Abstract
Purpose of Review
The relationship between successful aging, frailty, intrinsic capacity, and resilience is explored, in terms of underlying physiology, indicators, and utility.
Recent Findings
Frailty may be regarded as the reverse of successful aging conceptually, but more appropriate for clinical management and health promotion programs. Intrinsic capacity may be used as indicator of healthy aging, and the concept of resilience more relevant in research efforts to understand the heterogeneous age-related changes. In prevention of geriatric syndromes and diseases, as well as in the formulation of health policies, the use of a negative undesirable state (such as frailty) may elicit more response than the alternative approach of maintaining intrinsic capacity. For example, smoking cessation strategies heavily use negative images, as opposed to “maintaining good lung function.” Similarly, in hospital management, frailty assessment has rapidly become incorporated into management in various specialties such as cardiology, renal medicine, and oncology, in addition to Geriatric Medicine and primary care.
Summary
Successful aging, frailty, resilience, and intrinsic capacity share many common features; the use of these terms represents different approaches towards describing age-related changes at all levels: from cellular, physiological systems, to whole persons and community.
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References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Fougere B. Linda Fried ICFSR life achievement award: the 12 major advances in the field of frailty. USA: ICFSR; 2018.
Woo J. Challenges of population ageing: putting frailty as a cornerstone of health and social care systems. Eur Geriatr Med. 2018;9(3):273–6. https://doi.org/10.1007/s41999-018-0056-0.
Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific clinical practice guidelines for the management of frailty. J Am Med Dir Assoc. 2017;18(7):564–75. https://doi.org/10.1016/j.jamda.2017.04.018.
Archibald MM, Ambagtsheer R, Beilby J, Chehade MJ, Gill TK, Visvanathan R, et al. Perspectives of frailty and frailty screening: protocol for a collaborative knowledge translation approach and qualitative study of stakeholder understandings and experiences. BMC Geriatr. 2017;17:87. https://doi.org/10.1186/s12877-017-0483-7.
Warmoth K, Lang IA, Phoenix C, Abraham C, Andrew MK, Hubbard RE, et al. ‘Thinking you're old and frail’: a qualitative study of frailty in older adults. Ageing Soc. 2016;36(7):1483–500. https://doi.org/10.1017/S0144686x1500046x.
WHO. WHO Clinical Consortium on Healthy Ageing 2017 - report of consortium meeting 21 and 22 November 2017 in Geneva, Switzerland. Licence: CC BY-NC-SA 3.0 IGO. Switzerland: World Health organization; 2017.
Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, Cooper C, Martin FC, Reginster JY, et al. Evidence for the domains supporting the construct of intrinsic capacity. J Gerontol A Biol Sci Med Sci. 2018;73:1653–60. https://doi.org/10.1093/gerona/gly011.
Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? Brit Med J. 2011;343:D4163. https://doi.org/10.1136/Bmj.D4163.
•• Rowe JW, Kahn RL. Successful aging. Gerontologist. 1997;37(4):433–40. https://doi.org/10.1093/geront/37.4.433 This study discusses the relationship between frailty and successful aging.
Bowling A. Aspirations for older age in the 21st century: what is successful aging? Int J Aging Hum Dev. 2007;64(3):263–97. https://doi.org/10.2190/L0k1-87w4-9r01-7127.
Woo J, Leung J, Zhang T. Successful aging and frailty: opposite sides of the same coin? J Am Med Dir Assoc. 2016;17(9):797–801. https://doi.org/10.1016/j.jamda.2016.04.015.
Conti AA, Conti A. Frailty and resilience from physics to medicine. Med Hypotheses. 2010;74(6):1090. https://doi.org/10.1016/j.mehy.2010.01.030.
•• Hayman KJ, Kerse N, Consedine NS. Resilience in context: the special case of advanced age. Aging Ment Health. 2017;21(6):577–85. https://doi.org/10.1080/13607863.2016.1196336 This is a key paper introducing the concept of physical resilience.
Ng TP. Resilience and successful ageing among older Singaporeans: Singapore Longitudinal Ageing Study. Asian Pacific Rim Universities Conference, Singapore Oct 11, 2017.
Whitson HE, Duan-Porter W, Schmader KE, Morey MC, Cohen HJ, Colon-Emeric CS. Physical resilience in older adults: systematic review and development of an emerging construct. J Gerontol A Biol Sci Med Sci. 2016;71(4):489–95. https://doi.org/10.1093/gerona/glv202.
Miller BF, Seals DR, Hamilton KL. A viewpoint on considering physiological principles to study stress resistance and resilience with aging. Ageing Res Rev. 2017;38:1–5. https://doi.org/10.1016/j.arr.2017.06.004.
Felten BS, Hall JM. Conceptualizing resilience in women older than 85: overcoming adversity from illness or loss. J Gerontol Nurs. 2001;27(11):46–53.
Ferrucci L, Giallauria F, Schlessinger D. Mapping the road to resilience: novel math for the study of frailty. Mech Ageing Dev. 2008;129(11):677–9. https://doi.org/10.1016/j.mad.2008.09.007.
De Alfieri W, Borgogni T. Through the looking glass and what frailty found there: looking for resilience in older adults. J Am Geriatr Soc. 2010;58(3):602–3. https://doi.org/10.1111/j.1532-5415.2010.02754.x.
De Alfieri W, Costanzo S, Borgogni T. Biological resilience of older adults versus frailty. Med Hypotheses. 2011;76(2):304–5. https://doi.org/10.1016/j.mehy.2010.11.028.
Boers M, Cruz Jentoft AJ. A new concept of health can improve the definition of frailty. Calcif Tissue Int. 2015;97(5):429–31. https://doi.org/10.1007/s00223-015-0038-x.
Witham MD, Sayer AA. Biological resilience in older people - a step beyond frailty? Eur Geriatr Med. 2015;6(2):101–2. https://doi.org/10.1016/j.eurger.2014.12.008.
•• Rockwood K, Mitnitski A. Resilience and frailty: further steps, best taken together. Eur Geriatr Med. 2015;6(5):405–7. https://doi.org/10.1016/j.eurger.2015.06.001 This is a paper exploring the underlying physiology between physical resilience and frailty.
Varadhan R, Seplaki CL, Xue QL, Bandeen-Roche K, Fried LP. Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty. Mech Ageing Dev. 2008;129(11):666–70. https://doi.org/10.1016/j.mad.2008.09.013.
Varadhan R, Walston JD, Bandeen-Roche K. Can a link be found between physical resilience and frailty in older adults by studying dynamical systems? J Am Geriatr Soc. 2018;66:1455–8. https://doi.org/10.1111/jgs.15409.
Gijzel SMW, van de Leemput IA, Scheffer M, Roppolo M, Rikkert MGMO, Melis RJF. Dynamical resilience indicators in time series of self-rated health correspond to frailty levels in older adults. J Gerontol A-Biol. 2017;72(7):991–6. https://doi.org/10.1093/gerona/glx065.
Rebagliati GA, Sciume L, Iannello P, Mottini A, Antonietti A, Caserta VA, et al. Frailty and resilience in an older population. The role of resilience during rehabilitation after orthopedic surgery in geriatric patients with multiple comorbidities. Funct Neurol. 2016;31(3):171–7.
Martin CM. Self-rated health: patterns in the journeys of patients with multi-morbidity and frailty. J Eval Clin Pract. 2014;20(6):1010–6. https://doi.org/10.1111/jep.12133.
•• D’Avanzo B, Shaw R, Riva S, Apostolo J, Bobrowicz-Campos E, Kurpas D, et al. Stakeholders' views and experiences of care and interventions for addressing frailty and pre-frailty: a meta-synthesis of qualitative evidence. PLoS One. 2017;12(7):e0180127. https://doi.org/10.1371/journal.pone.0180127 This is the first paper to introduce the concept of intrinsic capacity promoted by the World Health Organization, as well as proposed indicators of intrinsic capacity in each of the five domains.
Lipsitz LA. Dynamic models for the study of frailty. Mech Ageing Dev. 2008;129(11):675–6. https://doi.org/10.1016/j.mad.2008.09.012.
Levine ME. Modeling the rate of senescence: can estimated biological age predict mortality more accurately than chronological age? J Gerontol A Biol Sci Med Sci. 2013;68(6):667–74. https://doi.org/10.1093/gerona/gls233.
Li Q, Wang S, Milot E, Bergeron P, Ferrucci L, Fried LP, et al. Homeostatic dysregulation proceeds in parallel in multiple physiological systems. Aging Cell. 2015;14(6):1103–12. https://doi.org/10.1111/acel.12402.
Cohen AA, Milot E, Li Q, Bergeron P, Poirier R, Dusseault-Belanger F, et al. Detection of a novel, integrative aging process suggests complex physiological integration. PLoS One. 2015;10(3):e0116489. https://doi.org/10.1371/journal.pone.0116489.
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Woo, J. Frailty, Successful Aging, Resilience, and Intrinsic Capacity: a Cross-disciplinary Discourse of the Aging Process. Curr Geri Rep 8, 67–71 (2019). https://doi.org/10.1007/s13670-019-0276-2
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DOI: https://doi.org/10.1007/s13670-019-0276-2