Review Article| Volume 14, ISSUE 2, 101421, March 2023

Intrinsic capacity and resilience: Taking frailty to the next level

Published:January 17, 2023DOI:


      In addition to frailty, two novel concepts have been introduced in the field of geriatrics to capture the heterogeneous ageing process: the first is intrinsic capacity, which uses a community-based, holistic approach and is propagated by the World Health Organization (WHO); and the second is resilience, which provides a more dynamic perspective on the individual's reserves, injury and recovery. While both concepts are linked to frailty, with all three focusing on reserves in relation to ageing, each approaches this issue from a different point of view. In this paper, we will compare and contrast these three concepts – frailty, intrinsic capacity and resilience – and assess their relevance to future geriatric oncology research as well as daily clinical practice.


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        • Mohile S.G.
        • Dale W.
        • Somerfield M.R.
        • Hurria A.
        Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: Asco guideline for geriatric oncology summary.
        J Oncol Pract. 2018; 14: 442-446
        • Li D.
        • Sun C.-L.
        • Kim H.
        • et al.
        Geriatric assessment-driven intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial.
        JAMA Oncol Published online. 2021;
        • Mohile S.G.
        • Mohamed M.R.
        • Xu H.
        • et al.
        Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
        Lancet (London, England). 2021; 398: 1894-1904
        • Soo W.
        • King M.
        • Pope A.
        • Parente P.
        • Darzins P.
        • Davis I.
        Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy.
        J Clin Oncol. 2020; 38: 12011
        • Kalsi T.
        • Babic-Illman G.
        • Ross P.J.
        • et al.
        The impact of comprehensive geriatric assessment interventions on tolerance to chemotherapy in older people.
        Br J Cancer. 2015; 112 (Accessed December 31, 2021): 1435-1444
        • Carvalho I.A.
        • Martin F.
        • Cesari M.
        • Sumi Y.
        • Thiyagarajan J.A.
        • Beard J.
        Operationalising the concept of intrinsic capacity in clinical settings. Published online.
        • Whitson H.E.
        • Duan-Porter W.
        • Schmader K.E.
        • Morey M.C.
        • Cohen H.J.
        • Colón-Emeric C.S.
        Physical resilience in older adults: systematic review and development of an emerging construct.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 489-495
        • Whitson H.E.
        • Cohen H.J.
        • Schmader K.E.
        • Morey M.C.
        • Kuchel G.
        • Colon-Emeric C.S.
        Physical resilience: not simply the opposite of frailty.
        J Am Geriatr Soc. 2018; 66: 1459-1461
        • Witham M.
        • Sayer A.
        Biological resilience in older people - a step beyong frailty?.
        Eur Geriatr Med. 2015; 6: 101-102
        • Rockwood K.
        • Mitnitski A.
        Resilience and frailty: furter steps, best taken together.
        Eur Geriatr Med. 2015; 6: 405-507
        • De Alfieri W.
        • Costanzo S.
        • Borgogni T.
        Biological resilience of older adults versus frailty.
        Med Hypotheses. 2011; 76: 304-305
        • Belloni G.
        • Cesari M.
        Frailty and intrinsic capacity: two distinct but related constructs.
        Front Med. 2019; : 6
        • Beard J.R.
        • Jotheeswaran A.T.
        • Cesari M.
        • Araujo De Carvalho I.
        The structure and predictive value of intrinsic capacity in a longitudinal study of ageing.
        BMJ Open. 2019; 9
      1. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity.
        (Accessed November 8, 2022)
        • Rockwood K.
        • Song X.
        • MacKnight C.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        CMAJ. 2005; 173: 489-495
        • Nicholson C.
        • Gordon A.L.
        • Tinker A.
        Changing the way “we” view and talk about frailty….
        Age Ageing. 2017; 46: 349-351
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56
        • Dent E.
        • Martin F.C.
        • Bergman H.
        • Woo J.
        • Romero-Ortuno R.
        • Walston J.D.
        Management of frailty: opportunities, challenges, and future directions.
        Lancet (London, England). 2019; 394: 1376-1386
        • Clegg A.
        • Young J.
        • Iliffe S.
        • Rikkert M.O.
        • Rockwood K.
        Frailty in elderly people.
        Lancet (London, England). 2013; 381: 752-762
        • Hoogendijk E.O.
        • Afilalo J.
        • Ensrud K.E.
        • Kowal P.
        • Onder G.
        • Fried L.P.
        Frailty: implications for clinical practice and public health.
        Lancet (London, England). 2019; 394: 1365-1375
        • Hamaker M.
        • Lund C.
        • te Molder M.
        • et al.
        Geriatric assessment in the management of older patients with cancer - a systematic review (update).
        J Geriatr Oncol. 2022; 13: 761-777
        • Shahrokni A.
        • Tin A.L.
        • Sarraf S.
        • et al.
        Association of Geriatric Comanagement and 90-day postoperative mortality among patients aged 75 years and older with cancer.
        JAMA Netw Open. 2020; 3
        • Hurria A.
        • Soto-Perez-de-Celis E.
        • Allred J.B.
        • et al.
        Functional decline and resilience in older women receiving adjuvant chemotherapy for breast cancer.
        J Am Geriatr Soc. 2019; 67: 920-927
        • Varadhan R.
        • Seplaki C.L.
        • Xue Q.L.
        • Bandeen-Roche K.
        • Fried L.P.
        Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty.
        Mech Ageing Dev. 2008; 129: 666-670
        • Kalyani R.R.
        • Varadhan R.
        • Weiss C.O.
        • Fried L.P.
        • Cappola A.R.
        Frailty status and altered glucose-insulin dynamics.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 1300-1306
        • Lagro J.
        • Schoon Y.
        • Heerts I.
        • et al.
        Impaired systolic blood pressure recovery directly after standing predicts mortality in older falls clinic patients.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 471-478
        • Messinger-Rapport B.
        • Snader C.E.P.
        • Blackstone E.H.
        • Yu D.
        • Lauer M.S.
        Value of exercise capacity and heart rate recovery in older people.
        J Am Geriatr Soc. 2003; 51: 63-68
        • O’Connell M.D.L.
        • Savva G.M.
        • Finucane C.
        • Romero-Ortuno R.
        • Fan C.W.
        • Kenny R.A.
        Impairments in hemodynamic responses to Orthostasis associated with frailty: results from the Irish longitudinal study on ageing (TILDA).
        J Am Geriatr Soc. 2018; 66: 1475-1483
        • Steffens D.
        • Ismail H.
        • Denehy L.
        • et al.
        Preoperative cardiopulmonary exercise test associated with postoperative outcomes in patients undergoing cancer surgery: a systematic review and meta-analyses.
        Ann Surg Oncol. 2021; 28: 7120-7146
        • Hadley E.C.
        • Kuchel G.A.
        • Newman A.B.
        Report: NIA workshop on measures of physiologic resiliencies in human aging.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 980-990
        • Olde Rikkert M.G.M.
        • Dakos V.
        • Buchman T.G.
        • et al.
        Slowing down of recovery as generic risk marker for acute severity transitions in chronic diseases.
        Crit Care Med. 2016; 44: 601-606
        • Scheffer M.
        • Elizabeth Bolhuis J.
        • Borsboom D.
        • et al.
        Quantifying resilience of humans and other animals.
        Proc Natl Acad Sci U S A. 2018; 115: 11883-11890
        • Gijzel S.M.W.
        • Whitson H.E.
        • van de Leemput I.A.
        • et al.
        Resilience in clinical care: getting a grip on the recovery potential of older adults.
        J Am Geriatr Soc. 2019; 67: 2650-2657
        • Greenhalgh T.
        • Hurwitz B.
        Narrative based medicine: why study narrative?.
        BMJ. 1999; 318: 48
        • Gijzel S.M.W.
        • Rector J.
        • van Meulen F.B.
        • et al.
        Measurement of dynamical resilience indicators improves the prediction of recovery following hospitalization in older adults.
        J Am Med Dir Assoc. 2020; 21: 525-530.e4
        • Maxwell C.A.
        • Mion L.C.
        • Mukherjee K.
        • et al.
        Preinjury physical frailty and cognitive impairment among geriatric trauma patients determine postinjury functional recovery and survival.
        J Trauma Acute Care Surg. 2016; 80: 195-203
        • Lawrence V.A.
        • Hazuda H.P.
        • Cornell J.E.
        • et al.
        Functional independence after major abdominal surgery in the elderly.
        J Am Coll Surg. 2004; 199: 762-772
        • Bongers K.T.J.
        • Schoon Y.
        • Olde Rikkert M.G.M.
        Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons.
        BMJ Open. 2016; 6
        • Ghomrawi H.M.
        • Baumann L.M.
        • Kwon S.
        • et al.
        Using accelerometers to characterize recovery after surgery in children.
        J Pediatr Surg. 2018; 53: 1600-1605
        • Kaye J.A.
        • Maxwell S.A.
        • Mattek N.
        • et al.
        Intelligent systems for assessing aging changes: home-based, unobtrusive, and continuous assessment of aging.
        J Gerontol B Psychol Sci Soc Sci. 2011; 66: 1
        • Molenaar C.J.L.
        • van Rooijen S.J.
        • Fokkenrood H.J.P.
        • Roumen R.M.H.
        • Janssen L.
        • Slooter G.D.
        Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery.
        Cochrane Database Syst Rev. 2022; 2022