This year’s ESC Florence Nightingale Lecture in Nurse-Led Research is given by Professor Izabella Uchmanowicz (Wroclaw Medical University – Wroclaw, Poland), whose research has helped to improve the lives of older adults with cardiovascular disorders.
“Frailty has evolved from being merely a concept at the margins of cardiology to becoming a central determinant of outcomes. Our research has shown that it is not simply an attribute of, or confined to, advanced age but is instead a multidimensional syndrome encompassing physical, psychological, cognitive and social domains [1,2]. And, importantly, frailty is at least partially reversible, which transforms it from a prognostic label into a therapeutic target for exercise, nutritional and psychosocial interventions delivered by multidisciplinary teams.
The greatest challenge is that frailty remains under-recognised in cardiology, often being mistaken for normal ageing, so the psychological and social dimensions that drive poor adherence and hospital readmissions go unnoticed. The huge influence that frailty has on self-care, treatment adherence and quality of life underlines the importance of developing ways to measure it and a focus of my research has been on the validation and development of instruments for this purpose. We now need to gain consensus on which instrument to use in which setting, because busy clinics understandably resist anything that adds time to the consultation. Nurses are uniquely positioned to assess frailty in everyday care, but education, recognition and advanced practice roles are needed.
Frailty is increasingly visible in European guidelines and consensus documents, legitimising its assessment as a standard of care rather than an optional extra. Digital health offers a genuine breakthrough, with wearables and remote monitoring allowing earlier and more continuous assessment of functional decline compared with clinic visits [3]. AI will help us move from screening to prediction, identifying patients on a trajectory towards frailty before it becomes clinically manifest, and digital adherence instruments will allow us to personalise support for self-care in real time.
I believe frailty assessment will become as routine as measuring blood pressure. I also expect the boundaries between disciplines to blur, with cardiologists, nurses, geriatricians, dietitians and psychologists working around the patient rather than in parallel. My hope is that in 10 years’ time, we will no longer speak of frailty as a barrier to treatment but as a modifiable condition that we routinely identify, prevent and reverse.”
