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| Frailty |
| Theme | Category | Sample statements |
|
| Time | Older age and aging process | Risk for frailty is age-related and increases over time |
| Over age 80; greater than 65 years; “old-old”; fourth age |
| Aberrancies in biologic and physiologic systems lead to frailty |
| Gradual and unpredictable in the aging process |
| Progressive physiologic dysregulation | Aging and impaired homeostasis and defense mechanisms adversely impact function |
| Ambiguous boundaries and cause-effect relationships exist between morbidity, disability, and frailty |
| Progressive, time-dependent changes in structure and function |
| Dynamic trajectory | Malleable and may be prevented, mitigated, or reversed |
| Frailty usually worsens over time; slow dwindling dying trajectory |
| Transitional; constantly changing and evolving |
| Exists on a continuum from robust to end-of-life |
|
| Relationships | Biopsychosocial domains of function | Domains are interrelated; mutually interacting and inextricably linked; adverse events in one domain impact the other domains |
| Frailty is used to classify people to prioritize care and health and social services |
| Frailty has many forms due to deficits in biopsychosocial domains of function |
| Blurred boundaries between frail and nonfrail state; distinctions between feeling frail and being frail |
| Quality of life and well-being | Frailty is a threat to emotional integration and wholeness |
| Frailty is associated with social isolation, weakened social position |
| Unstable social support or psychological states can precipitate or worsen frailty |
| Connections and interdependence | Dependence/interdependence between social network, services, resources, technology |
| Transactional process requiring negotiation of interdependency and care receiving needs |
| Failed adaptation to manage frailty and changing biopsychosocial needs |
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| Loss | Physical function decline | Observable frailty markers: weight loss, weakness, low energy, unstable balance, slow movement, and mobility aids |
| Accumulation of chronic diseases |
| Sensory losses in vision or hearing |
| Cascading pathway with negative consequences | Losses are exacerbated across biopsychosocial domains of function |
| Leads to impaired physical mobility and dependence |
| Falls, disability, hospitalization, institutionalization, quality of life, self-care deficits, early mortality |
| Psychological and social identity | Stigma and negative connotations and labeling as frailty erode self-esteem and threaten identity |
| Medical classification denies psychological and social aspects |
| Disempowerment; loss of autonomy, control, and inner drive |
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| Vulnerability | Impaired resilience | Reduced reserve capacity and ability to resist and overcome intrinsic and extrinsic stressors |
| Failing homeostasis and risk for adverse outcomes |
| Increased healthcare needs and utilization |
| Precarious state | Instability, uncertainty, fragility |
| Delicate balance and tipping point; fragility |
| Frailty precipitates increased healthcare needs and service utilization |
| Psychologic and social coping | Negative emotional reactions to frailty; diminished autonomy |
| High psychological and social support needs; negatively impacted by social isolation, living alone |
| Antonym for successful aging |
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