Background

Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.

Methods and Results

This review bridges the evidence gap by providing a broad overview of frailty in the context of global healthy ageing goals and policies. We highlight how research on frailty screening and management has been predominantly conducted in high-income countries and the lack of geographical and population representativeness, despite rapidly ageing population trends in lower-income countries.

The evidence base from lower-income countries is showing an increasing trend, and frailty research from these regions should capture the unique contexts, healthcare systems, population dynamics and cultural nuances.

Further considerations for frailty research in lower-income countries include assessing the narrative around frailty, correlations between frailty and intrinsic capacity in different populations, the social determinants of health as contributing risk factors in global majority populations and the socioeconomic implications of addressing frailty in ageing populations.

Supportive collaborative networks across high-income and lower-income countries would help drive context-specific research and develop robust care systems for frailty screening and management.

Conclusions

Rapid population ageing in lower-income countries poses significant challenges to healthcare systems and national economies. Ensuring that older people spend their later years in good health is crucial to achieve global healthy ageing goals, which include preventing frailty, a condition associated with problematic ageing. Studies on frailty have predominantly originated from HICs, but their findings cannot be simply generalised to lower-income countries owing to the multidimensional risk factors and heterogeneous manifestations of the condition. The growing and diversifying evidence landscape on frailty from lower-income countries in recent years signals the recognition of frailty as a serious public health challenge. However, research should be context-specific and informed by the cultural nuances, underlying social determinants of health, population dynamics, health system structures and policy priorities. Future directions for research, practice, policy in both global and resource-limited contexts include (1) reaching a consensus on an internationally recognised frailty definition; (2) adapting existing frailty screening tools, interventions and clinical guidelines for local populations; (3) exploring intrinsic capacity as an indicator of ageing over the life course, and its associations with frailty and utility in routine health and social care; (4) addressing the social determinants of health at different care levels to prevent frailty onset and worsening in HICs and lower-income countries; (5) evaluating the socioeconomic benefits of addressing frailty on an individual, community, national and global level, thereby helping drive policy change and (6) building supportive collaborative systems between HICs and lower-income countries to develop and improve care systems and drive research with and for older people to prevent frailty onset and progression.

Full publication

Frailty: a global health challenge in need of local action

(BMJ Global Health)

Date

August 2024

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