Psychological frailty in older adults: a systematic scoping review

Abstract

Background: Psychological frailty, along with physical and cognitive frailty, is linked to an increased risk of negative health outcomes among older adults. However, the definition of psychological frailty has received limited attention. A thorough comprehension of the concept of psychological frailty is therefore required. Objectives: To review existing definitions of psychological frailty and to provide a comprehensive overview of the concept of psychological frailty and associated measurements. Methods: This review followed the PRISMA guidelines for scoping reviews and the JBI Manual for Evidence Synthesis. Eligibility criteria were developed based on the Participants-Concept-Context (PCC) framework. We searched CINAHL, Scopus, PubMed, Web of Science, and PsycINFO databases and other sources for relevant studies published between January 2003 to March 2022. Results: The final scoping review included 58 studies. 40 (69%) of these studies provided a definition of psychological frailty and 7 studies provided a novel definition. The other 11 studies focused on components of defining psychological frailty. To better characterize psychological frailty, we propose four groups of components, including mood, cognitive, mental health, and fatigue-associated problems. We identified 28 measuring tools across studies and the Tilburg frailty indicator was the most frequently used (46.6% of studies). Conclusions: Psychological frailty is a complex concept that lacks a consensus definition. It should include both psychological features and physical frailty. Depression and other psychological problems are commonly used to define psychological frailty. This scoping review outlines future research directions to refine the concept of psychological frailty.

Prevalence of frailty in severe mental illness: findings from the UK Biobank

“…Future studies should longitudinally assess frailty, utilise frailty tools that better capture psychological frailty, 14 consider the effect of SMI and physical health treatments, and review mortality risk associated with frailty in those with SMI. Additionally, pilot feasibility studies of frailty-focused interventions in people with SMI would be critical in informing the development of frailty interventions for people with SMI who are frail.…”

Psychological aspects of rehabilitation nutrition: A position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication)

“…Depression is significantly associated with loneliness 13 and loneliness has a moderate effect on depression 14 . No clear consensus exists on the definition of psychological frailty, however depression and anxiety are the most commonly used definitions 15 . Psychological frailty was associated with physical frailty, and the determinants of psychological robustness were physical, cognitive, and social robustness 16 .…”

“…14 No clear consensus exists on the definition of psychological frailty, however depression and anxiety are the most commonly used definitions. 15 Psychological frailty was associated with physical frailty, and the determinants of psychological robustness were physical, cognitive, and social robustness. 16 Therefore, if depression can be improved, not only psychological but also physical, cognitive, and social robustness can be expected.…”

Commentary: The Limited Utility of the Hospital Frailty Risk Score as a Frailty Assessment Tool in Neurosurgery: A Systematic Review

“…railty scores play a crucial role in health care as valuable tools for assessing and predicting the outcomes of hospitalized patients. [1][2][3][4] These scores have been getting increasingly popular in the clinical literature to characterize "frailty" of the patients in an attempt to provide insights into a patient's baseline physiologic reserve, aiding in risk stratification and preoperative decision-making. In addition, they are also used on an epidemiologic level for better resource management for different patient populations.…”

“…Acknowledging the subjective nature of frailty's definition and understanding, the authors outline 10 core principles defining “frailty” in a patient, emphasizing the need to measure baseline frailty independently of acute conditions, prioritize physiological reserve over chief complaints, consider frailty and age nonlinearly, avoid reducing it to a comorbidity index, and promote global, preoperative, validated, and outcome-predictive applicability in patient-centered care across diverse settings and populations 6 (Figure). Thereby, comparing frailty scoring systems through the lens of these principles may allow for a more objective and standardized evaluation of all neurosurgical patients across the settings they present in references 1, 2, and 6. They also point out that HFRS includes ICD-10 codes that are more indicative of a patient's chief complaint or acute symptoms rather than true baseline frailty.…”