Combating frailty and sarcopenia in aging populations: Switching to a more positive paradigm

Frailty may be used as a public health indicator of aging well for projection of health and social care resource allocation. Frailty assessments have been adopted by various medical as well as surgical specialties as part of prognosis in influencing choice of therapy, although the assessment tools are even more heterogeneous than those in the gerontological fields. Recently, the World Health Organization called for a life course approach to healthy aging, placing the emphasis on function, expressed as intrinsic capacity, which would address concerns with the negative image of frailty and with the overemphasis on deficits. The impact of social and physical environments is taken into account in the concept of resilience. These are all related concepts that differ in the setting in which they are used. Frailty may be more useful in clinical management in hospitals and residential care homes, as well as in community models of care. Intrinsic capacity could be used for development of health-promotion policies and service models across the life course; mainly primary care with low resource needs, using a step-care approach. Resilience could be considered an overarching holistic concept covering physical, psychological, and environmental domains, which is still in the research arena.