Frailty: An overview

Frailty is an emerging global health concern driven by population aging and rising prevalence of multimorbidity. It is a multidimensional geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, leading to adverse outcomes such as disability, falls, hospitalization, and mortality. The prevalence of frailty varies across settings and populations, ranging from 4% to 16% among community-dwelling older adults to over 40% in clinical subgroups, with higher rates observed in women and the oldest-old. The etiology is multifactorial, involving sarcopenia, chronic inflammation, endocrine dysregulation, nutritional deficits, psychosocial stressors, and environmental influences. Pathophysiological mechanisms, such as inflammaging, mitochondrial dysfunction, and metabolic alterations, create a self-perpetuating cycle of decline across physiological domains. Diagnosis relies on clinical tools like the fried frailty phenotype, frailty index, and clinical frailty scale, supported by comprehensive geriatric assessment. Management requires a holistic, multidisciplinary approach that integrates exercise, nutritional optimization, medication review, fall prevention, cognitive and psychological support, and social engagement. Early identification and tailored interventions are essential to mitigate the burden of frailty, preserve independence, and improve quality of life. This review highlights current understanding of frailty's prevalence, mechanisms, clinical features, and evidence-based management strategies, underscoring the urgent need for integrated care models and context-specific interventions, particularly in low- and middle-income countries.