The relationship between frailty and glycemic control in older adults with diabetes remains uncertain, mainly due to the fact that previous studies have not accounted for measures of body composition. In older adults with diabetes, we examined the association between three types of frailty measures and glycemic control, while accounting for fat-free mass (FFM) and waist circumference (WC). Eighty older adults (age ≥65, 27 women and 53 men, mean age 80.5 ± 0.6 years) had gait speed, Cardiovascular Health Study Index (CHSI), Rockwood Clinical Frailty Scale (RCFS), and glycosylated hemoglobin (HgA1C) measured. HgA1C showed a negative association only with CHSI (standardized β = −0.255 ± 0.120, p = 0.038), but no association with gait speed or the RCFS. Even after accounting for FFM and WC, we demonstrated a negative association between glycated hemoglobin and increasing frailty in older adults with diabetes.

Frailty is a common but complex phenomenon that is approached from theoretical and professional perspectives but rarely from the perspectives of older people and their essential stakeholders. Different or opposing perspectives on frailty at personal, organisational, and community levels can negatively affect care for frail older people. This systematic integrative review synthesises the perspectives on frailty of older people, health/social care professionals, informal caregivers, managers and policymakers, using thematic analysis. We use the Joanna Briggs Institute–Critical Appraisal Checklist to appraise the quality of 52 qualitative and mixed-method studies drawn from the PubMed/MEDLINE, CINAHL, PsycINFO, Embase, and Web of Science databases (inception–December 2023). Of these, 33 include the perspectives of older people, 27 of health/social care professionals, four of managers, and six of informal caregivers. Structuring the perspectives along six themes – ‘the multi-dimensional nature of frailty’, ‘the dynamics of frailty’, ‘the complexity of frailty’, ‘frailty in relation to age’, ‘frailty in relation to health’ and ‘frailty in relation to dependence’ – revealed substantive similarities in the conceptualisation of frailty between older people and professionals, e.g. regarding frailty’s dynamic and multi-dimensional nature. However, older people and professionals differ in their interpretations of frailty: older people take a personal view, while professionals take a more practical view. The identified discrepancies in perspectives may affect care relationships and care for frail older people. Therefore, we advocate a systems approach that incorporates multiple perspectives to form a comprehensive view of frailty and allows for a situation-specific shared understanding of frailty in older people.

Functional decline following hospitalization remains an important problem in health care, especially for frail older adults. Modifiable factors related to reduction in harms of hospitalization are not well described. One particularly pervasive factor is emergency department (ED) boarding time; time waiting from decision to admit, until transfer to an in-patient medical unit. We sought to investigate how the functional status of frail older adults correlated with the length of time spent boarded in the ED. We found that patients who waited for 24 hours or more exhibited functional decline in both the Barthel Index and Hierarchical Assessment of Balance and Mobility and an increase in the Clinical Frailty Scale from discharge to 6 months post discharge. In conclusion, there is a need for additional investigation into ED focused interventions to reduce ED boarding time for this population or to improve access to specialized geriatric services within the ED.

Although older people who live alone might be in a vulnerable situation, they have often managed their everyday life for a long time, frequently with health challenges. In this article, we explore how nine older persons who live alone, who receive home care and are identified by home care professionals as being frail, manage their everyday lives by inquiring into their stories about living alone and receiving home care. We conducted three qualitative interviews with each of the nine participants over a period of eight months and analysed the data using thematic analysis and a narrative positioning analysis. Using the concept of resilience as our analytic lens, we identified three thematic threads: continuity, adaptation and resistance. In the narrative positioning analysis of three participants' stories, we identified that the participants used the processes of continuity, adaptation and resistance strategically and interchangeably. The study thus provides insight into how older people who live alone and use home care services narrate their balancing of strengths and vulnerabilities, and engage in the construction and maintenance of a sense of self through positioning in relation to master narratives. Older people's narrations are nuanced and complex, and this study indicates that encouraging storytelling and engaging with older people's narrations might support how older people enact resilience and thus their management of everyday life when living alone and ageing in place.

This review will provide an overview of the immune system and then describe the effects of frailty, obesity, specific micronutrients and the gut microbiota on immunity and susceptibility to infection including data from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic where relevant. A key role for the immune system is providing host defence against pathogens. Impaired immunity predisposes to infections and to more severe infections and weakens the response to vaccination. A range of nutrients, including many micronutrients, play important roles in supporting the immune system to function. The immune system can decline in later life and this is exaggerated by frailty. The immune system is also weakened with obesity, generalised undernutrition and micronutrient deficiencies, which all result in increased susceptibility to infection. Findings obtained during the SARS-CoV-2 pandemic support what was already known about the effects of ageing, frailty and obesity on immunity and susceptibility to infection. Observational studies conducted during the pandemic also support previous findings that multiple micronutrients including vitamins C, D and E, zinc and selenium and long-chain n-3 fatty acids are important for immune health, but whether these nutrients can be used to treat those already with coronavirus disease discovered in 2019 (COVID-19), particularly if already hospitalised, is uncertain from current inconsistent or scant evidence. There is gut dysbiosis in patients with COVID-19 and studies with probiotics report clinical improvements in such patients. There is an inverse association between adherence to a healthy diet and risk of SARS-CoV-2 infection and hospitalisation with COVID-19 which is consistent with the effects of individual nutrients and other dietary components. Addressing frailty, obesity and micronutrient insufficiency will be important to reduce the burden of future pandemics and nutritional considerations need to be a central part of the approach to preventing infections, optimising vaccine responses and promoting recovery from infection.

The starting point of our research is the inadequacy of assuming, in the construction of a model of mortality, that frailty is constant for the individuals comprising a demographic population. This assumption is implicitly made by standard life table techniques. The substantial differences in the individual susceptibility to specific causes of death lead to heterogeneity in frailty, and this can have a material effect on mortality models and projections—specifically a bias due to the underestimation of longevity improvements. Given these considerations, in order to overcome the misrepresentation of the future mortality evolution, we develop a stochastic model based on a stratification weighting mechanism, which takes into account heterogeneity in frailty. Furthermore, the stratified stochastic model has been adapted also to capture COVID-19 frailty heterogeneity, that is a frailty worsening due to the COVID-19 virus. Based on different frailty levels characterizing a population, which affect mortality differentials, the analysis allows for forecasting the temporary excess of deaths by the stratification schemes in a stochastic environment.

The Tilburg Frailty Indicator (TFI) is a validated tool for determining frailty in older adults. This study examined the validity and accuracy of the TFI Part B (TFI-B) in a North American context. Seventy-two individuals ≥ 65 years of age recruited from a rural geriatric medicine clinic completed a set of self-reported and performance-based measures, including TFI-B. Frailty level was determined using modified Fried’s Frailty Phenotype (FFP). Pearson correlation coefficients (r) assessed the concurrent relationships between the TFI-B and other measures. Accuracy of the TFI-B in classifying frailty level was assessed using assessing area under the curve (AUC). The TFI-B scores showed low correlations (r < 0.4) with gait speed and grip, suggesting that the TFI-B did not consider frailty as merely a physical problem. The AUC of 0.82 indicated that the TFI-B scores accurately classified frail versus non-frail individuals. The score of ≥ 5 on the TFI-B scores showed satisfactory sensitivity/specificity (73%/77%) and excellent negative predictive value (91.95%). This indicates that a TFI-B score of < 5 can be used to rule out frailty.

Age-related frailty and cognitive decline are complex multidimensional conditions that significantly impact the ability of older adults to sustain functional capacity and independence. While underlying causes remain poorly understood, nutrition continually emerges as one associated risk element. Many studies have addressed the importance of adequate nutrition in delaying the onset of these conditions, but the specific role of micronutrients is not well established. The consideration of pre-frailty as an outcome variable is also limited in the current literature. In this review, we focus on the potential value of maintaining micronutrient sufficiency to sustaining the health of the ageing population. Using data from the Irish longitudinal study on ageing, we consider several vitamins known to have a high prevalence of low status in older adults and their impact on pre-frailty, frailty and cognitive impairment. They include vitamin B12 and folate, both of which are associated with multiple biological mechanisms involved in long-term health, in particular in cognitive function; vitamin D, which has been associated with increased risk of musculoskeletal disorders, depression and other chronic diseases; and the carotenoids, lutein and zeaxanthin, that may help mitigate the risk of frailty and cognitive decline via their antioxidant and anti-inflammatory properties. We show that low concentrations of folate and carotenoids are implicated in poorer cognitive health and that the co-occurrence of multiple nutrient deficiencies confers greatest risk for frailty and pre-frailty in the Irish longitudinal study on ageing cohort. These health associations contribute to evidence needed to optimise micronutrient status for health in the older adult population.

Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event. Frailty is most frequently assessed in the old using the Clinical Frailty Scale (CSF) which ranks frailty from 1 to 9. This assessment typically takes less than one minute and is not validated in patients with learning difficulties or those under 65 years old. The National Institute for Health and Care Excellence (NICE) developed guidelines that use “frailty” as one of the priority-setting criteria for how scarce, but potentially lifesaving, health care resources should be allocated during the COVID-19 pandemic. Similar guidelines have been developed elsewhere. This paper discusses the ethical implications of such rationing and argues that this is an unproven and ethically problematic form of health care rationing. It specifically discusses: (1) how the frailty ascription becomes a self-fulfilling prophecy, (2) the problematic use of “frailty” in COVID-19 “triage,” (3) the circularity of the link between age and frailty, (4) indirect discrimination because of the use of a seemingly neutral criterion in health care rationing, and (5) the difficult link between comorbidities and frailty. It is found that there was no research into the use of global frailty scores as a criterion for access to acute treatment before January 2020 and so it is concerning how readily frailty scoring has been adopted to ration access to potentially lifesaving treatments. Existing gerontological frailty scoring systems have not been developed for this purpose, and repurposing them creates significant ethical issues.