Frailty Measure Development, Selection, and Implications

Many frailty assessment methods and instruments exist which generally agree in targeting older adult vulnerability to adverse outcomes but differ in other conceptual and practical respects. Multiple efforts to achieve definitional and operational consensus have fallen short. This chapter addresses the imperative, rather, of clearly understanding the purpose of frailty measurement in a given scenario and working to assure that the measurement meets its intended purpose. Elements of selecting or developing a frailty measurement that accurately targets a given frailty concept or achieves a specific purpose are detailed within validation frameworks highlighting concepts and, alternatively, utility. Additional high issues for frailty measurement are considered, including distinction between primary and secondary frailty, algorithmic bias, improved prefrailty assessment, and next-generation measurement methods. Principled frailty measurement promises to accelerate discovery of frailty etiology and efforts to manage threats to frail older adults’ health and well-being.