Understanding the Complexity of Frailty in Older Adults: From Early Detection to Management

The present thesis aims to explore the concept of frailty, from its diagnosis to its management. The interest in this topic stems from the growing body of scientific evidence emphasizing the importance of preserving an individual’s intrinsic capacity and robustness in older adults, to delay as much as possible the transition to a pre-frail or frail state, thereby promoting active and healthy ageing. Building on these premises, the objectives of the three studies presented herein are as follows: i) The first study aimed to comprehensively characterize frailty across its multiple dimensions and to validate its mid-term prognostic value in a population of geriatric patients. ii) The second study evaluated the impact of participation intensity in the multidomain AGIL+ intervention launched in Barcelona in 2016 to contrast frailty in older adults. The program included multicomponent exercise sessions, personalized counseling on nutrition and sleep hygiene, medication review, and screening for cognitive impairment, depression, and social isolation. iii) Finally, the third study aimed to explore the effectiveness of the Comprehensive Geriatric Assessment–Hospital at Home (CGA-HaH) model compared with usual care in the management of older patients. Study 1 demonstrated that comorbidity burden, along with physical rather than cognitive performance, represents a major determinant of adverse outcomes. Anyway, longitudinal changes in physical and cognitive performance, as well as in complex instrumental activities, appeared to have a stronger influence on outcomes than baseline values. Study 2 showed that the effectiveness of the AGIL+ intervention strongly depends on adherence, which directly impacts the risk of fall’s hospitalizations. Study 3 demonstrated that the CGA-HaH model, compared to a bed-based unit, increased the percentage of days spent at home without affecting the risk of mortality and first re-hospitalizations. Altogether, the evidence supports a paradigm shift toward person-centered, aimed at promoting healthy ageing and reducing adverse outcomes in this growing population.