Commentary response : frailty, not just about old people : Reply to Smith GD & Kydd A (2017) Getting care of older people right : the need for appropriate frailty assessment?

As highlighted in a recent editorial, the ageing population and burden of frailty amongst those aged 60 years and older represents an impending challenge for individuals and health care systems globally (Smith & Kydd 2017). As frailty is largely considered a geriatric syndrome, research has primarily occurred within elderly community dwelling populations (Fried et al. 2001). However, it is important to highlight that not all older people are frail; and conversely not all younger people are non-frail. With frailty research expanding its scope beyond geriatrics over the last 2 decades, our understanding of this syndrome and its complexities has progressed. Notably the disparities in why individuals either ‘thrive’ or ‘dive’, is being attributed to frailty severity rather than age alone. This is especially true when assessing younger critically ill patients, where the impact of frailty is said to be analogous to that of frailty in older people (Bagshaw et al. 2016). These younger populations have some of the highest reported frailty prevalence rates; where frailty plays a key role in morbidity, mortality and health care utilization above that of other populations (Arora et al. 2016; Jha, Hannu, Chang, et al. 2016; McAdams-DeMarco et al. 2015).