Early identification of frailty: Developing an international delphi consensus on pre-frailty

Duygu Sezgin, Mark O'Donovan, Jean Woo, Karen Bandeen-Roche, Giuseppe Liotta, Nicola Fairhall, Angel Rodríguez-Laso, João Apóstolo, Roger Clarnette, Carol Holland, Regina Roller-Wirnsberger, Maddalena Illario, Leocadio Rodríguez Mañas, Miriam Vollenbroek-Hutten, Burcu Balam Doğu, Cafer Balci, Francisco Orfila Pernas, Constança Paul, Emer Ahern, Roman Romero-OrtunoWilliam Molloy, Maria Therese Cooney, Diarmuid O'Shea, John Cooke, Deirdre Lang, Anne Hendry, Siobhán Kennelly, Kenneth Rockwood, Andrew Clegg, Aaron Liew, Rónán O'Caoimh*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

26 Citations (Scopus)
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Background:: Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent intermediate state before frailty becomes established. Despite being widely-used in the literature and increasingly in clinical practice, it is poorly understood. Objective:: To establish consensus on the construct and approaches to diagnose and manage pre-frailty. Methods:: We conducted a modified (electronic, two-round) Delphi consensus study. The questionnaire included statements concerning the concept, aspects and causes, types, mechanism, assessment, consequences, prevention and management of pre-frailty. Qualitative and quantitative analysis methods were employed. An agreement level of 70% was applied. Results:: Twenty-three experts with different backgrounds from 12 countries participated. In total, 70 statements were circulated in Round 1. Of these, 52.8% were accepted. Following comments, 51 statements were re-circulated in Round 2 and 92.1% were accepted. It was agreed that physical and non-physical factors including psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life. Experts considered pre-frailty to be an age-associated multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It can be reversed or attenuated by targeted interventions. Brief, feasible, and validated tools and multidimensional assessment are recommended to identify pre-frailty. Conclusions:: Consensus suggests that pre-frailty lies along the frailty continuum. It is a multidimensional risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies and socioeconomic disadvantages, predisposing to the development of frailty. More research is needed to agree an operational definition and optimal management strategies.

Original languageEnglish
Article number104586
JournalArchives of Gerontology and Geriatrics
Publication statusPublished - 1 Mar 2022


  • Consensus
  • Definition
  • Delphi
  • Frailty
  • Geriatric assessment
  • Older people
  • Pre-frailty
  • 2023 OA procedure


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