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Frailty

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With the number of older persons projected to double to 1.5 billion individuals by the year 2050, population aging has become a burgeoning global phenomenon. With frailty demanding further understanding of its epidemiological characteristics and course, advancements in frailty research are imperative for better understanding of how to diagnose, reduce and mediate the drastic impact frailty has on aging populations. Frailty is an increasingly important concept within both clinical practice and research, being linked to a more than 2 times increase in the risk of adverse outcomes such as mortality, hospitalization, functional disability, and falls.

Within this collection at BMC Geriatrics we are interested in attracting both clinical and experimental studies focused on, but not strictly limited to the following:

Epidemiology and Measurement

  • Early life risk factors of frailty
  • Characterization of trajectory of frailty development or transitions between frailty states and their implications in clinical care including end-of-life care
  • Covid19, other common infections and frailty
  • Neuropsychiatric diseases and frailty
  • Measurement of pre-frailty
  • Cognitive impairment, frailty, and their unique and/or intersecting pathophysiology
  • Frailty and other geriatric syndromes (e.g., Falls, cognitive impairment) and their unique and/or intersecting pathophysiology

Frailty biology

  • Novel biomarkers of pre-frailty and frailty, particularly related to cellular senescence, intercellular communication, and mitochondrial dysfunction
  • Characterization, quantification, and validation of multisystem dysregulations at the cellular, molecular, and/or physiological levels and their relationships with frailty
  • Life-course studies of frailty using animal models

Frailty and Clinical Care

  • Frailty in sub-specialties  (e.g., surgery, HIV, nephrology)
  • Frailty and comorbidity: distinguishing frailty and disease-specific pathology and its severity
  • Innovative community or clinical trials of interventions either targeting frailty and related biology or improving clinical care of pre-frail and frail older adults (including trial protocols)
  • Cost-benefit analysis of frailty interventions
  • Frailty and end-of-life care

Interdisciplinary topics

  • Frailty and technology (e.g., bioengineering, sensor technology)
  • Frailty and ethics

Systematic and scoping reviews and meta-analysis within each area listed above. 

Articles will undergo the journal’s standard peer-review process overseen by our Guest Editors:


Prof Ivan Aprahamian

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Ivan Aprahamian is specialized in Internal Medicine, Geriatrics and Psychiatry. Currently, he is the director of the Geriatrics Program at the Jundiaí Medical School, Brazil and is also an Honorary Research Fellow at the Geriatric Psychiatry Department, University of Groningen. He holds a Fellowship position at the American College of Physicians and the International Society of Affective Disorders. His main research interests are frailty in the context of neuropsychiatric conditions including depressive disorders, cognitive impairment, sarcopenia and malnutrition in older adults. He also participated as co-author of 4 consensus of frailty.

Dr Qian-li Xue

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Dr. Qian-Li Xue is Associate Professor of Medicine, Biostatistics, and Epidemiology at the Johns Hopkins University. He is a biostatistician and a gerontologist whose research focuses on the natural history of physical frailty with particular emphasis on measurement and research methods for understanding aging phenotypes including physical frailty and cognitive impairment. Dr. Xue is a fellow of the Gerontological Society of America.

Published articles

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  1. Frailty assessment promises to identify older adults at risk for adverse consequences following stressors and target interventions to improve health outcomes. The Physical Frailty Phenotype (PFP) is a widely-s...

    Authors: Karen Bandeen-Roche, Jing Tian, Brian Buta, Jeremy Walston and Qian-Li Xue
    Citation: BMC Geriatrics 2023 23:451
    Content type: Research article Published on:

  2. Frailty is recognized as a geriatric syndrome associated with depression. The consequences and mechanism of frailty transitions are still understudied. This study assessed the influence of frailty transitions ...

    Authors: Nataliya Nerobkova, Yu Shin Park, Eun-Cheol Park and Jaeyong Shin
    Citation: BMC Geriatrics 2023 23:148
    Content type: Research Published on:

  3. Age-related changes in frailty have been documented in the literature. However, the evidence regarding changes in frailty prior to death is scarce. Understanding patterns of frailty progression as individuals ...

    Authors: Natalie D. Jenkins, Miles Welstead, Lucy Stirland, Emiel O. Hoogendijk, Joshua J. Armstrong, Annie Robitaille and Graciela Muniz-Terrera
    Citation: BMC Geriatrics 2023 23:49
    Content type: Research Published on:

  4. The decline in everyday life physical activity reflects and contributes to the frailty syndrome. While especially self-reported frailty assessments have the advantage of reaching large groups at low costs, lit...

    Authors: Stephanie Schmidle, Philipp Gulde, Raphael Koster, Cristina Soaz and Joachim Hermsdörfer
    Citation: BMC Geriatrics 2023 23:43
    Content type: Research Published on:

  5. Few studies emphasize on predictors of incident cognitive frailty (CF) and examine relationships between various gait characteristics and CF. Therefore, we conducted a 2-year prospective study to investigate p...

    Authors: Hei-Fen Hwang, Lalu Suprawesta, Sy-Jou Chen, Wen-Yu Yu and Mau-Roung Lin
    Citation: BMC Geriatrics 2023 23:24
    Content type: Research Published on:

  6. Hyperhomocysteinemia (HHcy) is considered to increase the risk of sarcopenia (S) and remains controversial. In this study, we aimed to investigate the prevalence of S among older Chinese adults and explore whethe...

    Authors: Bing Lu, Lingyu Shen, Haiqiong Zhu, Ling Xi, Wei Wang and Xiaojun Ouyang
    Citation: BMC Geriatrics 2022 22:896
    Content type: Research Published on:

  7. The early identification of pre-frailty and frailty among older people is a global priority because of the increasing incidence of frailty and associated adverse health outcomes. This study aimed to validate t...

    Authors: Emma Yun Zhi Huang, Jasmine Cheung, Justina Yat Wa Liu, Rick Yiu Cho Kwan and Simon Ching Lam
    Citation: BMC Geriatrics 2022 22:788
    Content type: Research Published on:

  8. Personalised Care Planning (PCP) is a collaborative approach used in the management of chronic conditions. Core components of PCP are shared decision making to achieve joint goal setting and action planning by...

    Authors: Nicky Kime, Alan Wright, Anne Heaven, Rebecca Hawkins, Jane Smith, Bonnie Cundill, Robbie Foy, Rebecca Lawton, Amanda Farrin, Claire Hulme and Andrew Clegg
    Citation: BMC Geriatrics 2022 22:760
    Content type: Research Published on:

  9. Few studies have examined the relationship between oral functions and the physical pre-frailty status, classified using physical function tests. This cross-sectional study aimed to clarify this association amo...

    Authors: Asuka Tani, Shinsuke Mizutani, Saori Oku, Harukaze Yatsugi, Tianshu Chu, Xin Liu, Kiyomi Iyota, Hiro Kishimoto and Haruhiko Kashiwazaki
    Citation: BMC Geriatrics 2022 22:726
    Content type: Research Published on:

  13. Pelvic fractures in older patients are associated with relevant morbidity and mortality. Both might be determined by fracture morphology and/or patient characteristics. The aim of this project is to investigat...

    Authors: Michaela Ramser, Werner Vach, Nathalie Strub, Dieter Cadosch, Franziska Saxer and Henrik Eckardt
    Citation: BMC Geriatrics 2022 22:669
    Content type: Research Published on:

  14. Frail older people are at higher risk of further deterioration if their needs are not acknowledged when they are acutely ill and admitted to hospital. Mental health comprises one area of needs assessment.

    Authors: Theresa Westgård, Isabelle Andersson Hammar, Katarina Wilhelmson and Margda Waern
    Citation: BMC Geriatrics 2022 22:645
    Content type: Research Published on:

  16. This study investigated the impact of physical frailty on the development of disabilities in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) according to sex amon...

    Authors: Seoyoon Lee, Miji Kim, Yunhwan Lee, Jinhee Kim, Hak Chul Jang, Belong Cho, Kyung Mook Choi, Eun Roh, Sang Joon Son, Jin-Hee Lee, Yong Soon Park, Sam-Gyu Lee, Bong Jo Kim, Hyeonju Kim and Chang Won Won
    Citation: BMC Geriatrics 2022 22:588
    Content type: Research Published on:

  18. Multitasking is an essential part of our everyday life, but performance declines typically in older age. Many studies have investigated the beneficial effects of cognitive, motor and combined cognitive-motor t...

    Authors: Melanie Mack, Robert Stojan, Otmar Bock and Claudia Voelcker-Rehage
    Citation: BMC Geriatrics 2022 22:581
    Content type: Research Published on:

  19. Exercise has been one of the key strategies for preventing frailty. While training programs for preventing frailty have been mainly developed in person, which have now become difficult to perform due to the co...

    Authors: Koji Oba, Yusuke Kagiwada, Masamitsu Kamada, Ryusuke Miki, Yuta Kondo, Tadashi Kamakura, Takeshi Yamagami, Tomomi Fujita and Yasuhiro Tsuchida
    Citation: BMC Geriatrics 2022 22:574
    Content type: Research Published on:

  20. Among adult kidney transplant (KT) candidates, 21% are frail and 55% have cognitive impairment, increasing the risk of pre- and post-KT mortality. Centers often assess frailty status and cognitive function dur...

    Authors: Prakriti Shrestha, Sarah E. Van Pilsum Rasmussen, Elizabeth A. King, Elisa J. Gordon, Ruth R. Faden, Dorry L. Segev, Casey Jo Humbyrd and Mara McAdams-DeMarco
    Citation: BMC Geriatrics 2022 22:566
    Content type: Research Published on:

  22. Compared with conventional hospitalization, admission to an acute geriatric care unit (AGU) is associated with better outcomes in elderly patients. In 2012, 50% of the hospitalizations of elderly patients were...

    Authors: D. Naouri, N. Pelletier-Fleury, N. Lapidus and Y. Yordanov
    Citation: BMC Geriatrics 2022 22:555
    Content type: Research Published on:

  24. There is no study on the frailty trajectory including both middle-aged and older people, and the understanding of the long-term frailty trajectory is insufficient. This study aimed to identify the frailty traj...

    Authors: Ah Ram Jang, Hae Sagong and Ju Young Yoon
    Citation: BMC Geriatrics 2022 22:524
    Content type: Research Published on:

  25. Frailty is clinically associated with multiple adverse outcomes, including reduced quality of life and functioning, falls, hospitalisations, moves to long-term care and mortality. Health services commonly focu...

    Authors: Rachael Frost, Christina Avgerinou, Claire Goodman, Andrew Clegg, Jane Hopkins, Rebecca L. Gould, Benjamin Gardner, Louise Marston, Rachael Hunter, Jill Manthorpe, Claudia Cooper, Dawn A. Skelton, Vari M. Drennan, Pip Logan and Kate Walters
    Citation: BMC Geriatrics 2022 22:485
    Content type: Study protocol Published on:

  26. Screening is often recommended as a first step in frailty management. Many guidelines call to implicate frailty screening into practice in the primary care setting. However, few countries or organizations impl...

    Authors: Jiahui Nan, Yunzhu Duan, Shuang Wu, Lulu Liao, Xiaoyang Li, Yinan Zhao, Hongyu Zhang, Xianmei Zeng and Hui Feng
    Citation: BMC Geriatrics 2022 22:482
    Content type: Research Published on:

  27. The term “frailty” might appear simple, but the methods used to assess it differ among studies. Consequently, there is inconsistency in the classification of frailty and predictive capacity depending on the fr...

    Authors: Daiki Watanabe, Tsukasa Yoshida, Yuya Watanabe, Yosuke Yamada, Motohiko Miyachi and Misaka Kimura
    Citation: BMC Geriatrics 2022 22:478
    Content type: Research Published on:

  28. Older US adults often receive care from multiple ambulatory providers. Seeing multiple providers may be clinically appropriate but creates challenges for communication. Whether frailty is a risk factor for gap...

    Authors: Oluwasegun P. Akinyelure, Calvin L. Colvin, Madeline R. Sterling, Monika M. Safford, Paul Muntner, Lisandro D. Colantonio and Lisa M. Kern
    Citation: BMC Geriatrics 2022 22:476
    Content type: Research Published on:

  29. There are currently no validated globally and freely available tools to estimate the modified frailty index (mFI). The widely available and non-proprietary International Statistical Classification of Diseases ...

    Authors: Ashwin Subramaniam, Ryo Ueno, Ravindranath Tiruvoipati, Jai Darvall, Velandai Srikanth, Michael Bailey, David Pilcher and Rinaldo Bellomo
    Citation: BMC Geriatrics 2022 22:422
    Content type: Research Published on:

  30. To create an electronic frailty index (eFRAGICAP) using electronic health records (EHR) in Catalunya (Spain) and assess its predictive validity with a two-year follow-up of the outcomes: homecare need, institu...

    Authors: Francesc Orfila, Lucía A. Carrasco-Ribelles, Rosa Abellana, Albert Roso-Llorach, Francisco Cegri, Carlen Reyes and Concepción Violán
    Citation: BMC Geriatrics 2022 22:404
    Content type: Research Published on:

  31. Aneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. Traditional markers of aSAH have established their utility in the prediction of aSAH outcomes while frailty m...

    Authors: Jia Xu Lim, Yuan Guang Lim, Aravin Kumar, Tien Meng Cheong, Julian Xinguang Han, Min Wei Chen, David Wen, Winston Lim, Ivan Hua Bak Ng, Vincent Yew Poh Ng, Ramez Wadie Kirollos and Nicole Chwee Har Keong
    Citation: BMC Geriatrics 2022 22:333
    Content type: Research Published on:

  32. Cardiovascular disease (CVD) is associated with a greater frailty risk, but it remains unknown if pathways that contribute to CVD are associated with the frailty risk. Thus, we aimed to investigate whether ele...

    Authors: Yu Jia, Dongze Li, Jing Yu, Yi Liu, Fanghui Li, Wentao Li, Qin Zhang, Yongli Gao, Wei Zhang, Zhi Zeng, Rui Zeng, Xiaoyang Liao, Qian Zhao and Zhi Wan
    Citation: BMC Geriatrics 2022 22:321
    Content type: Research Published on:

  33. Low serum 25-hydroxyvitamin D [25(OH)D] level is associated with a greater risk of frailty, but the effects of daily vitamin D supplementation on frailty are uncertain. This secondary analysis aimed to examine...

    Authors: Yurun Cai, Amal A. Wanigatunga, Christine M. Mitchell, Jacek K. Urbanek, Edgar R. Miller III, Stephen P. Juraschek, Erin D. Michos, Rita R. Kalyani, David L. Roth, Lawrence J. Appel and Jennifer A. Schrack
    Citation: BMC Geriatrics 2022 22:312
    Content type: Research Published on:

  34. The process of aging renders older people susceptible for adverse outcomes upon stress. Various indicators derived from complex systems theory have been proposed for quantifying resilience in living organisms,...

    Authors: Alexandros Katsiferis, Pernille Yde Nielsen, Majken K. Jensen and Rudi G. J. Westendorp
    Citation: BMC Geriatrics 2022 22:301
    Content type: Research Published on:

  35. Despite increased recognition of frailty and its importance, high quality evidence to guide decision-making is lacking. There has been variation in reported data elements and outcomes which makes it challengin...

    Authors: Jeanette C. Prorok, Paula R. Williamson, Beverley Shea, Darryl Rolfson, Leocadio Rodriguez Mañas, Matteo Cesari, Perry Kim and John Muscedere
    Citation: BMC Geriatrics 2022 22:284
    Content type: Research Published on:

  36. Frailty is a complex multifactorial syndrome characterised by a significant increase in vulnerability and worsened health outcomes. Despite a range of proposed frailty screening measures, the prevalence and pr...

    Authors: Josh McGovern, Ross D. Dolan, Paul G. Horgan, Barry J. Laird and Donald C. McMillan
    Citation: BMC Geriatrics 2022 22:260
    Content type: Research Published on:

  38. Fear of falling (FoF) has far-reaching implications including activity restriction, functional decline and reduced quality of life. It is a common consequence of falls but may be present even in non-fallers. T...

    Authors: Jacqueline Giovanna De Roza, David Wei Liang Ng, Blessy Koottappal Mathew, Teena Jose, Ling Jia Goh, Chunyan Wang, Cindy Seok Chin Soh and Kar Cheng Goh
    Citation: BMC Geriatrics 2022 22:186
    Content type: Research Published on:

  39. To explore the association between social capital and frailty and the mediating effect of health-promoting lifestyles among Chinese older adults, while providing scientific evidence for frailty intervention.

    Authors: Shan Hu, Canhuan Jin and Shaojie Li
    Citation: BMC Geriatrics 2022 22:175
    Content type: Research article Published on:

  40. Several methods are available for identifying frailty, but limited tools have been validated in Thai context. Our objective was to evaluate the validity and reliability of the Thai version of the Simple Frailt...

    Authors: Warut T.Sriwong, Waroonkarn Mahavisessin, Varalak Srinonprasert, Arunotai Siriussawakul, Wichai Aekplakorn, Panita Limpawattana, Patumporn Suraarunsumrit, Rachaneekorn Ramlee and Titima Wongviriyawong
    Citation: BMC Geriatrics 2022 22:161
    Content type: Research Published on:

  41. Healthcare outcome goals are central to person-centred acute care, however evidence among older people is scarce. Older people who are living with frailty have distinct requirements for healthcare delivery and...

    Authors: James David van Oppen, Timothy John Coats, Simon Paul Conroy, Jagruti Lalseta, Kay Phelps, Emma Regen, Peter Riley, Jose Maria Valderas and Nicola Mackintosh
    Citation: BMC Geriatrics 2022 22:156
    Content type: Research Published on:

  42. The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated.

    Authors: Ragnhild Munthe-Kaas, Stina Aam, Ingvild Saltvedt, Torgeir Bruun Wyller, Sarah T. Pendlebury, Stian Lydersen, Guri Hagberg, Till Schellhorn, Siri Rostoft and Hege Ihle-Hansen
    Citation: BMC Geriatrics 2022 22:139
    Content type: Research Published on:

  43. Frailty predicts adverse post-kidney transplant (KT) outcomes, yet the impact of frailty assessment on center-level outcomes remains unclear. We sought to test whether transplant centers assessing frailty as p...

    Authors: Xiaomeng Chen, Yi Liu, Valerie Thompson, Nadia M. Chu, Elizabeth A. King, Jeremy D. Walston, Jon A. Kobashigawa, Darshana M. Dadhania, Dorry L. Segev and Mara A. McAdams-DeMarco
    Citation: BMC Geriatrics 2022 22:82
    Content type: Research Published on:

  44. The incorporation of acute frailty services into the acute care pathway is increasingly common. The prevalence and impact of acute frailty services in the UK are currently unclear.

    Authors: Thomas Knight, Catherine Atkin, Finbarr C Martin, Chris Subbe, Mark Holland, Tim Cooksley and Daniel Lasserson
    Citation: BMC Geriatrics 2022 22:19
    Content type: Research Published on:

  45. Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at incr...

    Authors: Kevin F. Boreskie, Jacqueline L. Hay, Patrick E. Boreskie, Rakesh C. Arora and Todd A. Duhamel
    Citation: BMC Geriatrics 2022 22:13
    Content type: Review Published on:

  46. Multidimensional frailty, including physical, psychological, and social components, is associated to disability, lower quality of life, increased healthcare utilization, and mortality. In order to prevent or d...

    Authors: Marcel A. L. M. van Assen, Judith H. M. Helmink and Robbert J. J. Gobbens
    Citation: BMC Geriatrics 2022 22:7
    Content type: Research Published on:

  47. Routine screening for frailty at admission by nurses may be useful to detect geriatric risks and problems at an early stage. However, the added value of this screening is not clear yet. Information about the o...

    Authors: Ron M. J. Warnier, Erik van Rossum, Monique F. M. T. Du Moulin, Marjolein van Lottum, Jos M. G. A. Schols and Gertrudis I. J. M. Kempen
    Citation: BMC Geriatrics 2021 21:624
    Content type: Research Published on:

  48. Frailty is a kind of geriatric syndrome, which is very common in the elderly. Patients with malnutrition are at higher risk of frailty. This study explored the correlation between nutrition and frailty and com...

    Authors: Hong Liang, Xiaoping Li, Xiaoye Lin, Yanmin Ju and Jiyan Leng
    Citation: BMC Geriatrics 2021 21:619
    Content type: Research Published on:

  50. There is growing interest for interventions aiming at preventing frailty progression or even to reverse frailty in older people, yet it is still unclear which frailty instrument is most appropriate for measuri...

    Authors: Marlies Feenstra, Frederike M.M. Oud, Carolien J. Jansen, Nynke Smidt, Barbara C. van Munster and Sophia E. de Rooij
    Citation: BMC Geriatrics 2021 21:499
    Content type: Research article Published on:

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