Preface

The progressive and persistent growth in the number of elderly people worldwide has led to a modification of the current care scenario and a parallel increase in the use of the health resources (human, structural, economic, etc.) of this age group. These changes in combination with the lack of evidence-based data on the elderly population, and the need to rationalize limited public health resources, have contributed to discriminatory attitudes towards the elderly. Indeed, ageing is instinctively associated with the inevitable presence of pathologies and a reduction in health status. However, there is no single way of ageing, but different types of ageotypes have been identified. In view of the progressive increase in the number of elderly people with maintained cognitive abilities and functional autonomy, we now finally speak of successful ageing ("healthy ageing" or "ageing well"). This consideration creates the conditions for implementing modern ageing management strategies in both physiological and pathological forms.

However, complex clinical pictures arise in old age, due to the simultaneous presence of several diseases in the same individual of several diseases that are often chronic and not necessarily disabling. Frailty is the most problematic expression of the ageing population. It has also been used to measure degrees of interaction in a single system or to describe non-linear increases in vulnerability in relation to the number of physiological systems involved.

Chapter 1 deals with a lifespan and multisystemic perspective on frailty and proposes that clinical management must qualify itself as a "customized multidimensional approach" according to the principle of "taking care of the patient and not only of the disease." Chapter 2 discusses the concepts of frailty, operationalization strategies, and assessment tools and clarifies some ideas from the debate on what frailty is. Chapter 3 elaborates further and contributes towards reliability and validity aspects of currently applied frailty scales and indicators across different populations. It also mentions the emerging field of geropsychology. Chapter 4 discusses the existing simple, performance-based frailty screening tools that can be conducted effectively in clinical as well as home environments on the initiative of an older adult themselves or their personal physician.

Chapter 5 shifts the emphasis to the evidence that physiological and cognitive changes interfere with drug pharmacodynamics and pharmacokinetics, contributing to drug-related problems. Attention is therefore given to strategies and tools developed to assess the appropriateness of medication use in the elderly. The next two chapters focus on non-pharmacological monitoring and treatment. Chapter 6 describes exercise-based interventions as the best alternative methods for treating frailty syndrome. The focus is on presenting strategies for designing exercise programs for this type of population, considering their practical application in the field. Chapter 7 provides an overview of how the psychological environment may affect frailty, suggesting a possible role of new technology solutions and physical activity as therapeutic interventions.

The final chapter turns the spotlight on the topic of social frailty: the vulnerability of the elderly to acts of violence. This contribution analyzes the emblematic case of crimes against an elderly woman in India with the twofold aim of understanding the nature of crimes against elderly women and examining the impact of crime on the physical and emotional well-being of elderly women.

This book presents all the essential elements for identifying and managing frailty in the elderly to prevent loss of functional autonomy and the consequent deterioration of quality of life. To carry out such interventions, it is necessary to have a deep psychogeriatric culture able to contrast every insidious form of ageism. Thanks to a modern multidimensional perspective, experts dedicated to older people are increasing in number and competence, forming a stronger movement to fight ageism and protect human rights at all ages.

> **Sara Palermo** National Institute of Philanthropy – Filantropolis, Numana, (Ancona) Italy
