Publications on Physical frailty
Conference Proceedings
Evaluating Frailty Among Older Adults Using a Principal Components-Based Indicator
Statistical Science: From Theory to Applied Research II – SIS2026 • 2026 • pp. 356-362
Abstract
Population ageing is an expanding phenomenon, driven by increased life expectancy and declining fertility, leading to higher prevalence of chronic-degenerative conditions and growing pressure on care services. Therefore, early identification of frail subjects is essential to protect older adults. This study proposes a new frailty indicator developed using administrative health data from the ULSS6 Euganea(ULSS6 Euganea is a health authority that manages the health care of the population of the 101 municipalities in the province of Padua (located in north-east of Italy), which has approximately 936000 inhabitants.) and including all individuals aged at least 65 years, observed between 2016 and 2017. Six distinct outcomes were chosen to represent frailty, each associated with a specific group of previously identified determinants. For each outcome, a logistic regression was estimated and a principal component analysis was applied to the values predicted by the models, identifying the indicator in the first component. Different frailty stratification methods were compared, including quantiles, the F1-score, and the k-means method. The indicator was validated using two different cohorts, which also made it possible to evaluate its temporal evolution.
Scientific article
Identifying core adverse health outcomes for frailty assessment in older adults using administrative data
Frontiers in medicine • 2025 • Vol. 12
Abstract
Objectives: Measurement of frailty can be based on the ability to predict adverse health outcomes. Although frailty research is progressing rapidly, a unique work that analyzes together outcomes related to frailty condition is still lacking in literature. This article aims to fill this gap, selecting a parsimonious set of outcomes relevant in frailty studies that exploit administrative healthcare data.
Methods: Starting with an extensive literature review, we identified several health outcomes that can be measured with administrative healthcare databases. We computed the prevalence and correlation of these outcomes in a local health unit in North-East Italy. We performed a factor analysis and estimated a graphical model to examine the conditional independence relationships between the outcomes.
Results: Our analysis revealed two primary outcome groups: adverse events (characterized by various forms of hospital use) and adverse conditions (such as dementia and disability). Femur fracture emerged as a distinct outcome, while death showed positive associations with all other outcomes. Considering overlaps and relationships, we selected a core set of six representative outcomes: death, high priority access to the emergency room, femur fracture, hospitalization, disability, and dementia.
Conclusion: This study identified six central and non-redundant adverse health outcomes related to frailty that can be easily derived from routinely available administrative healthcare data. These findings provide a methodologically grounded selection of outcomes that are clinically meaningful and feasible, offering a solid foundation for developing population-based frailty indices.
Book chapter
Beyond longevity. Measuring frailty to inform health policy and practice
Associazione Neodemos • 2025 • pp. 79-86
Introduction
The increase in life expectancy is one of the greatest achievements of modern societies. However, the so-called ‘longevity paradox’, described by Fries in 1980 and, more recently, by Garmany and colleagues, shows that the additional years are not always lived in good health. In Italy, life expectancy at birth rose from 79.6 years in 2000 to 83.4 years in 2019. Naghavi and the Global Burden of Disease group have calculated that healthy life expectancy (HALE) increased from 68.5 years (95% CI: 65.271.3) in 2000 to 70.9 years (67.4–73.8) in 2021, confirming that longer lives do not necessarily translate into years lived in full independence. The issue is not purely medical: it concerns health systems, families, and the sustainability of social services. Over the last two decades, the concept of ‘frailty’ has become central to explaining why some older people, even without serious disease, are more vulnerable to adverse events such as falls, hospital admissions, loss of autonomy, and mortality. Recognising and measuring frailty is crucial for public health and for the planning of preventive interventions.
Book chapter
La Fragilità negli anziani: comprenderla e misurarla per orientare le politiche sanitarie
Associazione Neodemos • 2025 • pp. 84-92
Introduction
L’aumento della longevità è uno dei più grandi successi delle società moderne. Tuttavia, il cosiddetto “paradosso della longevità”, ben descritto, fra gli altri, da Fries nel 1980 e da Garmany e colleghi in anni più recenti, mostra che gli anni guadagnati non sempre sono vissuti in buona salute. In Italia, la speranza di vita alla nascita è aumentata da 79,6 anni nel 2000 a 83,4 anni nel 2019. Naghavi e il gruppo Global Burden of Disease hanno calcolato che la speranza di vita in buona salute (HALE) è aumentata da 68,5 anni (IC 95%: 65,2–71,3) nel 2000 a 70,9 anni (67,4–73,8) nel 2021, confermando che l’allungamento della vita non si traduce in pari misura in anni vissuti in piena autonomia. Il problema non è solo medico: riguarda i sistemi sanitari, le famiglie, la sostenibilità dei servizi sociali. Negli ultimi vent’anni il concetto di “fragilità” (frailty) è diventato fondamentale per spiegare perché alcune persone anziane, anche senza malattie gravi, siano più vulnerabili a eventi avversi come cadute, ricoveri, perdita di autonomia e morte. Riconoscere e misurare la fragilità è cruciale per la sanità pubblica e per la programmazione di interventi di prevenzione.
Book
Misurare la fragilità negli anziani. Metodi e strumenti a supporto delle politiche e della ricerca
Franco Angeli • 2025
In this volume:
- G. Boccuzzo, A. Donno. Prefazione, pp. 9–14
- A. Donno, M. Nicolaio, M. Silan, G. Boccuzzo. Cos’è la fragilità dell’anziano e come può essere identificata. pp. 15–34
- E. Bovo, G. Boccuzzo. Misure di fragilità sulla base di indagini di popolazione. pp. 35–86
- M. Nicolaio, A. Donno, G. Boccuzzo. Indicatori di fragilità sulla base di dati amministrativi. pp. 87–170
- A. Ghirardo, G. Boccuzzo. La fragilità sociale. pp. 194–231
- E. Bovo, A. Donno. La fragilità in Italia. pp. 232–268
Scientific article
Assessing Frailty in Older Adults: Strategies and Tools for Effective Policy and Research
Rivista Italiana di Economia Demografia e Statistica • 2024 • Vol. 78(3)
Abstract
The progressive ageing of the population, not accompanied by a corresponding increase in healthy life expectancy, brings to the forefront the study of the health of older adults from a holistic perspective. The concept of frailty aligns with this perspective, as it considers a broader condition of vulnerability involving mainly older individuals, which is much more difficult to define and measure. This article aims to provide an overview of the concept of frailty, the various definitional approaches, and, consequently, the measurement methods, while also focussing on the relationship between frailty and the two main concepts that define health: multimorbidity and disability. Following a brief overview of the types of data and their role in the study of frailty, the article concludes with an analytical approach for defining a measure of frailty.
Scientific article
Construction of a Frailty Indicator with Partially Ordered Sets: A Multiple-Outcome Proposal Based on Administrative Healthcare Data
Social Indicators Research • 2022 • Vol.160, pp. 989–1017
Abstract
Given the progressive aging of Italian and European populations, the number of cases with chronic diseases is steeply increasing. This calls for new strategies for health resource management and the implementation of prevention policies. Among chronic patients, frail subjects have special and wider care requirements, along with an increased risk of adverse health outcomes. Thus, their identification is an important step for the Italian National Program for Chronic Diseases. This study aims at constructing an indicator that measures the frailty level of individuals in the population aged over 65 y using administrative healthcare data-flows of the Piedmont region. Following the multidimensional nature of frailty, we adopted a multiple-outcome approach in our proposal. This was done by considering the capacity to predict six unfavorable outcomes: death, urgent unplanned hospitalization, access to the emergency room with red code, avoidable hospitalization, hip fracture, and disability. We identified a parsimonious set of seven explanatory variables that can simultaneously predict the six outcomes we considered. We then assembled them into a unique frailty indicator through the use of a partially ordered set (poset) theory. Our indicator performed well with respect to all the outcomes and was able to describe several individual characteristics that are not directly considered in the computation of the indicator. Thanks to its parsimony and to the use of administrative healthcare data, our indicator allows all the stakeholders involved in the healthcare process, such as Italian Local Health Units, general practitioners, and regional managers, to use it to target frail individuals with better comprehensive healthcare actions.
Scientific article
Quantifying Frailty in Older People at an Italian Local Health Unit
Social Indicators Research • 2019 • Vol.146(3), pp. 757-782
Abstract
Population aging, which is common in developed countries, highlights issues related to the health and social assistance of frail individuals. The Italian Chronic Disease Program launched by the Ministry of Health proposes the implementation of tools that stratify the population based on health and care needs and enhances the integration of existing admin- istrative health data flows. This work has its roots in the need to identify frail individuals conveyed by an Italian Local Health Unit (LHU) of the Veneto region and organize an efficient service of care and prevention. We propose an indicator of frailty, computed using the poset approach, comprising only eight variables available in administrative health data at the LHU level. The proposed indicator associates a value of frailty between 0 and 1 to every individual of the population aged 65 years and older, thereby allowing stratification of the population by the risk level. By validating and analyzing the frailty indicator, we show that this approach provides an effective stratification of older people.