Frailty and delirium are two common geriatric syndromes sharing several clinical characteristics, risk factors, and negative outcomes. Understanding their interdependency is crucial to identify shared mechanisms and implement initiatives to reduce the associated burden. This literature review summarizes scientific evidence on the complex interplay between frailty and delirium; clinical, epidemiological, and pathophysiological commonalities; and current knowledge gaps. We conducted a PubMed systematic search in June 2023, which yielded 118 eligible articles out of 991. The synthesis of the results—carried out by content experts—highlights overlapping risk factors, clinical phenotypes, and outcomes and explores the influence of one syndrome on the onset of the other. Common pathophysiological mechanisms identified include inflammation, neurodegeneration, metabolic insufficiency, and vascular burden. The review suggests that frailty is a risk factor for delirium, with some support for delirium associated with accelerated frailty. The proposed unifying framework supports the integration and measurement of both constructs in research and clinical practice, identifying the geroscience approach as a potential avenue to develop strategies for both conditions. In conclusion, we suggest that frailty and delirium might be alternative—sometimes coexisting—manifestations of accelerated biological aging. Clinically, the concepts addressed in this review can help approach older adults with either frailty or delirium from a different perspective. From a research standpoint, longitudinal studies are needed to explore the hypothesis that specific pathways within the biology of aging may underlie the clinical manifestations of frailty and delirium. Such research will pave the way for future understanding of other geriatric syndromes as well.

Background: Different programs promote healthy ageing through the optimization of intrinsic capacity. However, a major challenge is to assess their sustained effects over time. +AGIL Barcelona, a consolidated multidomain program, aims to optimize older adults’ intrinsic capacity through a coordinated approach among primary care, geriatrics and community resources, in agreement with the integrated care for older people (ICOPE) guidelines. We aimed to evaluate the +AGIL Barcelona longitudinal effect on older adults’ physical performance.Methods: All +AGIL Barcelona consecutive participants since 2016 were enrolled. After a comprehensive geriatric assessment, a tailored, multidisciplinary intervention aligned with the ICOPE guidelines is offered. It includes a 10‐week boost multicomponent exercise program, nutritional and sleep‐hygiene counselling, revision and optimization of pharmacological treatments and screening for cognitive impairment, depression and loneliness. Changes in physical performance after 3 and 6 months were assessed using mixed models including baseline frailty degree, time and all potential significant confounders.Results: We included 194 participants in the analysis (mean age = 81.6 [standard deviation = 5.8], 68% women). An independent, clinically and statistically significant improvement in physical performance (Short Physical Performance Battery [SPPB] test, combining gait speed, strength and balance) was found at 3 months (SPPB mean change: 1.4; 95% CI: 1.1–1.6) and 6 months (SPPB mean change: 1.1; 95% CI 0.8–1.5). Equivalent results were observed for all the SPPB sub‐tests.Conclusions: A coordinated, multidisciplinary and integrated program can benefit older adults’ intrinsic capacity. The participants’ empowerment and the connection with the available community resources are critical points for a successful intervention.

Postoperative delirium (POD) is often under-recognized in clinical practice. Blood-based markers could facilitate delirium detection and risk stratification. Neurofilament-Light chain (NfL) and Glial Fibrillary Acidic Protein (GFAP) are promising blood-based markers for neurodegenerative diseases and potential candidates for delirium. This study explored their role as blood-based risk markers for POD in older patients undergoing hip fracture surgery. In this prospective multicohort study, preoperative blood and intraoperative cerebrospinal fluid (CSF) samples were collected from patients aged ≥65 years with hip fractures. POD was assessed daily using the 4AT scale. NfL and GFAP concentrations in both blood and CSF were compared between POD and Non-POD groups, further stratifying by dementia status. Logistic regression models adjusted for covariates were used to assess associations. A total of 143 patients (median age, 85 years; 76.9% female) were included, with POD occurring in 38 patients (26.6%). Blood NfL and GFAP concentrations were significantly higher in the POD group than in Non-POD (64.55 vs. 44.6 pg/mL and 22 vs. 14.8 pg/mL, P<0.001). CSF NfL levels were also elevated in POD (2154 vs. 1565 pg/mL, P=0.007), but no significant difference was observed for CSF GFAP levels. Higher preoperative blood NfL and GFAP levels independently predicted POD after adjusting for age, sex, dementia, frailty, and Interleukin-6 (Odds Ratio, OR: 3.21, 95% Confidence Interval, CI: 1.26-8.21, and OR: 3.66, 95% CI: 1.38-9.68, respectively). Although further research is needed, our findings support the role of NfL and GFAP as blood-based risk markers for POD in older patients undergoing hip fracture surgery.

Urinary catheterization is a common procedure in the perioperative management of patients with hip fracture. However, decisions on its insertion or removal are often variable. This systematic review aimed to synthesize current evidence on urinary catheterization management in older patients with hip fracture by thoroughly reviewing the implementation of structured programs. Systematic review. Older adults hospitalized for hip fracture. Studies published until April 1, 2023, were retrieved from MEDLINE (PubMed interface), SCOPUS (Elsevier interface), and Cochrane Central Register of Controlled Trials (EBSCO interface). Observational and interventional studies investigating the use of urinary catheterization in older adults with hip fracture were included and corresponding data on structured programs and associated results were extracted. The quality assessment of the studies was performed using the Critical Appraisal Skills Programme tool. Of the 674 articles identified through the literature search, 16 studies were included. The mean ages in the 16 studies ranged from 67 to 86 years. Studies on the implementation of structured programs were few and heterogeneous. These studies identified 24 to 48 hours as the appropriate duration of postoperative catheterization; intermittent catheterization was associated with a lower incidence of complications. Our review revealed a lack of standardized perioperative urinary catheterization management in older patients with hip fracture and uncovered the need for a tailored approach, which is crucial to improving the quality of care and outcomes in these patients.

Purpose: This study aimed to explore the perceptions of geriatricians and experienced geriatric trainees in Europe of the complex relationship between dementia, delirium and frailty, including their relative prevalence, overlaps and causality. Methods: An online anonymous survey was administered across 30 European countries, via the mailing list of the European Geriatric Medicine Society (EuGMS), national member groups and the authors’ professional networks. Questions were framed in the context of recently hospitalised 80-year-old patients. Results: Within the 440 included surveys, respondents particularly over-estimated frailty prevalence in older hospitalised patients, with two-thirds choosing between 41 and 80% prevalence, when the literature suggests only 23–46%, but paradoxically underestimated the frequency of frailty in people with delirium (more than three quarters of responses across 21–80%; literature suggests 71–93%). Severe dementia and previous delirium were correctly considered the strongest risks for future inpatient delirium. However, many considered pre-frailty a moderate (44%) or even strong (19%) risk for future delirium, while a minority considered severe dementia a low risk. Respondents viewed delirium superimposed on dementia (DSD) as having the strongest influence on in-hospital mortality and discharge to residential care, dementia as having the strongest influence on future residential care admission, and frailty as the condition most strongly influencing future mortality. Conclusion: Geriatricians and experienced geriatric trainees across Europe gave varied responses to questions about delirium, dementia and frailty prevalence, co-occurrence and consequences. This indicates a need for the performance and wide dissemination of robust, prospective research examining all three conditions in older hospital cohorts. We suggest a merging of selective delirium-frailty and dementia-delirium interests to the dementia-delirium-frailty triumvirate.

This report examines how European geriatricians understand the concept of ‘cognitive frailty’, which was first formally defined by the International Academy on Nutrition and Aging (IANA) and the International Association of Gerontology and Geriatrics (IAGG) in 2013. An online survey about delirium, dementia and frailty relationships and pathways was distributed across Europe through appropriate professional groups. Eligible participants were geriatricians or trainees in their final two years of specialist geriatric training, in a European country. Snowball sampling was used. In total, 440 people replied to the survey, of which 324 responded to the section on cognitive frailty. Respondents were predominantly female and there was a marked under-representation of Eastern European participants. From a list of possible definitions, only one in four of the 324 respondents identified cognitive frailty as defined by the IANA and the IAGG, i.e., a combination of physical frailty and mild cognitive impairment. Almost two thirds of those who stated that they currently use the term in their work did not choose the IANA-IAGG definition. After the definition was shared with respondents, only 44% strongly agreed with it as an apt description of cognitive frailty, with some considering it too narrow (by omitting delirium and dementia) while others considered it too broad (by including physical frailty). There is no clear consensus opinion among geriatricians in Europe on the definition of ‘cognitive frailty’. While there is some core support for the IANA-IAGG definition, it is not intuitive to those not already familiar with the term. The variance in the current understanding of cognitive frailty among geriatricians suggests the time is right for a meaningful debate on this issue. While there is ongoing, growing research on a shared pathophysiology between physical frailty and cognitive impairment, further studies are required to evaluate the added benefit of this particular conceptual theorization in older persons care rather than its single components, and if beneficial, how awareness, understanding and correct usage of the concept can be improved.