Facing Frailty from other perspectives: neglected patients, features, and new ways to address them.

Frailty is a dynamic and multidimensional condition, with physical, psychological, and social factors playing a part in its development. The interaction between these domains is marked by considerable complexity. This thesis aimed to explore this complexity from other perspectives and broaden the debate on frailty towards 1) neglected patients; 2) neglected features, and 3) new ways to address them. This aim is addressed through the following individual studies: Study I and Study II focus on young patients admitted to the emergency department with acute alcoholic intoxication (neglected patients), assessing their long-term mortality, evaluating among potential deaths predictors minor trauma and social vulnerability (neglected features), and developing a multivariable logistic regression model to predict 1-year readmission to the emergency department (new ways). In Study III the first systematic map of the published evidence on the use of wearable sensors (new ways) in caregivers of people with dementia (neglected patients) is provided, mainly focusing on sleep disorders (neglected features). Study IV investigates associations between Fried’s frailty phenotype and sleep disorders (neglected features), evaluating possible associations with gastrointestinal symptoms (new ways) in hospitalized middle-aged adults with low comorbidities and without cognitive impairment (neglected patients). Lastly, Study V explores the association between multimorbidity, evaluated through chronic disease patterns (neglected features) and physical performance tests by examining their longitudinal trajectories over 15 years (new ways) in a community-based cohort of older adults. Frailty is not just a physical phenomenon. The findings of this thesis suggest broadening the discussion surrounding frailty by evaluating the interplay between physical, psychological, and social factors, and by shifting the focus to patient groups beyond older adults. Moreover, this thesis provides novel instruments to approach this interplay, aiming to foster resilience in patients and improve their ability to prevent functional decline through tailored prevention and person-centered care.