Frailty Prevalence, Multidomain Intervention Effects, and Hospitalisation Reduction in Community-Dwelling Older Adults

Frailty — the age-associated reduction in physiological reserve across multiple organ systems, characterised by vulnerability to stressors and disproportionate health consequences from minor insults — is both a major predictor of adverse outcomes in older adults and a potentially modifiable target for preventive intervention. Despite high prevalence estimates of 10–15 percent for frailty and 40–50 percent for the pre-frail state in community-dwelling adults above 70 years, evidence-based multidomain intervention programmes targeting the biological and functional components of frailty simultaneously remain under-evaluated in randomised controlled designs with long-term outcome follow-up. This two-year RCT enrolled 8,641 community-dwelling adults aged 60 and above across fifteen geriatric outpatient clinics in Spain, Sweden, France, Finland, and Italy, screening for frailty using the Fried Frailty Phenotype and the Frailty Index, and randomising pre-frail and frail participants to a structured multidomain intervention or standard geriatric care. The multidomain intervention combined structured progressive resistance and balance exercise (three sessions per week), protein-targeted nutritional supplementation (1.2 g/kg/day), cognitive stimulation therapy, and polypharmacy review by a clinical pharmacist. At twenty-four months, the intervention arm showed significant reductions in Frailty Index score (0.28 to 0.16 vs. 0.27 to 0.31 in controls), gait speed improvement (0.24 m/s increase vs. 0.02 m/s in controls), and a 41.2 percent reduction in hospital admissions relative to the control arm. Frailty reversal — transition from frail to pre-frail or robust — was achieved in 34.8 percent of intervention arm participants compared to 8.4 percent in controls.