Exploring frailty and its domains - Systematic mapping of the literature

'Frailty' has no consensual definition till date, although the term occupies a pivotal role in geriatric medicine. A bibliometric analysis of the literature serves to capture the keyword cooccurrences and linkages, co-citations, author collaborations, research trends and to present the extant research in a nutshell.

To explore the usage of frailty, its domains in medical research and the evolution of the term to other disciplines through systematic mapping by bibliometric analysis.

Literature search was done in the Scopus database using a pre-formed search strategy. 2629 documents were retrieved. Co-occurrence citation analysis using keywords and link strength was obtained using the VOSviewer ver.1.6.16. A three-field plot was constructed using 'biblioshiny' package of the R-studio to identify the various domains of frailty. Descriptive statistics were applied to identify the trends in frailty research, number of contributions from countries, fields of research involving frailty.

Total of 3739 publications were observed, with the USA having most number of contributions (740, 20%) as single country, while India has only 19 contributions (0.5%) in the past 20 years. As a region, Europe and Central Asia contributed to the maximum (1714, 46.4%), most of them being from the high-income countries. Research on frailty has steadily increased over the past two decades, with most of the researches being conducted in the fields of Medicine, Biochemistry and Genetics. Cooccurrence citations and three-field plots indicate the evolving usage of frailty in other domains, such as cognition, mental health, indicators of survival, risk assessment, mortality, and quality of life.

Upon exploring frailty, it also makes one wonder if frailty could be the cause for what is known as death due to 'natural causes' or 'old age'. The implementation of extension codes in the ICD-11 related to 'Ageing' (XT9T) and 'Old Age' (MG2A), paves way for researchers to further explore 'frailty' as a cause of mortality.