In light of the growing need to increase sustainability and efficiency of health and social care systems, strengthening the person-centered and integrated approach in geriatric care is essential. This approach may contribute to the prevention of age-related dependency and subsequently allow better management of human and material resources allocated in health.1 For optimal success, the person-centered and integrated care approach should be based on the synergistic work between professionals from different sectors, including healthcare providers as well as social and community stakeholders and patients' families. Moreover, its implementation should be accompanied by actions that aim to raise global awareness in promoting preventive health measures throughout the life cycle, encouraging social responsibility and fostering active and meaningful engagement in health-related issues across the ecosystem. With regard to geriatric care specifically, the person-centered and integrated approach should recognize that frailty is an important outcome and target potential adverse health events associated with this condition.2

Frailty has been considered a clinical condition for many years. Initially in the research, frailty was defined as a state of vulnerability that results from the accumulation of subclinical losses of physiological reserve across multiple systems, which can be observed through a set of changes in physical functioning.3 It has been suggested that this state of vulnerability is associated with limited capacity to maintain homeostasis after a stressor event and constitutes an important risk factor for age-related disability.3 Later, an alternative proposed definition of frailty emerged.4 The new proposal, based on the count of accumulated deficits, emphasized the multidimensional nature of biological changes underpinning the condition of frailty. It also demonstrated that stratification of risk of future adverse outcomes must consider context-dependent cognitive, emotional, motivational, and social changes.4 With this comprehensive definition, new lines of research were followed, leading to the description of frailty in terms of dynamic processes that occur within and across interrelated physiological systems and involve frequent transitions over time.5

Currently, it is widely recognized that frailty-related changes experienced by older adults may include depressive symptoms, feelings of anxiety and an inability to cope with problems (mood and motivational frailty), loss of resources required for fulfilling basic social needs, perception of lack of social interactions and support, isolation and loneliness (social frailty), as well as potentially reversible changes in cognition resulting from a reduction in cognitive reserve that cannot be explained by physiological brain aging or concurrent dementia, pre-existing brain disorders or acute event (cognitive frailty).6-9 The common feature of these changes in functioning is coexistence with physical losses observed through difficulties in one or more activities of daily living, impaired mobility, strength, balance and/or endurance, sensorial abnormalities (visual and hearing problems), weight loss or undernutrition, and/or poor self-rated health.3,10 These changes (physical, social, cognitive, mood, and motivational) may occur in the absence of a specific disease or disability; they may also be associated to a known comorbid condition.11 In the first case, frailty is considered in terms of a risk state, which constitutes a primary or preclinical condition for pathology development. In the second case, frailty converts to a real pathological state,11 requiring differentiated attention in the primary and secondary healthcare system.

The clarification of relationships between the different manifestations of frailty and other pathological conditions is paramount for clinical practice because it facilitates the choice of a more appropriate and, therefore, more effective treatment.2 For example, the initial research on cognitive frailty has characterized it as potentially reversible deterioration in memory, executive function, attention, language, visuospatial function, and processing speed.7,12 However, according to some authors,8 in less severe cases, such deterioration may not be detectable in cognitive testing due to the compensatory efforts of an individual.

More recently, a distinction has been proposed between cognitive frailty that manifests itself through physical frailty and subjective cognitive decline, and cognitive frailty that involves physical frailty and mild cognitive impairment, with the former being designated as reversible and the latter as potentially reversible.11 Both reversible and potentially reversible cognitive frailty share risk factors (e.g. vascular, nutritional and metabolic disturbances, and inflammatory processes) with neurocognitive disorders, conferring a greater risk for incident neurodegenerative processes.6,11 As for the impact of these two conditions on health-related outcomes, it has been shown that reversible cognitive frailty is associated with an increased risk of all-cause mortality, whereas potentially reversible cognitive frailty is associated with an increased risk of functional disability and poor quality of life, with findings on mortality being inconclusive.11 These findings show that frailty must be considered as a relevant target in the prevention of cognitive and functional impairment in older adults.

It is unquestionable that frailty constitutes a health and societal challenge, and, as such, more efforts should be made to improve the transfer and use of evidence related to screening and assessment, as well as prevention and treatment. The existing guidelines on how to prevent, delay, or reverse frailty have predominantly focused on physical manifestations of this condition.10,13 It is necessary that we overcome this gap. The impact of a new approach in geriatric care for improving the sustainability and efficiency of health and social care systems requires us to consider the multidimensional nature of frailty and to outline pathways for addressing the mood, motivational, cognitive, and social aspects of this age-related vulnerability.

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