Frailty is a complex condition for a number of reasons. The complexity of frailty can be described through three main themes:

  • Structural Complexity: As described in the frailty fulcrum model, frailty has ‘structural’ complexity. The condition of frailty has a complex structure because it is not a simple one or two-dimensional condition, but instead it is made up a number of different domains. Furthermore, the overall extent of frailty is not just the result of adding up all the contributions in these different domains, but instead depends upon a wide range of interactions of the different elements within and between all these different domains (see frailty fulcrum);
  • Temporal Complexity: This refers to the fact that frailty changes over time. The frailty fulcrum model can help us to understand that overall levels of frailty can change over time, getting better or worse depending upon changes within the individual domains of frailty and the interactions between them. This model also helps us to understand that sometimes these changes can be small and gradual and sometimes they can be sudden and more severe. Furthermore, sometimes the changes within the individual domains are reversible and sometimes they are not
    (see frailty fulcrum);
  • Multiple Stakeholders: The third dimension of complexity in frailty is the fact that frailty has ‘multiple stakeholders’. In other words, there are often many different people interested and involved in supporting a person with frailty. First and foremost, there is of course the individual with frailty. However, other individuals with important roles can include the person’s spouse, children or other close family members, friends, other informal and formal carers, and health and care professionals. Furthermore, very often these different ‘stakeholders’ can have different perspectives and opinions regarding the best approach to care for that individual and aligning these
    differing perspectives to support the individual’s person-centered goals and plan of care can be complex at times. This can be further complicated in the case of a person with frailty who also has cognitive impairment impacting upon their mental capacity to independently make all the necessary decisions about their care.