Editorial| Volume 22, ISSUE 3, P520-523, March 2021

Download started.


Research on Frailty: Where We Stand and Where We Need to Go

Published:January 22, 2021DOI:
      More than a century ago, Elie Metchnikoff, winner of the Nobel Prize of Physiology and Medicine in 1908, proposed the term gerontology to define the “scientific study of old age.”
      • Metchnikoff E.
      The Nature of Man: Studies in optimistic phylosophy (PC Mitchell, trans.).
      Six years later, Ignatz Leo Nascher coined the term geriatrics to define the branch of medicine devoted to the prevention and care of diseases in older people in a book and presentation to the NewYork Academy of Sciences.
      • Nascher I.L.
      Geriatrics. The diseases of the old age and their treatments.
      Two decades later, in the 1930s, Marjorie Warren showed that “chronic sick, unclassified and ill-assorted” disabled older patients, long admitted to a London Hospital, when appropriately treated were able to recover functionally and be discharged to their homes.
      • Warren M.W.
      Care of chronic sick.
      • Warren M.W.
      Care of the chronic aged sick.
      These three milestones emphasized aging as a process, initially focused on longevity, and inspired care of older people to change the focus on recovering or mitigating lost function through prosthetic technical devices (eg, canes, walkers) or environmental adaptations.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Metchnikoff E.
        The Nature of Man: Studies in optimistic phylosophy (PC Mitchell, trans.).
        Putnams, London1903
        • Nascher I.L.
        Geriatrics. The diseases of the old age and their treatments.
        NY Med J. 1909; 90: 358-359
        • Warren M.W.
        Care of chronic sick.
        BMJ. 1943; 2: 822-823
        • Warren M.W.
        Care of the chronic aged sick.
        Lancet. 1946; 1: 841-843
        • Campbell A.J.
        • Buchner D.M.
        Unstable disability and the fluctuations of frailty.
        Age Aging. 1997; 26: 315-318
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        • Cardiovascular Health Study Collaborative Research Group
        Frailty in older adults: Evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Rockwood K.
        • Mitnitski A.
        Frailty in relation to the accumulation of deficits.
        J Gerontol A Biol Sci Med Sci. 2007; 62: 722-727
        • World Health Organization
        World Report on Ageing and Health. Geneva, Switzerland.
        2015 (Available at:)
        Date accessed: January 24, 2021
        • Kaeberlein M.
        Translational geroscience: A new paradigm for 21st century medicine.
        Transl Med Aging. 2017; 1: 1-4
        • Rodriguez-Mañas L.
        • Rodríguez-Artalejo F.
        • Sinclair A.J.
        The third transition: The clinical evolution oriented to the contemporary older patient.
        J Am Med Dir Assoc. 2017; 18: 8-9
        • García-García F.J.
        • Carcaillon L.
        • Fernandez-Tresguerres J.
        • et al.
        A new operational definition of frailty: The Frailty Trait Scale.
        J Am Med Dir Assoc. 2014; 15 (371.e7-371.e13)
        • Oviedo-Briones M.
        • Laso Á.R.
        • Carnicero J.A.
        • et al.
        A comparison of frailty assessment instruments in different clinical and social settings: The Frailtools project.
        J Am Med Dir Assoc. 2020; (S1525-8610(20)30821-5. [Epub ahead of print])
        • Huang S.T.
        • Tange C.
        • Otsuka R.
        • et al.
        Subtypes of physical frailty and their long-term outcomes: A longitudinal cohort study.
        J Cachexia Sarcopenia Muscle. 2020; 11: 1223-1231
        • Pamoukdjian F.
        • Laurent M.
        • Martinez-Tapia C.
        • et al.
        Frailty parameters, morbidity and mortality in older adults with cancer: A structural equation modelling approach based on the Fried Phenotype.
        J Clin Med. 2020; 9: 1826
        • Mei F.
        • Gao Q.
        • Chen F.
        • et al.
        Frailty as a predictor of negative health outcomes in chronic kidney disease: A systematic review and meta-analysis.
        J Am Med Dir Assoc. 2020; (S1525-8610(20)30833-1. [Epub ahead of print])
        • World Medical Association
        World Medical Association declaration of Helsinki. Ethical principles for medical research involving human subjects.
        Bull World Health Organ. 2001; 79: 373-374
        • Denson A.C.
        • Mahipal A.
        Participation of the elderly in clinical trials: barriers and solutions.
        Cancer Control. 2014; 21: 209-214
        • Banzi R.
        • Camaioni P.
        • Tettamanti M.
        • et al.
        Older patients are still under-represented in clinical trials of Alzheimer's disease.
        Alzheimers Res Ther. 2016; 8: 32
        • Morley J.E.
        • Sinclair A.
        Individualising treatment for older people with diabetes.
        Lancet. 2013; 382: 378-380
        • Rodriguez-Mañas L.
        • Laosa O.
        • Vellas B.
        • et al.
        Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus.
        J Cachexia Sarcopenia Muscle. 2019; 10: 721-733
        • Crome P.
        • Cherubini A.
        • Oristrell J.
        The PREDICT (Increasing the Participation of the Elderly in Clinical Trials) Study: The Charter and Beyond.
        Expert Rev Clin Pharmacol. 2014; 7: 457-468
        • World Health Organization
        Integrated Care for Older People: Guidelines on Community-Level Interventions to Manage Declines in Intrinsic Capacity.
        World Health Organization, Geneva2017
        • Robert B.
        • Sun A.H.
        • Sinden D.
        • et al.
        A case-control study of the Sub-Acute Care for Frail Elderly (SAFE) Unit on hospital readmissions, emergency department visits and continuity of post-discharge care.
        J Am Med Dir Assoc. 2020; (S1525-8610(20)30631-9. [Epub ahead of print])
        • Needham S.L.
        Toward priorities for aging research.
        Rejuvenation Res. 2014; 17: 154-156
        • Dent E.
        • Martin F.C.
        • Bergman H.
        • et al.
        Management of frailty: Opportunities, challenges, and future directions.
        Lancet. 2019; 394: 1376-1386
        • Rodríguez Mañas L.
        • García-Sánchez I.
        • Hendry A.
        • et al.
        Key messages for a frailty prevention and management policy in Europe from the Advantage Joint Action Consortium.
        J Nutr Health Aging. 2018; 22: 892-897
        • Bethell J.
        • Puts M.T.E.
        • Sattar S.
        • et al.
        The Canadian Frailty Priority Setting Partnership: Research priorities for older adults living with frailty.
        Can Geriatr J. 2019; 22: 23-33
        • World Health Organization
        The Decade of Healthy Aging: A new UN-wide initiative.
        (Available at:) (Published December 14, 2020)