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Frailty (22)

Fragility

Posted on June 12, 2025

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The progressive aging of the population determines the increase in those who have difficulties in personal care, in maintaining their autonomy, independence and carrying out daily activities.

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  • According to ISTAT data (Report Anziani 2019), poor autonomy in at least one personal care activity affects approximately one fifth of the elderly aged 75 and over in Italy (18.3%). On average, in the European Union, almost half of the EU's older population (aged 65 and over) reported moderate or severe difficulties in at least one personal or household care activity.
  • After the era of infectious diseases and that of degenerative diseases (related to well-being), it is confirmed that the current phase of epidemiological transition is increasingly characterized by the aging of the population and the increase in frailty. Frailty is recognized as a significant predictor of adverse health outcomes in the elderly and is increasingly considered in a public health perspective. This shifts the focus from a disease-centered approach to a more integrated and global vision of health in old age, highlighting the growing inequalities related to factors such as age, health status, functional autonomy and socio-economic context.
  • Maintaining health in old age increasingly takes into account the dynamic characteristics of robustness and resilience. Recent studies confirm that robustness (resistance to damage) and resilience (ability to recover from stress) decline with age. Research suggests that the decline in resilience, in particular, may be a universal factor contributing to increased vulnerability and reduced survival rates in the most frail older adults, even in the absence of new pathologies. 

Fragility as a difficulty in adapting to the environment

Over the past decade, the concept of frailty in the health and social fields has undergone a profound transformation, moving away from a purely deficit vision linked to age and disease to embrace a more dynamic and multidimensional interpretation. This change is intrinsically linked to the new concept of health, no longer understood as the simple absence of pathology, but as the ability of an individual to adapt and self-manage their living conditions in the face of physical, psychological and social challenges.

This innovative perspective has shifted the focus from the mere treatment of diseases ("cure") to taking care of the person in their entirety ("care"), enhancing their residual resources and recovery potential. Frailty, in this new framework, emerges as a reduced capacity for adaptation and less resilience to stressors, which increases the risk of adverse health outcomes, such as disability, hospitalization and mortality.

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Competenze di salute

The Evolving Landscape of Health and Frailty

The concept of health is constantly evolving, as is the understanding of frailty, a topic of growing social and academic relevance. Although frailty is often associated with aging, it transcends age groups, manifesting itself in different life stages and social contexts. Global challenges such as pandemics, climate change and socio-economic transformations have further accentuated the importance of analyzing individual and collective resilience and vulnerability. In this scenario, traditional biomedical conceptions of health are being challenged by more holistic and dynamic perspectives, a fundamental shift to understand current discussions on frailty.

The Multidimensional Nature of Fragility: Bio-Psycho-Social-Environmental Interactions

The bio-psycho-social paradigm considers frailty as a state that affects an individual who experiences losses in one or more domains (physical, psychic, social), caused by the influence of multiple variables that increase the risk of adverse health outcomes. As highlighted for the frail elderly, "physical, psychological and social elements converge in determining the state of suffering". This holistic approach goes beyond the purely biomedical model, recognizing that frailty is a multidimensional phenomenon. This multidimensionality implies that interventions must also be multifaceted, addressing not only physical issues, but also psychological well-being, social support and environmental factors. This vision aligns closely with the new definition of health, which emphasizes the ability to adapt to "social, physical and emotional challenges".   


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