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[This article belongs to Volume - 70, Issue - 9]
Published on : 2025-09-11 18:58:38
Article Code: AMJ-11-09-2025-12332
Title : A Conceptual Framework for Understanding Frailty in Older Adults: A Comprehensive Literature Review
Author(s) : Hiroshi Tanaka, Kenji Sato, Yuki Nakamura
Abstract :
This review employed several key procedures to synthesize the current evidence on frailty. An extensive literature
search was conducted across major databases to identify relevant studies on frailty definitions, epidemiology,
assessment tools, interventions, and conceptual models. The search results were analyzed using bibliometric
techniques including thematic mapping with Biblioshiny and co-occurrence network visualization with VOSviewer.
These bibliometric analyses identified core research themes, emerging topic clusters, and connections across the
frailty literature. The main findings highlighted frailty’s multidimensional nature spanning physical, cognitive,
psychological, and social domains. While the frailty phenotype by Fried et al. (2) provided an initial operational
definition, subsequent models increasingly encompassed a broader biopsychosocial frailty construct. Globally, over
10% of community-dwelling older adults were estimated to be frail, with rates exceeding 40% in those over 90 years
old. Frailty was associated with numerous adverse outcomes like disability, falls, hospitalization and mortality.
Current assessment approaches included the frailty phenotype, frailty index, and various clinical performance tests,
though no single comprehensive tool existed. Evidence supported tailoring multimodal interventions combining
physical, nutritional, cognitive, psychological and social strategies to individual risk profiles. The principal conclusion
highlighted the critical need for a unified, holistic conceptual model elucidating the complex interplay of factors
driving frailty’s development and progression. By integrating the findings, a biopsychosocial framework was proposed
that conceptualizes frailty as a multifactorial health state arising from the cumulative impact of interconnected
physical, cognitive, psychological, social and environmental determinants over the life course. Such models are
essential for advancing frailty science, shaping clinical practices, and informing policies to promote healthy, resilient
aging amid rapidly aging populations worldwide.