of a robust older individual
into a different clinical phenotype of risk (1-5). Frailty is
generally described as a multisystemic impairment responsible
for a state of increased vulnerability to endogenous and
exogenous stressors (6, 7). This syndrome may represent the
first step towards the evident and clinically relevant functional
disability (a cornerstone outcome for geriatric medicine)8, and
has shown to be predictive of major negative health-related
events, including hospitalization, institutionalization, and
mortality (7, 9-11).
Differently from disability, frailty is widely considered a
reversible condition, still amenable of improvement when
effective interventions are put in place (12, 13). Available data
indicate frailty as a highly prevalent condition in the general
older population (14-16), rendering it of special interest for
public health authorities. The increasing interest around frailty
in many medical specialties other than geriatrics, especially
oncology (17, 18) and cardiology (19, 20) it is noteworthy.
The problems of frailty and possible solutions
Frailty is one of the most relevant geriatric conditions which
has shown to be extremely suitable to serve as target for
preventive and therapeutic interventions. Nevertheless, to date,
its recognition as a “real” clinical condition worth to be
identified, assessed, and treated is still too limited. Multiple
issues are currently affecting the implementation of frailty in
the standard geriatric routine e.g., lack of a unique operational
definition, limited awareness of the syndrome, difficulties of
developing primary prevention strategies. Nevertheless, the
interest of the scientific community for this condition is
exponentially growing as demonstrated by the number of
publications on the topic over the last years (Figure 1).
To date, the theoretical foundations of frailty are largely
agreed by the scientific community (6, 7). What is still a matter
of debate and controversy concerns the most appropriate way to
translate the theory into clinical practice (21). Such scientific
debate is surely justified and important to be conducted.
Nevertheless, the risk exists that being too focused at
theoretically shaping the condition of interest may unduly delay
the development of structural actions against disability (22).
It is important to realize that the theme of frailty is relatively
recent in literature with the main publications dating less than
15 years ago (3, 10). Therefore, we realize that our knowledge
about the pathophysiological mechanisms underlying the frailty
syndrome is forcedly limited. However, the current
demographic scenario and economic threats challenging the
sustainibility of healthcare systems require specific and urgent
actions against the well-established and burdensome
consequences of frailty. In other words, the urgency of reaching
clinical answers to a specific need imposes the adoption of
actions even before the inner nature of frailty is fully elucidated
and understood.
The European Union Geriatric Medicine Society (EUGMS)
working group on "Frailty in older persons"
In order to receive the urgent demands of knowledge and
data in the field, the European Union Geriatric Medicine
Society (EUGMS) has recently launched a new working group
on "Frailty in older persons". This initiative is consistent with
the priority that the EUGMS poses on the prevention of
disability through the study of frailty (23). The working group
consists of clinicians and researchers from different
backgrounds and Countries, all of them with a specific interest
on frailty and disability prevention.
The main objective of the group is to support and facilitate
the clinical detection, assessment, and treatment of the frailty
THE EUROPEAN UNION GERIATRIC MEDICINE SOCIETY (EUGMS)
WORKING GROUP ON "FRAILTY IN OLDER PERSONS"
M. CESARI1,2,3, G. ABELLAN VAN KAN1,2, S. ARIOGUL4, J.P. BAEYENS5, J. BAUER7,
M. CANKURTARAN4, T. CEDERHOLM7, A. CHERUBINI8, A.J. CRUZ-JENTOFT9, A. CURGUNLU10,
F. L AN DI 11, A.A. SAYER12, T. STRANDBERG13, E. TOPINKOVA14, D. VAN ASSELT15, B. VELLAS1,2,
D. ZEKRY16, J.P. MICHEL16
1. Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; 2. Inserm UMR 1027, Toulouse France; 3. Université de Toulouse III Paul Sabatier, Toulouse, France;
4. Division of Geriatric Medicine, Hacettepe University, Ankara, Turkey; 5. Université du Luxembourg, Walferdange, Luxembourg; 6. Klinikum Oldenburg, Oldenburg, Germany;
7. Department of Public Health and Caring Services, Uppsala University, Uppsala, Sweden; 8. Department of Geriatrics, Italian National Research Center on Aging (INRCA), Ancona,
Italy; 9. Department of Geriatrics, Hospital Universitario Ramón y Cajal, Madrid, Spain; 10. Istanbul Bilim University, Department of Geriatrics, Istanbul, Turkey; 11. Centro Medicina
dell'Invecchiamento, Università Cattolica Sacro Cuore, Roma, Italy; 12. Academic Geriatric Medicine, University of Southampton, Southampton, United Kingdom; 13. Department of
Medicine, University of Helsinki, Helsinki, Finland; 14. Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; 15. Geriatric Medicine, Medical
Centre Leeuwarden, Leeuwarden, The Netherlands; 16. Geneva University Hospitals and University of Geneva, Geneva, Switzerland. Corresponding author: Matteo Cesari, MD, PhD,
Institut du Vieillissement, Gérontopôle, INSERM UMR 1027, Université Toulouse III – Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse France, Phone: +33 (0)5 61145628,
Fax: +33 (0)5 61145640, email: macesari@gmail.com
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The Journal of Frailty & Aging©
Volume 2, Number 3, 2013
Received June 15, 2013
Accepted for publication July 7, 2013
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syndrome in older persons across European countries. The
group will specifically generate actions aimed at:
–Developing possibilities for primary care physicians to
detect frailty in non-disabled community-dwelling older
persons;
– Designing dedicated clinical pathways for the identification
of causes of frailty in older persons;
–Implementing clinical interventions aimed at preventing or
delaying the onset of disability in older persons by targeting
the frailty syndrome;
– Building structured follow-up methodologies to monitor the
effectiveness of the implemented preventive interventions
against disability and the evolution of the health status in
frail older persons.
Moreover, additional objectives of the working group will
be:
–To discuss available evidence and develop new areas of
research in order to theoretically and biologically
characterize the frailty status of older persons;
– To explore the biological and clinical foundations of frailty.
In particular, the identification of specific characteristics and
possible targets of interventions will be pursued in order to
facilitate actions against the disabling cascade;
–To design interventions specifically focused at preventing
the onset of frailty and at restoring robustness in frail
subjects;
–To support the development of national and international
scientific collaborations on the theme of frailty;
–To educate healthcare professionals as well as the general
population about the concept of frailty and its clinical
relevance in the context of disability prevention.
Although it might appear quite ambitious to look at frailty
and prevention of disability with a so wide approach (from the
biological mechanisms of frailty to novel healthcare system
modifications), the nature of the topic imposes such a
comprehensive strategy (24). In fact, as mentioned, the priority
of the theme is given by public health agencies facing the rapid
growing number of older persons, heavily challenging the
economic sustainability of healthcare services. On the other
hand, a lot is still to be understood in order to biologically and
clinically define the frailty syndrome, golden target to prevent
disability in older persons8. Consequently, simultaneous
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Figure 1
Number of articles indexed in PubMed on "frailty" during the last 40 years. Updated on July 4, 2013
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strategies operating on different but complementary aspects of
frailty are needed to quickly obtain relevant results.
To pursue these objectives, the working group will regularly
meet and intensively interact. Scientific as well as divulgative
documents will be produced to update current evidence in the
field and provide recommendations for future initiatives and
objectives.
At this time, in order to facilitate the foundations of future
activities, the access to the working group is by invitation only.
Nevertheless, all the research and clinical proposals resulting
from the working group will be immediately extended to every
institution willing to collaborate in their practical
implementation. In fact, the group will try to gather European
researchers and clinicians around shared and agreed models for
building a dedicated network facilitating the design,
development, and conduction of future studies and trials on the
topic. In this context, it is noteworthy that the European
Medicines Agency is also developing a concept paper on the
characterisation of the frailty status of patients enrolled in
clinical trials (25). It is important to define interventions
targeting frailty, but also the development of treatments in the
presence of frailty.
The EUGMS working group met for the first time in
Amsterdam (The Netherlands) on May 31, 2013. This kick-off
meeting was aimed at planning the future activities of the group
and starting the discussion of the preliminary initiatives. Those
who are interested at being directly involved in the future
implementation of the working group proposals and
recommendations can contact the corresponding author of the
present report.
Funding: The European Union Geriatric Medicine Society
(EUGMS) working group on "Frailty in Older Persons" is
supported by an unrestricted grant by Nutricia.
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