University of Oulu

Dent, E., Morley, J.E., Cruz-Jentoft, A.J. et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 23, 771–787 (2019).

Physical frailty : ICFSR international clinical practice guidelines for identification and management

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Author: Dent, E.1,2; Morley, J. E.3; Cruz-Jentoft, A. J.4;
Organizations: 1Torrens University Australia, Adelaide, Australia
2Baker Heart and Diabetes Institute, Melbourne, Australia
3Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
4Servicio de Geriatria, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
5Department of Physical Therapy, Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
6Servicio de Geriatria, Hospital Universitario de Getafe, Madrid, Spain
7Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
8Department of Medicine, The Chinese University of Hong Kong, Hong Kong, China
9Geriatrics Division, Internal Medicine, Department, Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
10Medical School, University City of São Paulo, São Paulo, Brazil
11Perry County Memorial Hospital, Perryville, Missouri, USA
12Fondazione Policlinico A. Gemelli, Roma, Italy
13Population Health Sciences, King’s College, London, UK
14Center for Geriatric Medicine, Heidelberg University Agaplesion Bethanien Krankenhaus, Heidelberg, Germany
15Intramural Research Program of the National Institute on Aging, Bethesda, USA
16Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
17Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
18National Center for Geriatrics and Gerontology, Obu, Japan
19Department of Epidemiology and Biostatistics, Amsterdam Public Health Research institute, Amsterdam UMC — location VU University Medical Center, Amsterdam, the Netherlands
20Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
21Alzheimer’s Disease Clinic Department, Azienda Sanitaria Locale (ASL) di Frosinone, Frosinone, Italy
22Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University and Theme Aging, Karolinska University Hospital, Stockholm, Sweden
23Center for Life Course Health Research, University of Oulu, Oulu, Finland
24University of Helsinki and Helsinki University Hospital, Helsinki, Finland
25National Institute of Geriatrics, Mexico City, Mexico
26Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
27Research Program in Mean’s Health: Aging and Metabolism, Boston Claude D. Pepper Older American Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
28Dept des Sciences de l’activité physique, Université du Quebec à Montréal, CRIUGM, Montreal, Québec, Canada
29Dept of Geriatrics and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland
30Dept of Epidemiology and Public Health, Division of Gerontology, University of Maryland School of Medicine, Baltimore, Maryland, USA
31Dept of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada
32Dept of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
33Miami VA Healthcare System GRECC and Division of Geriatrics & Palliative Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
34School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
35WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium and Chair for Biomarkers of Chronic Diseases, Department of Biochemistry, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
36Dept of Medicine/School of Physiotherapy, University of Otago, Dunedin, New Zealand
37Gérontopôle UMR Inserm 1027, Université Paul Sabatier, CHU Toulouse, Toulouse, France
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Springer Nature, 2019
Publish Date: 2020-03-26


Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.

Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care.

Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation).

Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

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Series: Journal of nutrition, health & aging
ISSN: 1279-7707
ISSN-E: 1760-4788
ISSN-L: 1279-7707
Volume: 23
Issue: 9
Pages: 771 - 787
DOI: 10.1007/s12603-019-1273-z
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The authors wish to thank MN Vaquero-Pinto and V Sánchez-Cadenas for coordinating and compiling feedback from both patient consumer groups and healthcare practitioners. ED is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Research Fellowship (Grant ID: #1112672). IA receives National public grant level 2 from the National Council for Scientific and Technological Development (Ministry of Science, Technology, Innovation and Communications, Brazil).
Copyright information: © The Authors 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.