From frailty to resilience: time for a new approach.

Frailty is a well-known concept in ageing societies. Frailty is considered common in old age. It indicates a loss of resources on physical, cognitive, and social domains, like loss of energy or appetite, forgetfulness or diminishing social activity.
Research shows large differences in the prevalence of frailty in European countries. A study in Romania, using the Groningen Frailty Indicator (GFI), showed that 48% of the sample of citizens 65 years and older was frail, which is a relatively high percentage compared to international data. The GFI is a 15-item screening instrument assessing four domains of functioning and resources: physical, cognitive, social, and psychological.
Being frail means a higher risk for disability, hospital admission and mortality. A recent study showed that life expectancy at age 70 is shorter for frail women and men as compared to not frail, which indicates that it is worthwhile to identify frailty in time. Life-expectancy is longer in pre-frail as compared to frail and also living with disabilities is shorter. Frailty is a relatively short transition state as compared to pre-frailty and pre-frailty offers more opportunities for prevention.
A concept that seems the opposite of frailty is ‘resilience’. The concept ‘resilience’ may be known to many people by experience. One may wonder how one patient is able to recover from an adverse event while another cannot not. One person may overcome a disaster, while another person cannot. The concept resilience has been developed in biological and psychological research to explain why some living entities (plants, animals, humans) could overcome adverse events and others could not.
Resilience seems the opposite of frailty or a way to cope with frailty. Recent studies, however, consider resilience to be less a personal characteristic, but rather a societal concept. As such communities or states may be qualifies as more or less resilient. And it may be expected that in such societies citizens life longer (and or more happy). Indeed in a recent study, we found that vulnerability, social cohesion, and resilience are interconnected and relevant determinants of healthy ageing ( . The study shows that citizens become older and are happier in resilient countries in Europe. This finding indicates that a new policy is needed, i.e. an integrated approach to realize healthy ageing.

Besides policy, also health care professionals, especially primary health care workers, may learn from the relationship between resilience and frailty. First: Screening of older citizens on frailty in primary health care is possible and effective, as has been shown in many studies. Second: frail elderly have to get offered preventive interventions (diet, physical activities, social contacts etc.) and surveillance.
And as we have shown: policy measures to create a resilient community are helpful and therefore needed. Health care workers might (should!) convince policy makers to take action. Which actions are needed is evidently shown.

Author: Wim van den Heuvel

W.J.A. (Wim) van den Heuvel is born in Nuenen, the Netherlands. He is professor emeritus of the University of Groningen and of Maastricht University, the Netherlands, but still works as advisor/consultant/researcher. After Grammar School (Dutch: ‘Gymnasium’), he got his masters in Sociology and his PhD (thesis on ‘Adjustment in Nursing Homes’) at Radboud University Nijmegen. After assistant Professor at the Institute of Social Medicine, and of the Gerontology Centre, Radboud University Nijmegen (1969-1975) he was pointed as Director of the Institute of Social Oncology (Dutch Cancer Society, KWF), Amsterdam (1976 -1980). In 1979 Queen Juliana appointed him as Professor of medical sociology, University of Groningen, Faculty of Social Sciences and Faculty of Medicine. In 1989 he also became Scientific Director of the Northern Centre for Health and Research University of Groningen. In the period 2000-2005 he was working as Professor in Rehabilitation and Handicap Maastricht University, Maastricht, also acting as Director General Institute for Rehabilitation Research and as Scientific Director of Research school of Primary Health Care Research (CaRe), Maastricht University. He was visiting professor at Syracuse University USA (1975), the University of Vienna, Austria (1997) and Titu Maiorescu University, Bucharest, Romania (2008). Besides visiting professorships he made study tours to Brazil, Australia, China, Cuba, India, New-Zealand and USA. During his professorship he supervised successfully 61 PhD students. He was project leader of various international research and development projects (financed by EU or the Dutch Ministry of Foreign Affairs), including subjects like developments of primary health care, palliative care, home care for the aged, primary health care, care for specific diagnosis like cancer, rheumatoid arthritis, and spina bifida. These projects included researchers and practitioners from Belgium, Croatia, Czech Republic, France, Germany, Greece, Ireland, Italy, Norway, Poland, Romania, Slovenia, Slovakia, Sweden, Switzerland, and United Kingdom. He received various rewards, including Academy Medal University PJ Safarit, Kosice, Slovakia, Honorary member of Romania Society of Family Medicine/General Practice, Romania, Honorary member of the European Society of Health and Medical Sociology, Honorary member Academy of Medical Sciences, Romania, Academy Medal University of Groningen, The Netherlands, Officer in Royal Order Oranje Nassau, The Netherlands, Siglium University of Krakow. He chaired – and still chairs - various national and international committees all related to scientific research in health care and gerontology.

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