Prefrailty

Pre-frailty is a transitional state in the spectrum of frailty, describing a level of increased vulnerability in older adults that does not meet the criteria for frailty itself. It reflects the accumulation of deficits and reduced physiological reserve, making individuals more susceptible to stressors while still maintaining a degree of independence and function.

In clinical and research settings, pre-frailty is typically identified through frailty assessment tools. For example, in Fried’s frailty phenotype, one or two positive criteria designate a pre-frail status, while zero indicates robustness and three or more indicate frailty. Other scales, such as the FRAIL scale, categorize a two-point score as pre-frail. Additional approaches use a frailty index to identify an intermediate level of deficit accumulation. These tools help standardize detection and comparison across populations.

Pre-frailty is associated with an elevated risk of adverse health outcomes and an increased likelihood of progression to frailty, disability, falls, hospitalizations, longer care needs, and higher mortality. Prevalence varies by population and method, but it is relatively common among community-dwelling older adults and tends to rise with age.

Risk factors for pre-frailty include advanced age, multimorbidity, obesity or undernutrition, low physical activity, sedentary behavior, cognitive impairment, polypharmacy, social isolation, and chronic inflammation. These factors can interact and magnify vulnerability.

Pre-frailty is a target for preventive and reversible interventions. Management typically involves multi-component approaches such as tailored physical activity programs emphasizing strength and balance, nutritional optimization with adequate protein, effective management of chronic diseases and medications, fall prevention, and social and cognitive engagement. Regular monitoring and re-assessment help track progression and response to interventions.