[Fragility in a Public Health perspective: principles and tools for a "life course" approach prevention- oriented]

The increased average life expectancy, not followed by an increase in healthy life years,\r\nresults in a growing prevalence of frailty, with a significant change in the health needs of\r\nthe population. Consequently, frailty can be considered an important threat to public\r\nhealth that can be labeled as the future cornerstone of public health. The purpose of this\r\npaper is to provide an overview of the concept of frailty that shows how public health\r\nlanguage, logic and tools should intervene in the definition of frailty and the related\r\nhealth needs in order to promote a deeper knowledge of the considered condition, its\r\nprevention and its management at the individual and population level.\r\nSocial and environmental determinants of health get a relevant role according to the\r\nbiopsychosocial definition of frailty. In fact following this approach this condition is\r\nreported as multidimensional syndrome. For this reason, different screening and\r\nevaluation tools have been developed to investigate the different domains and to allow an\r\nearly identification of this condition which is essential to help patients in regaining\r\nfunctionality and in the prevention of associated negative outcomes. n addition to these individual assessment systems, from a public health perspective, it is\r\nalso necessary to have risk stratification tools that can read and evaluate the whole\r\npopulation in order to plan and organize services intended for a community. The\r\ncharacterization of the need for health of the "frail" people does not require a univocal\r\ndefinition that fits all health and social contexts, but rather a sharing among all\r\nprofessionals about the ways to define and recognize frailty according to a\r\nmultidimensional approach. The training lever represents a qualifying element for Public\r\nHealth to develop policies, programs and interventions intended for all professional\r\nactors involved in the treatment of frailty as well as for patients and their caregivers. The\r\nparticipation of the caregivers and of the community represents a key element for\r\ndeveloping adequate responses in a perspective of participatory prevention. Therefore, it\r\nis essential that primary care and public health professionals as well organizations act\r\nsynergically at fragile individual and population level according to a "life-course" and\r\n"patient-centered" approach.