Does frailty need a new name?

Sarah Hopkins and colleagues argue that labelling patients as frail can be problematic and call for greater inclusion of older people in deciding how best to talk about the condition The biomedical concept of frailty has been an important advance in how we approach the care of older people: it is central to better evidenced medicine and policy.1 In high income countries, around 40% of older patients with unplanned hospital admissions are living with moderate or severe frailty.2 Identifying frailty can help clinicians provide best care for such patients, keeping people living at home,3 helping avoid iatrogenic harm,4 and potentially reversing some aspects of frailty.5 Reflecting the importance of detecting and acting on frailty, NHS England included assessment targets for acute hospitals in its 2023 Commissioning for Quality and Innovation (CQUIN) guidance, which is linked to performance related financial incentives.6 Globally, national guidelines recommend using frailty to guide patient care and service design.7 Research into the nature, underlying mechanisms, measurement, and reversibility of frailty is ongoing.1589 However, here we focus on the term itself, which many older people find pejorative. We consider the pros and cons of renaming frailty and, aligning with the UN’s plan of action for a decade of healthy ageing, recommend greater collaboration with older people to develop improved ways of talking about the condition.10 Research on public perceptions of frailty shows that older people commonly understand frailty to be a state of physical, psychological, and social decline linked to dependency, loss of identity, social exclusion, and stigma.1112 It is associated with negative age related stereotypes. “Frail” is thus often understood as a pejorative term and can have connotations of a weak incapable person who is “failing” (box 1).1114 Box 1 ### Oxford dictionary definitions of frailty13RETURN TO TEXT