Open research questions in Frailty in Older Adults

What the literature leaves open

• The scarcity of evidence on nurses' frailty-related competencies in southwestern China. The complexity of measuring frailty-management competency. The need to account for hospital-level clustering and mutual adjustment in the analysis.

  Nurses’ knowledge, attitudes, practices, and educational needs regarding frailty: a multicenter cross-sectional survey in southwestern China · 2026 · DOI

• The scarcity of evidence on nurses' frailty-related competencies in southwestern China. The lack of understanding of the associated factors and educational needs of nurses regarding frailty. The need for a comprehensive study on nurses' knowledge, attitudes, and practices regarding frailty in southwestern China.

  Nurses’ knowledge, attitudes, practices, and educational needs regarding frailty: a multicenter cross-sectional survey in southwestern China · 2026 · DOI

• The study identifies the challenge of addressing the compounded impact of multiple cardiometabolic diseases on frailty. The research highlights the need to consider the health burden of cardiometabolic diseases in ageing populations. The study notes the importance of early intervention to address the impact of cardiometabolic diseases on frailty.

  Cardiometabolic multimorbidity and frailty in middle-aged and older adults: a cross-nationally harmonized study · 2025 · DOI

• The intricate nature of frailty's etiology and pathophysiological mechanisms. The need to address potential confounding factors. The requirement for further rigorously designed studies to validate the relationship between non-HDL-C and frailty.

  U-shaped relationship between frailty and non-HDL-cholesterol in the elderly: a cross-sectional study · 2025 · DOI

• further rigorously designed studies are imperative to validate the relationship between non-HDL-C and frailty, - investigation of the mechanisms behind the nonlinear association, - studies on the modulation of lipid metabolism in the management of frailty

  U-shaped relationship between frailty and non-HDL-cholesterol in the elderly: a cross-sectional study · 2025 · DOI

• Further studies are needed to elucidate the mechanisms underlying the relationship between frailty and CVD, - Research on the development of a gold standard assessment tool for cardiovascular populations is necessary, - Investigations on the effectiveness of multimodal interventions in managing frailty and CVD are required, - Studies on the economic burden of frailty and CVD are needed

  Frailty and cardiovascular disease: a bidirectional relationship with clinical implications · 2025 · DOI

• The absence of a gold standard assessment tool for cardiovascular populations. Traditional cardiovascular risk scores often fail to account for frailty. The need for a paradigm shift in management of frailty and CVD.

  Frailty and cardiovascular disease: a bidirectional relationship with clinical implications · 2025 · DOI

• The pathways in which sleep quality and depression affect frailty are not well understood. Prior studies have shown inconsistent results regarding the relationships between frailty, depression, and sleep quality.

  Association of depression and sleep quality with frailty: a cross-sectional study in China · 2024 · DOI

• The study faced challenges in terms of low physical activity levels among older adults with SCD. Another challenge is the lack of effective interventions to improve PA behavior in this population.

  Determinants of physical activity behavior among older adults with subjective cognitive decline based on the capability, opportunity, motivation, and behavior model: mediating and moderating effects · 2024 · DOI

• further studies are needed to investigate PA levels in the older SCD population, - studies should examine the effects of interventions on PA behavior in older adults with SCD

  Determinants of physical activity behavior among older adults with subjective cognitive decline based on the capability, opportunity, motivation, and behavior model: mediating and moderating effects · 2024 · DOI

• The causal link between sleep traits and frailty is uncertain. Prior research has shown a relationship between sleep traits and frailty, but the causal relationship has not been established. There is a need to investigate the causal relationship between sleep traits and the risk of frailty index.

  Causality between sleep traits and the risk of frailty: a Mendelian randomization study · 2024 · DOI

• There is no consensus on the precise prediction of frailty. The study aims to fill this gap by exploring the association between grip strength and frailty.

  Predicting grip strength-related frailty in middle-aged and older Chinese adults using interpretable machine learning models: a prospective cohort study · 2024 · DOI

• The study had to account for the influence of baseline chronic lung disease or smoking habits on the relationship between peak expiratory flow and frailty. The study had to address the lack of data from Asian populations, limiting the applicability of peak expiratory flow in detecting frailty in these groups. The study had to investigate the relationship between peak expiratory flow and frailty using both cross-sectional and longitudinal approaches.

  Associations between peak expiratory flow and frailty in olderly individuals: findings from the China health and retirement longitudinal study · 2024 · DOI

• Limited to an Asian demographic, - Limited to a specific age group (60 years or older), - Relies on self-reported histories of chronic conditions

  Associations between peak expiratory flow and frailty in olderly individuals: findings from the China health and retirement longitudinal study · 2024 · DOI

• The study identifies the challenge of developing targeted nursing interventions for patients with frailty. The study notes the lack of standardized screening criteria for frailty in gynecological oncology. The study highlights the need for further research on the relationship between frailty, self-management, and quality of life in middle-aged and older adult postoperative gynecologic malignancy patients.

  Frailty in middle-aged and older adult postoperative patients with gynecological malignancies structural equation modeling · 2024 · DOI

• Further studies are needed to explore the pathways in which sleep quality and depression affect frailty, - Longitudinal studies could be conducted to examine the relationship between sleep quality, depression, and frailty over time, - Studies could be done to develop interventions to improve sleep quality and reduce depression in older adults

  Association of depression and sleep quality with frailty: a cross-sectional study in China · 2024 · DOI

• However, the specific contribution of neuromuscular factors—including inspiratory strength, lower-limb strength, and balance—to frailty development remains unclear.

  Frailty and its Association With Strength and Balance Variables in Chilean Older Adults: A Structural Equation Model · 2026 · DOI

• Future research should investigate whether interventions focused on inspiratory muscle training, lower-limb strengthening, and functional balance exercises are able to prevent or reduce frailty in older adults.

  Frailty and its Association With Strength and Balance Variables in Chilean Older Adults: A Structural Equation Model · 2026 · DOI

• Although these risks are typically assessed independently, their interaction has been scarcely explored, and the identification of integrated patient risk profiles could better guide nursing care.

  Risk Profiles in Hospitalized Adults Based on Functional Capacity, Pressure Injury Risk, and Fall Risk: A Cluster and Multiple Correspondence Analysis · 2026 · DOI

• BACKGROUND AND OBJECTIVES: The contribution of late-life vascular risk factors to dementia risk remains controversial.

  Frailty as a Modifier of the Associations Between Vascular Risk Factors and Incident Dementia · 2026 · DOI

• Future research should explore the optimal timing, structure, and continuity of geriatric input to maximize potential benefit.

  Preoperative geriatric assessment and postoperative outcomes in older adults at risk for frailty-related complications following major surgery: a retrospective comparative cohort study · 2026 · DOI

• Despite the widespread use of the Clinical Frailty Scale (CFS), little is known about how patients experience being assessed for frailty in an ED setting.

  Being screened for frailty in the emergency department: the voice of patients in an exploratory qualitative study · 2026 · DOI

• Since its introduction, several adapted SARC-F-based approaches have been proposed, although their ability to predict clinical outcomes among older hospitalized individuals remains underexplored.

  SARC-F and six modified versions: prognostic role for prolonged hospital stay and 1-year mortality in older inpatients · 2026 · DOI

• Although physical exercise and nutritional interventions have been widely recognized as beneficial for managing frailty, the comparative effectiveness of various intervention approaches remains uncertain.

  Effect of multicomponent exercise and nutrition intervention on frailty status in older adults: a network meta-analysis · 2026 · DOI

• However, representation of very old adults in prehabilitation research is scarce.

  Prehabilitation as a litmus test for surgery in frail nonagenarians: a case series · 2026 · DOI

Most-cited papers in Frailty in Older Adults

• Frailty in elderly people · The Lancet · 2013 · 8,345 citations
• A global clinical measure of fitness and frailty in elderly people · Canadian Medical Association Journal · 2005 · 7,777 citations
• Frailty: implications for clinical practice and public health · The Lancet · 2019 · 2,959 citations
• Prevalence of Frailty in Community‐Dwelling Older Persons: A Systematic Review · Journal of the American Geriatrics Society · 2012 · 2,588 citations
• Exercise Training and Nutritional Supplementation for Physical Frailty in Very Elderly People · New England Journal of Medicine · 1994 · 2,140 citations
• High-Intensity Strength Training in Nonagenarians · JAMA · 1990 · 2,065 citations
• The burden of disease in older people and implications for health policy and practice · The Lancet · 2014 · 1,907 citations
• Price of Adaptation—Allostatic Load and Its Health Consequences · Archives of Internal Medicine · 1997 · 1,579 citations
• Immortal Time Bias in Pharmacoepidemiology · American Journal of Epidemiology · 2007 · 1,558 citations
• Management of frailty: opportunities, challenges, and future directions · The Lancet · 2019 · 1,535 citations

Most recent work

• Frailty and intrinsic capacity: integrating complementary concepts to promote healthy ageing and transformation of care · Age and Ageing · 2026
• A High Geriatric Depression Scale Score on Admission to Hospital Predicts a Worse Clinical Frailty Scale Score After Discharge · Geriatrics and gerontology international/Geriatrics & gerontology international · 2026
• Integrating machine learning and SHAP analysis to identify the risk of cognitive frailty in older adults with chronic heart failure · Journal of Psychosomatic Research · 2026
• Multi-Polygenic prediction of Frailty and its Trajectories highlights Chronic Pain, Rheumatoid Arthritis, and Educational Attainment pathways · medRxiv · 2026
• Effect of multicomponent exercise intervention on multidimensional frailty in older adults with mild cognitive impairment: a secondary analysis of the MIND-STEP randomised clinical trial · Age and Ageing · 2026
• Development and independent external validation of a novel nomogram to predict cognitive frailty in older adult patients with heart failure · BMC Geriatrics · 2026
• Oral Frailty and Meal Positioning Associated With Aspiration Pneumonia in Long‐Term Care Residents at High Risk of Malnutrition · Geriatrics and gerontology international/Geriatrics & gerontology international · 2026
• A prospective study with Comprehensive Geriatric Assessment (CGA) before curative treatment in older patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) · Oral Oncology · 2026
• A Review of Community-Based Frailty and Malnutrition Screening in Older Adults: Current Interventions and Tools · Journal of Community Health · 2026
• Exploring cost trajectories of patients admitted to geriatric rehabilitation in the Netherlands · Age and Ageing · 2026

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