Person-environment interaction processes in frailty: a scoping review

Frailty is an age-related syndrome characterized by increased vulnerability to stressors and adverse health outcomes. The environment influences older adults across many dimensions, yet person-environment (P-E) interactions related to frailty remain underexplored. This review aims to synthesize knowledge on P-E interactions associated with frailty.

We searched PubMed, Web of Science, and CINAHL for studies published between January 2001 and December 2024. Extracted data included study characteristics, definitions of environment and frailty, conceptual models, and key findings.

From 2,991 articles, 130 met inclusion criteria. Findings highlight the COntext Dynamics in Aging (CODA) framework's relevance to frailty research. We identified a variety of environmental indicators across the CODA domains in these studies. Furthermore, we propose a refined model illustrating the dynamic interplay between individual adaptation and environmental stress. This model introduces a spatial-differential perspective, the "hierarchical stair" principle, where meeting needs at proximal levels enables engagement at broader spatial scales. The model also suggests that adaptation strategies evolve as individuals transition from proximal to more distal environments, with the strongest effects occurring at the home level.

This review emphasizes the dynamic interaction between individual adaptation and environmental stress across spatial levels. However, the review is limited by the scarcity of studies explicitly examining these interaction processes and by the lack of empirical evidence on spatial dynamics. Therefore, the proposed model provides a heuristic framework for hypothesis‑driven research, and future studies should prioritize empirical testing of this multilevel approach.