Promoting an international consensus on frailty assessment: An urgent call to address the challenges of perioperative management in an aging population.

Abstract

As populations age at an unprecedented pace globally, frailty has emerged as a critical challenge in perioperative care. While clinicians broadly acknowledge the value of frailty assessment, embedding it systematically in care pathways remains difficult to implement systematically. We compared perioperative frailty guidelines from the United Kingdom, United States, Europe, and the Asia-Pacific, finding significant inconsistencies in tool selection, risk stratification criteria, and pathway design. Strikingly, approximately 99.6% of frailty research remains confined to risk characterization, whereas only 0.4% is directed toward improving care, highlighting a substantial gap between evidence and practice. Digital technologies promise a wider uptake of frailty screening, and yet algorithmic bias threatens to under-detect frailty in underserved groups if left unchecked. We outline five policy priorities: first, an internationally coordinated consensus on core assessment standards needs to be reached; second, end-to-end pathways that span screening, graded assessment, targeted intervention, and outcome tracking need to be devised; third, digital technology needs to be accelerated along with the devising of explicit safeguards for equity; fourth, high-quality evidence needs to be generated through function-centered outcomes and cost-effectiveness analyses to demonstrate the real-world value of frailty-focused care pathways; and fifth, frailty management needs to be integrated into national chronic-disease frameworks. Closing the gap between detection and action will require global collaboration and a reframing of frailty, not as a passive label but as a call to intervene.