Exploring frailty, mental health and related outcomes: a multi-cultural population-based approach to ageing.

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We are facing an unparalleled change in demographics, where people are increasingly living longer. This phenomenon is occurring across the whole globe, but at a different pace. Rich countries have experienced a steadier increase in the number of older adults, whereas low and middle-income countries are facing a much more rapid transition. Frailty is closely linked to older age. Although the word 'frail' has become part of our day-to-day vocabulary, geriatricians and the wider medical community have seen far less agreement as to what constitutes a frailty syndrome. The past two decades have seen remarkable advances in understanding this condition, with a number of definitions been put forward. Having a solid and appropriate definition of frailty is extremely important, as without such definition most clinicians would fall back on instinct and experience to identify frail patients. Although there has been considerable progress in the understanding of this condition, most of the work has been carried out in high-income countries and has been mainly driven by clinical insights. It is therefore not known whether the criteria that are currently used in those settings could be used in low and middle-income countries. In this project I aim to investigate whether the current definitions of frailty could be applied to diverse settings, including developing countries, and whether these definitions are good at predicting a range of outcomes. These outcomes include death, illness, disability, cognitive decline and usage of health care. A significant part of the research will focus on the contribution of common mental disorders, such as anxiety and depression, to frailty. The study of anxiety and depression in later life has been relatively neglected, because of an emphasis on acute psychiatric disorders in younger life and the dementias in older age. However these conditions are extremely common in older age and have been associated with higher level of disability, hospitalisation, and lower quality of life. More treatment and research in those conditions should be made a national priority. The research will be novel using a comprehensive and integrative approach in respect to cognitive, physical and psychological age-related changes, and using cutting-edge statistical analytical procedures. This project will also be using data from three large population-based studies carried out in diverse settings. One was carried out across a number of low and middle-income countries in Latin America and Asia. The other two were conducted in the Netherlands and Scotland. The findings from this research will help in developing tools that may help clinicians in predicting the course of illness and its treatment, but also policy-makers and commissioners in planning health care facilities and prioritise resources.