Identification and Management of Physical Frailty in elderly: ICFSR Guidelines

The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) have developed clinical practice guidelines to provide recommendations for the identification and management of frailty in older adults.These recommendations focus on the clinical and practical aspects of care for older people with frailty and promote person-centered care.The new guidelines have been published in the Journal of nutrition, health & aging.

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, anemia, 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.

Following are the major recommendations:

• All adults aged 65 years and over should be offered opportunistic screening for frailty using a simple, validated frailty instrument suitable to the specific setting or context.


• Clinical assessment of frailty should be performed for all older adults screening as positive for frailty or pre-frailty.


• A comprehensive care plan for frailty should systematically address: polypharmacy, the management of sarcopenia, treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and vitamin B12 deficiency).


• Where appropriate, persons with advanced (severe) frailty should be referred to a geriatrician.


• Older people with frailty should be offered a multi-component physical activity programme (or those with pre-frailty as a preventative component).


• Health practitioners are strongly encouraged to refer older people with frailty to physical activity programs with a progressive, resistance-training component.


• Protein/caloric supplementation can be considered for persons with frailty when weight loss or undernutrition has been diagnosed.


• Health practitioners may offer nutritional/protein supplementation paired with physical activity prescription.


• Advise older adults with frailty about the importance of oral health.


• Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.


• Vitamin D supplementation is not systematically recommended for the treatment of frailty unless vitamin D deficiency is present.


• Cognitive or problem-solving therapy is not systematically recommended for the treatment of frailty.


• Hormone therapy is not recommended for the treatment of frailty.


• All persons with frailty should be offered social support as needed to address unmet care needs and encourage adherence to the Comprehensive Management Plan.


• Persons with frailty can be referred to as home-based training.