Research Agenda for Frailty in Older Adults: Toward a Better Understanding of Physiology and Etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults

Authors

  • Jeremy Walston MD,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • Evan C. Hadley MD,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • Luigi Ferrucci MD, PhD,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • Jack M. Guralnik MD, PhD,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • Anne B. Newman MD, MPH,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • Stephanie A. Studenski MD, MPH,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • William B. Ershler MD,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • Tamara Harris MD,

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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  • Linda P. Fried MD, MPH

    1. From the *Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MarylandNational Institutes on Aging, Bethesda, MarylandDepartment of Epidemiology, Graduate School of Public Health, and §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaGeriatric Research, Education and Clinical Center, Department of Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, PennsylvaniaNational Geriatrics Resource Consortium/Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC.
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Address correspondence to Jeremy D. Walston, MD, John R. Burton Pavilion, 5505 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: jwalston@jhmi.edu

Abstract

Evolving definitions of frailty, and improved understanding of molecular and physiological declines in multiple systems that may increase vulnerability in frail, older adults has encouraged investigators from many disciplines to contribute to this emerging field of research. This article reports on the results of the 2004 American Geriatrics Society/National Institute on Aging conference on a Research Agenda on Frailty in Older Adults, which brought together a diverse group of clinical and basic scientists to encourage further investigation in this area. This conference was primarily focused on physical and physiological aspects of frailty. Although social and psychological aspects of frailty are critically important and merit future research, these topics were largely beyond the scope of this meeting. Included in this article are sections on the evolving conceptualization and definitions of frailty; physiological underpinnings of frailty, including the potential contributions of inflammatory, endocrine, skeletal muscle, and neurologic system changes; potential molecular and genetic contributors; proposed animal models; and integrative, system biology approaches that may help to facilitate future frailty research. In addition, several specific recommendations as to future directions were developed from suggestions put forth by participants, including recommendations on definition and phenotype development, methodological development to perform clinical studies of individual-system and multiple-system vulnerability to stressors, development of animal and cellular models, application of population-based studies to frailty research, and the development of large collaborative networks in which populations and resources can be shared. This meeting and subsequent article were not meant to be a comprehensive review of frailty research; instead, they were and are meant to provide a more-targeted research agenda-setting process.

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