Frailty: understanding biological age to better prevent loss of independence
Getting older doesn’t have to mean becoming frail or dependent. It’s not the age you put on forms that matters, but your biological age – the age your organs and functions appear to be. Understanding this distinction means rethinking how we prevent, care for and support ageing.
Professor Antoine Piau
Frailty and ageing: better detection for better prevention
Text transcription
Assessing the true age of a person is essential in our profession. We often look at aging itself as the problem. But in reality, it is often confused with poor health.
Chronological age is not the same as biological age, the age of your cells, the age of your organs.
Why is it important to distinguish between the two?
Because the goal is not to grow old whatever the cost. It is to remain autonomous and healthy. Since the end of WWII, we have extended our absolute life expectancy by 20 years.
But healthy life expectancy has advanced much less. It is biological age, the true age of your organs, that is important.
To preserve it, we need to maintain what we call functions: memory, good spirits, mobility, vision and hearing, so the senses, as well as nutrition and muscle quality.
This must be done as soon as possible. And this involves, as I'm sure you can imagine, physical activity, a better, more balanced diet, close social connections, which actually exercise the brain.
Age, a misleading number
Age is often associated with decline, but this is a common misconception. Chronological age does not reflect biological reality. Two people of the same age can have very different levels of health. Ageing pathways are determined more by how robust the body’s functions are than by age.
From geriatrics to the notion of frailty
Since the 1980s, geriatrics has promoted an overall patient assessment focused on the major functions, including memory, mobility, nutrition, psychological balance, hearing, sight and social inclusion, rather than simply counting up organ diseases. But why do some seniors suddenly lose independence after a simple infection, while others resist?
The answer comes from the concept of frailty, defined by Linda Fried in the 2000s. Frailty allows us to look at people who seem healthy and independent and identify those who are at high risk of suddenly becoming dependent following a minor medical event by using five criteria: reduced walking speed, weight loss, fatigue, loss of muscle strength and decreased activity.
Frail, robust, dependent: three profiles, three strategies
The concept of frailty helps to clarify the diversity of ageing pathways:
- Robust: people who are ageing healthily, without any sign of frailty.
- Frail: people who remain independent but are in a state of instability.
- Dependent: people who have already lost a significant part of their autonomy.
This division helps to adapt prevention: detecting weak signals in the frail, building the capacities of the robust and supporting dependent people with personalised care.
Walking speed, a key indicator
Walking speed is now a universal marker of health. It reflects the body’s overall condition and anticipates many risks. Eventually, it could become a new vital sign, just like blood pressure or heart rate.
Towards proactive, personalised prevention
Frailty is no longer an academic concept: it is a tool to transform our practices. It allows us to:
- detect vulnerabilities at an early stage,
- take action in terms of physical activity, nutrition, cognition, social connections and other functions
- adapt care to actual abilities, rather than chronological age.
Clariane’s role and the ICOPE programme
In partnership with the University Hospital Institute of Toulouse, Clariane is rolling out the WHO ICOPE programme, which tracks six essential functions of healthy ageing: mobility, memory, nutrition, vision, hearing and psychological well-being. The aim is to identify frailties before dependency arises and to strengthen prevention to reflect needs as closely as possible.
Age doesn’t determine frailty – loss of function does. Prevention means tacking action before dependency sets in