Vitality, Medicine & Engineering Journal

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B. Fougère1,2,3


1. Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; 2. Inserm UMR1027, Université de Toulouse III Paul Sabatier, Toulouse, France; 3. Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA

Corresponding to: B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France.
Tel: +33561145657 ; fax: +33561145640. E-mail address:

Care Weekly 2018;1:5-6
Published online May 4, 2018,


Key words: Disability, frailty, interventions, older people, prevention.


The number and proportion of older people in the global population are rapidly rising (1). Frailty is a multidimensional geriatric concept that influences several domains (2), and it is directly related to adverse consequences, such as falls, disability, the need for long term care, hospitalization, and even mortality (3–5). These adverse outcomes constitute a source of considerable healthcare expenditure, and it is known that the reduction of adverse outcomes could lead to an offset in medical costs (6). In this sense, the clinical outcomes related to frailty should be treated to prevent the socioeconomic burden associated with this condition. There is evidence suggesting that frailty is a potentially modifiable dynamic process characterized by frequent transitions between states over time. Given its multidimensional nature, reversing frailty requires a comprehensive approach. In this context, several studies testing the effects of pharmacological approach, physical activity, nutritional intervention, or cognitive training and even multidomain interventions has to be developed.
Over the last decades, several intervention studies against disability in the older people using frailty indicators as inclusion criteria have been reported. It is possible to identify people who are frail for inclusion in a randomized trial and frailty can be successfully treated using an interdisciplinary multidomain program. There is the potential to reduce disability in community dwelling people who are frail. A recent review summarizes the findings of lessons learned from clinical trials (7). Specific interventions targeting physical activity have been shown to improve physical function (8–11), and intervention with nutritional supplements has resulted in increased energy intake and improved strength (12). The Mediterranean-style diet was also shown to be associated with a slower decline in mobility over time in community-dwelling older persons (13). Pharmacological interventions have produced inconsistent results (14–17). On the contrary, several clinical trials in older persons have shown that multidomain interventions are effective in improving morbidity, disability, hospitalization, institutionalization, and mortality (18–20).
However, there is substantial heterogeneity in frailty studies, in terms of intervention content and duration, study populations, length of follow-up, and outcome measures. Moreover, one of the most important limitations of research in this area is the lack of an agreed upon standardized global clinical definition of the frailty syndrome. Standardization of trial methods, especially in terms of duration of follow-up, comparators, target population definitions, and outcome measures, would enable the comparison of effect sizes across different types of interventions. Further researches are needed to establish the optimum type, duration, timing, and intensity of lifestyle-based interventions, and the clinical meaningfulness of any beneficial effects.
To be effective worldwide, interventions against disability in frail older adults must be feasible, inexpensive, and easy to implement in a wide range of settings, in addition to being safe. These interventions must aim at maximizing personal independence and minimizing personal disability so that individuals may delay or even avoid institutionalization (21). Lifestyle interventions, particularly multidomain interventions targeting physical exercise, cognitive training, and nutritional approach, could be a key component of our efforts to be effective against disability. The success of these interventions will be also linked to the capacity of the scientific community to involve other influential actors, such as policy makers and industrial partners, to facilitate access to specific interventions.


Conflict of Interest

BF declares no conflict of interest.

Authors’ contributions

BF made substantial contributions to conception and design. BF wrote the manuscript.



1.     World Health Organization. World report on ageing and health [Internet]. WHO. [cited 2016 Sep 14]. Available from:
2.     Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. Toward a conceptual definition of frail community dwelling older people. Nurs Outlook. 2010 Apr;58(2):76–86.
3.     Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-156.
4.     Rockwood K. What would make a definition of frailty successful? Age Ageing. 2005 Sep;34(5):432–4.
5.     Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255–63.
6.     Cutler DM. Declining disability among the elderly. Health Aff Proj Hope. 2001 Dec;20(6):11–27.
7.     Fougère B, Morley JE, Little MO, Barreto P de S, Cesari M, Vellas B. Interventions against disability in frail older adults: Lessons learned from clinical trials. J Nutr Health Aging. 2017 Oct 26;1–13.
8.     Paterson DH, Warburton DE. Physical activity and functional limitations in older adults: a systematic review related to Canada’s Physical Activity Guidelines. Int J Behav Nutr Phys Act. 2010 May 11;7:38.
9.     Tak E, Kuiper R, Chorus A, Hopman-Rock M. Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Res Rev. 2013 Jan;12(1):329–38.
10.     Jak AJ. The impact of physical and mental activity on cognitive aging. Curr Top Behav Neurosci. 2012;10:273–91.
11.     Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014 Jun 18;311(23):2387–96.
12.     Kim C-O, Lee K-R. Preventive effect of protein-energy supplementation on the functional decline of frail older adults with low socioeconomic status: a community-based randomized controlled study. J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):309–16.
13.     Milaneschi Y, Bandinelli S, Corsi AM, Lauretani F, Paolisso G, Dominguez LJ, et al. Mediterranean diet and mobility decline in older persons. Exp Gerontol. 2011 Apr;46(4):303–8.
14.     Dhesi JK, Jackson SHD, Bearne LM, Moniz C, Hurley MV, Swift CG, et al. Vitamin D supplementation improves neuromuscular function in older people who fall. Age Ageing. 2004 Nov;33(6):589–95.
15.     Atkinson RA, Srinivas-Shankar U, Roberts SA, Connolly MJ, Adams JE, Oldham JA, et al. Effects of testosterone on skeletal muscle architecture in intermediate-frail and frail elderly men. J Gerontol A Biol Sci Med Sci. 2010 Nov;65(11):1215–9.
16.     Friedlander AL, Butterfield GE, Moynihan S, Grillo J, Pollack M, Holloway L, et al. One year of insulin-like growth factor I treatment does not affect bone density, body composition, or psychological measures in postmenopausal women. J Clin Endocrinol Metab. 2001 Apr;86(4):1496–503.
17.     Sumukadas D, Witham MD, Struthers AD, McMurdo MET. Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial. CMAJ Can Med Assoc J J Assoc Medicale Can. 2007 Oct 9;177(8):867–74.
18.     Stuck AE, Minder CE, Peter-Wüest I, Gillmann G, Egli C, Kesselring A, et al. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med. 2000 Apr 10;160(7):977–86.
19.     Landi F, Onder G, Russo A, Tabaccanti S, Rollo R, Federici S, et al. A new model of integrated home care for the elderly: impact on hospital use. J Clin Epidemiol. 2001 Sep;54(9):968–70.
20.     Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, et al. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ. 1998 May 2;316(7141):1348–51.
21.     Khachaturian AS, Hoffman DP, Frank L, Petersen R, Carson BR, Khachaturian ZS. Zeroing out preventable disability: Daring to dream the impossible dream for dementia care: Recommendations for a national plan to advance dementia care and maximize functioning. Alzheimers Dement J Alzheimers Assoc. 2017 Oct;13(10):1077–80.