Defining optimal care: AGE Members’ Role in Shaping the First White Paper on Frailty 

Why is this EAPC White Paper on Frailty timely and relevant? 

While the 2021 Decade of Healthy Aging report of the World Health Organisation highlighted the significant societal and economic contributions of older people, it is undeniable that the aging of the population also comes along with important challenges for many health systems worldwide.  The rapid expansion of the aging population has led to a fast-growing number of older people living with frailty. At times, they experience complex care and support needs that can persist for months or years until the end of life. In fact, frailty is a syndrome estimated to affect about one in ten community-dwelling people aged 50 to 59 years old, up to about half of those aged 90 years and over, and we see comparable figures in the nursing home and acute hospital care settings.

Over the last half-century, frailty has become a major topic in aging research and numerous quality improvement efforts internationally. However, to date, there remains no evidence- and consensus-based framework that brings together this vast evidence and knowledge on how to optimally address the needs of older people living with frailty and their family caregivers while supporting their capacities and resilience. 

The development of this EAPC White Paper on Frailty: an integrative palliative, geriatric and rehabilitative approach to care and support for older people living with frailty and their family caregivers 

To develop this White Paper, the multidisciplinary core members of the EAPC Reference Group on Aging and Palliative Care conducted seven iterative discussion rounds and three rounds of rapid literature reviews. By reflecting on existing evidence and literature, they developed 11 key domains and 34 key recommendations, jointly defining an integrative palliative, geriatric and rehabilitative approach to care and support for older people living with frailty and their family caregivers. This preliminary set of key domains and recommendations underwent further evaluation using an online Delphi survey, involving 63 key international experts in research, practice and policy and 19 representatives of older people themselves and their family, of whom 12 were AGE members. 

On behalf of the EAPC Reference Group on Aging and Palliative Care, we would like to explicitly thank AGE Platform Europe and their expert members for taking the time to share their insights and ideas. Beyond scoring the domains and recommendations in terms of importance and relevance, they provided us with fantastic elaborations on what they find important in older people’s care. Currently, we are working to further develop the White Paper by involving the EAPC board members. We expect to publish the full White Paper in 2025. 

Preliminary findings of this White Paper for frailty 

This White Paper on frailty covers 11 key domains that were jointly evaluated as highly important for older people living with frailty (Table 1 – find it below).

Given the contemporary predominant biomedical view on frailty, this White Paper ensures that the other domains that are also essential for frailty are considered, such as psychosocial, mental, emotional, and spiritual/existential domains. Also integrated are the best-practice approaches to care and support from palliative, geriatric as well as rehabilitative care, which are crucial disciplines for frailty. This integrative palliative, geriatric and rehabilitative approach to care and support addresses both the overlapping and distinct aspects between these disciplines, as well as the misperceptions about the limits of each individual discipline, for example in terms of the relevance of rehabilitation only for the early stages of frailty or palliative care only for the end of life. It strives to outline an interdisciplinary approach promoting the timely and synchronized planning and delivery of the needed care and support for older people living with frailty and their family caregivers. 

Importantly, many views on frailty have consistently focused on the deficits and vulnerabilities of older people living with frailty, which have contributed to their stigmatization. In the development of this White Paper, we ensured to combine a deficit-based approach with the strong illumination of the assets and capacities of people, focusing on needs as well as quality of life and wellbeing, in a holistic and comprehensive manner. Finally, this White Paper will bring together the existing vast evidence that could guide and support those caring for older people living with frailty, including their family caregivers, their health and social care providers, volunteers and neighbours within the communities where people live. It strives to integrate a clinical, health service, and public health approach in its domains. 

Table 1. Key domains that were evaluated as highly important in frailty