Screening and preventing risks of frailty in community-dwelling senior citizens: a global personalised approach to promote healthy ageing

Concept and theory: multi-domains prevention at early stageFrailty is defined today within two main paradigms.The traditional approach considers frailty as an exclusively physical condition. This frailty syndrome represents declines in physiologic reserves and functions as well as resistance to stressors, leading to increased vulnerability and adverse health events. A person is said frail if three or more of the following criteria are present: unintentional weight loss, self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity (Fried LP, 2001).The second paradigm includes the psychological and social domains of frailty, shifting from a vision of frailty as a phenotype to frailty as an accumulation of deficits in various domains: cognition, mood, motivation, motor skills, balance, capacity to carry out day-to-day activities, nutrition, social status and comorbidities (Rockwood K, 2005). A more recent model defines frailty as “a dynamic state affecting individuals with losses through one or more functional domains (physical, psychological and social), increasing overall the risk of adverse outcomes"(Gobbens RJ, 2010).Inspired by this multidimensional paradigm, the CARSAT concentrates its efforts on the risks of frailty, far preceding the state of acknowledged frailty (Noguès M, 2015). Through a global approach, we aim to improve frailty prevention by targeting individuals who, although still in good health, might be at risk of frailty. This implies transforming the traditional vision of primary, secondary and tertiary prevention (often leading to segmentation) into a more evolving and comprehensive process, based on the consideration of health from three dimensions: physiological, social and environmental. From this integration of social and health approaches at an early stage, individually-tailored responses are possible.Integrated care in practise: the concerted window serviceThe Regional Institute of Ageing (IRV) was founded by the CARSAT. This community, gathering regional experts and institutional stakeholders of the field, implemented in 2014 an experimental territorial project to offer global support to insured retirees or pre-retirees at risk of frailty.Individuals at risk of frailty are identified through the IRV's Frailty Observatory (geographic information system) or through other various social security organisations, and are then invited to present themselves. The aim is to provide advice and facilitate th