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. 2026 Jun 11;9(3):297–308. doi: 10.1002/agm2.70091

Defining Frailty in Chinese‐Language Biomedical Literature (2014–2024): A Decade of Conceptual Evolution

Haodong Wei 1,✉, David Mockler 2, Giulia Cavrini 1,3, Nathan W Hill 4, Daniel Kam Yin Chan 5, Román Romero Ortuño 1
PMCID: PMC13347167  PMID: 42428685

ABSTRACT

Frailty is increasingly recognized as a central concept in aging research and clinical practice, which reflects reduced physiological reserve and heightened vulnerability to stressors. While extensively examined in Western biomedical literature, how frailty is defined and conceptualized in Chinese‐language biomedical research remains insufficiently explored. This systematic review examined frailty definitions in Chinese biomedical publications from 2014 to 2024, analyzing definitional sources, conceptual emphases, and temporal trends. Searches across major Chinese and international databases identified 1804 eligible articles. Results show growing alignment with international frameworks, particularly through expert consensus statements, alongside improving terminological standardization. However, biomedical interpretations remain dominant, with limited attention to psychological, social, dynamic, and reversible dimensions. Emerging contributions from traditional Chinese medicine introduce distinct perspectives centred on balance and restoration. Clarifying these definitional patterns is essential for cross‐cultural comparability and the development of culturally relevant frailty research and clinical practice.

Keywords: aged, cross‐cultural comparison, frailty, geriatrics, terminology as topic

Frailty definitions in Chinese‐language biomedical literature increasingly align with international frameworks, while retaining conceptual diversity, underscoring the need for multidimensional, cross‐cultural research and integration with traditional Chinese medicine for culturally sensitive clinical practice.

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1. Introduction

Frailty has increasingly been recognized as a critical concept in aging medicine. Clinically, it is understood as a decline in physiological function across multiple organ systems, resulting in heightened vulnerability to relatively minor stressors [1]. Although frailty becomes more common with advancing age, it is distinct from chronological aging. Rather, it represents a biomedical syndrome or state associated with elevated risks of adverse outcomes including falls, hospitalization, institutionalization, and mortality [2]. Consequently, identifying and managing frailty have become central priorities in geriatric medicine, public health, and health policy [3, 4].

The conceptualisation of frailty continues to evolve in biomedical research, accompanied by ongoing debates about its operational definition [5, 6]. Globally, two dominant models have shaped its identification: the phenotype model proposed by Fried et al. [7], which defines frailty as meeting three or more of five physical criteria (unintentional weight loss, exhaustion, weakness, slowness, and low physical activity), and the cumulative deficit model developed by Rockwood and Mitnitski [8], which quantifies frailty as the proportion of health deficits accumulated over time. While both models are widely applied, they differ in theoretical foundations, measurement approaches, and clinical scope. More recently, increasing attention has been paid to the dynamic and potentially reversible nature of frailty [9, 10, 11, 12, 13]. In parallel, China's long‐standing tradition of traditional Chinese medicine (TCM) offers a unique conceptual framework, with constitution‐based TCM assessments offering potential for personalized strategies to mitigate frailty [14].

China's population aging is characterized by both rapidity and scale. In 2020, adults aged 65 years or older accounted for 14% of the population—equivalent to 191 million older individuals. Whilst this 2020 proportion was not as high as European countries such as Germany (22%) or France (21%), China's much higher absolute number of older adults makes the challenge particularly urgent. By 2050, one‐quarter of the population is projected to be aged 65 or above, including nearly 8% aged 80 and older [15, 16]. Such demographic changes pose major challenges for healthcare delivery, long‐term care, and social support systems. In response, China has adopted international evidence and best practices as part of its national strategy, Healthy China 2030 [17].

Against this demographic backdrop, frailty has attracted growing attention among Chinese biomedical researchers and clinicians. The estimated prevalence of frailty among community‐dwelling older adults in China is 10.1% (95% CI: 8.5%–11.7%) [18]. However, definitions of frailty remain non‐standardized, varying not only in terminology but also in conceptual emphasis—biomedical, psychological, social, or multidimensional [19]. Some authors adopt international definitions directly; others adapt them or propose original frameworks reflecting local clinical and cultural contexts [20]. Previous research has also noted that frailty identification criteria developed in Western countries may not fully apply to older Chinese adults, particularly those with lower levels of physical activity [21].

Furthermore, public understanding of frailty in China remains limited. In a qualitative study, Guo et al. found that many older participants in a social welfare institution had never heard the term. Misconceptions were common: frailty was often viewed as an inevitable part of aging or conflated with old age or neurasthenia. These perceptions were associated with greater psychological burden, reduced quality of life, and lower self‐efficacy in managing frailty [22]. By contrast, recent Western evidence suggests that the subjective experience of frailty may not necessarily be negative [23].

Such inconsistencies, both in academic definitions and public perceptions, may hinder cross‐study comparability, limit the applicability of international findings to Chinese populations, and create uncertainty in clinical guidelines. A systematic understanding of how frailty is defined within Chinese biomedical discourse could therefore facilitate the harmonization of terminology, enhance comparability with international research, and inform culturally relevant assessment tools and interventions.

2. Research Objective

This systematic review examined how frailty has been defined by Chinese‐language biomedical scholars over the past decade (2014–2024). Specifically, it identified and categorized definitions as original, cited from Chinese‐language literature, or cited from English‐language Western sources, and analyzed whether cited definitions were used verbatim or adapted. Original definitions were further examined in terms of their conceptual perspective (biomedical, psychological, or sociological) while all definitions were evaluated against six commonly recognized biomedical features of frailty, as identified in prior conceptual and methodological reviews [24, 25]:

  • non‐diagnostic nature (i.e., frailty is a state or a syndrome, but not a single medical diagnosis),

  • association with geriatric syndromes (i.e., overlapping but distinct from multimorbidity, disability, dementia, falls, incontinence, etc.),

  • conferral of vulnerability,

  • dependence on a defined stressor,

  • dynamic nature, and

  • potential reversibility.

Any introduction of novel conceptual elements beyond these six dimensions was also noted. Additionally, bibliometric methods were employed to identify frequently used keywords, assess citation patterns, and trace the evolution of definitional trends over time.

This review focused exclusively on Chinese‐language biomedical literature published between 2014 and 2024, offering an integrated overview of definitional trends, conceptual emphases, and methodological developments. By mapping this body of Chinese‐language discourse, the study aimed to provide a foundation for future cross‐cultural comparisons with English‐language Western frailty research, through which similarities and divergences in the conceptualisation and operationalisation of frailty may be identified.

3. Literature Search Strategy and Methodology

3.1. Database Selection

The selection of Chinese‐language databases was guided by recommendations from the libraries of leading medical universities in China. Although several multidisciplinary platforms, such as China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Information (VIP), offer broad coverage [26], they are multidisciplinary in scope rather than specialized biomedical databases. Therefore, this study focused on two specialized databases: the Chinese Biomedical Literature Service System (SinoMed) and the Chinese Medical Journal Full‐Text Database (CMA Journals). These platforms were considered the most relevant for capturing biomedical and clinical representations of frailty within the Chinese‐language context. In addition, three major international databases were also searched specifically for Chinese‐language articles on frailty: MEDLINE (via Ovid), Embase, and Scopus. Together, this strategy provided comprehensive coverage of internationally indexed Chinese‐language biomedical literature on frailty.

3.2. Keywords and Search Strategy

When the concept of frailty was first introduced into Chinese‐language biomedical discourse, it was sometimes rendered as the traditional Chinese medicine (TCM)–associated term “虚弱” (deficiency‐weakness). However, following repeated discussions at national geriatric conferences [27], a consensus emerged that “衰弱” (decline‐weakness) more accurately conveyed the biomedical meaning of frailty, distinguishing it from the TCM concept of “虚弱”. Although alternative translations appeared sporadically in early publications, over time, “衰弱” emerged as the dominant term, as leading scholars such as Xi Xing and colleagues consistently advocated for its standardized use in medical research [28, 29].

Based on this consensus, “衰弱” was adopted as the primary Chinese‐language term in our database searches. Supplementary searches using “虚弱” were conducted to ensure inclusiveness; however, these yielded numerous irrelevant results, often pertaining to non‐geriatric topics or general weakness, thereby confirming its unsuitability as a primary search term.

To maintain focus, all searches were restricted to articles written in Chinese, even when retrieved from international databases, regardless of the country of affiliation. This ensured the inclusion of Chinese‐language publications indexed globally.

The search strategy for the international databases (Appendix S1) was developed by David Mockler, while Haodong Wei executed searches across all databases and performed the primary collation of all retrieved articles.

3.3. Time Frame

The search covered the period from January 2014 to December 2024, which was selected to capture a decade of developments in Chinese‐language biomedical frailty research. Preliminary bibliometric analyses indicated that prior to 2014, publications on frailty in the Chinese‐language literature were scarce, typically numbering fewer than five per year [29]. From 2014 onwards, publication output increased noticeably, marking the onset of sustained academic interest in the topic. Restricting the timeframe to this decade enabled a focused examination of recent conceptual and methodological trends while maintaining a dataset of manageable size for detailed qualitative coding.

3.4. Exclusion Criteria

Studies were excluded if they:

  • were not written in Chinese;

  • did not focus on human participants (e.g., animal studies);

  • addressed pediatric or non‐geriatric populations;

  • were available only as conference abstracts without full text; or

  • presented only operational measures of frailty (e.g., identification tools or indices) without accompanying methodological detail or conceptual discussion.

These criteria ensured that only articles contributing substantively to the conceptual or definitional understanding of frailty were included.

3.5. Literature Classification

Included studies were classified into four categories based on how frailty was conceptually defined:

  • no explicit definition of frailty;

  • original definitions proposed by the authors, referring to instances in which authors articulated a description of frailty without explicit citation. This category does not necessarily imply conceptual innovation but includes independent articulation consistent with established models;

  • definitions cited from Chinese‐language literature; and

  • definitions cited from international sources.

This classification captured both the provenance and the degree of originality of conceptual frameworks, thereby helping to elucidate the balance between Chinese‐language and other influences in frailty research. By employing this framework, the study aimed to clarify how biomedical scholars writing in Chinese have adopted, adapted, or locally contextualized the concept of frailty over time.

3.6. Bibliometric Methods

Quantitative and visual analyses were conducted using R (version 4.4.1), with the bibliometrix package partially employed for bibliometric data processing. Publication trends, definitional categories, and coverage of conceptual features were summarized using descriptive statistics and visualized through line graphs and bar charts generated with the ggplot2 package.

Citation‐based analyses were used to identify the most frequently referenced authors and publications, which were ranked according to citation frequency. Relative citation proportions were calculated by dividing the citation count of each item by the total number of citations within its definitional category (Chinese‐language or international sources).

To assess conceptual evolution over time, the annual coverage of key frailty features (e.g., stress dependence, vulnerability, reversibility) was quantified and visualized using multi‐line trend graphs, enabling temporal comparisons across conceptual dimensions.

All figures and tables were generated by the author based on manually coded bibliographic and conceptual data.

A PRISMA 2020 flow diagram [30] was used to illustrate the flow of records through the different stages of the systematic review, including identification, screening, eligibility assessment, and inclusion.

4. Results

4.1. Included Studies

A total of 1804 Chinese‐language articles met the inclusion criteria for this review (Figure 1). The complete list of included studies and their respective classifications is provided in Appendix S3.

FIGURE 1.

FIGURE 1

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Flowchart of included studies.

4.2. Temporal Trends

Publication activity on Chinese‐language frailty definitions has expanded rapidly since 2014. Between 2005 and 2013, output remained minimal, with only 0–1 article published annually until 2012, followed by a modest increase to five publications in 2013. A turning point occurred in 2014, when the number of publications rose to 11 [31], marking the onset of a sustained upward trend that surpassed 100 publications per year by 2019 and reached 400 definitional publications by 2024.

When disaggregated by definitional category (Figure 2), the data showed diverging trajectories. Internationally derived definitions increased steadily across the decade, reaching 235 articles in 2024 and comprising approximately 60%–65% of annual publications since 2018. Citations to Chinese‐language literature also grew, from three publications in 2014 to 160 in 2024, representing a proportion of published studies increasing up to 40%. By contrast, original definitions remained a small but relatively stable minority throughout the study period.

FIGURE 2.

FIGURE 2

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Annual trends in publications on frailty definitions in Chinese‐language literature, 2014–2024.

4.3. Key Authors

Research influence in this field was concentrated among a relatively small group of scholars. The top five sources accounted for nearly half of all definitional publications, underscoring the leading role of major geriatric hospitals and medical universities in shaping academic discourse.

Among Chinese‐language sources, the most frequently cited works were two expert consensus statements issued by national geriatric professional bodies, including the Geriatric Medicine Branch of the Chinese Medical Association (CMA) and the Chinese Geriatrics Society (CGS), which had 128 and 43 citations, respectively, as of 31 December 2024:

  • Expert Consensus on the Assessment and Intervention for Frailty (2017) [32]—128 citations.

  • Expert Consensus on Prevention of Frailty in the Elderly (2022) [33]—43 citations.

Together, these documents seemed to establish the core framework guiding Chinese‐language biomedical research on frailty (Table 1). Other highly cited contributors included Dong Birong, Ma Lina, and Xi Xing [34, 35, 36], whose conceptual analyses and reviews aimed to standardize local terminology and orientation.

TABLE 1.

Top five most frequently cited Chinese‐language sources of frailty definitions.

Rank Author (first author) Source title Year Citation count Citation proportion
1 Geriatric Medicine Branch of Chinese Medical Association Chinese experts' consensus on assessment and intervention for elderly patients with frailty 2017 128 21.62%
2 Chinese Geriatrics Society Chinese expert consensus on prevention of frailty in the elderly (2022) 2022 43 7.26%
3 Birong Dong Research progress of senile syndrome 2014 22 3.72%
4 Lina Ma Frailty research in China: current status and perspectives 2020 19 3.21%
5 Xing Xi The connotation of weakness and its conceptual framework 2013 18 3.04%
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In contrast, international citations were dominated by two landmark publications:

  • Fried et al. (2001)—Frailty in Older Adults: Evidence for a Phenotype [7] (253 citations).

  • Clegg et al. (2013)—Frailty in Elderly People [2] (213 citations).

Together, these accounted for over one‐third of all citations to international sources (Table 2). Other frequently referenced works in this category included consensus statements by Morley et al. (2013) and guidelines by Dent (2019) and Hoogendijk (2019) [6, 24, 37]. Rockwood's cumulative deficits model also appeared among the top‐ranked international citations [2, 8].

TABLE 2.

Top five most frequently cited international sources of frailty definitions.

Rank Author (first author) Source title Year Citation count Citation proportion
1 Linda P. Fried Frailty in older adults: evidence for a phenotype 2001 253 20.56%
2 Andrew Clegg Frailty in elderly people 2013 213 17.31%
3 John Edward Morley Frailty consensus: a call to action 2013 82 6.67%
4 Elsa Dent Physical Frailty: ICFSR international clinical practice guidelines for identification and management 2019 61 4.96%
5 Emiel O. Hoogendijk Frailty: implications for clinical practice and public health 2019 54 4.39%
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Temporal citation analysis (Figure 3) shows parallel trajectories between leading Chinese‐language and international sources. The CMA's 2017 consensus gained prominence after 2018, with citations increasing from two that year to nearly twenty per year by 2020 and peaking in 2022. The 2022 prevention consensus was rapidly adopted, with most citations occurring in 2023–2024. Similarly, references to Fried et al. (2001) and Clegg et al. (2013) rose steadily after 2017 and remained consistently high after 2020. The synchrony of Chinese‐language and international citation patterns suggests a maturing research ecosystem that increasingly integrates global frameworks into Chinese‐language biomedical narratives.

FIGURE 3.

FIGURE 3

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Annual citation trends of the top two Chinese‐language (CN) and top two international (EN) sources, 2014–2024.

4.4. Terminology Used to Define Frailty and Its Non‐Diagnostic Status

Temporal analysis of the five most frequently used terms—“Geriatric Syndrome,” “Clinical Syndrome,” “Nonspecific State,” “State,” and “Syndrome”—revealed distinct longitudinal patterns between 2014 and 2024 (Figure 4).

  • “Geriatric Syndrome” showed the sharpest growth, from one article in 2014 to 92 in 2024.

  • “Clinical Syndrome” rose from one to 52 over the same period.

  • “Nonspecific State” and “State” increased more moderately, reflecting the broader adoption of general descriptors.

FIGURE 4.

FIGURE 4

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Trends of the top five terms used to define frailty (2014–2024).

Notably, both CMA and CGS expert consensuses (2017 and 2022, respectively) described frailty as a nonspecific state [31, 32]. Following these publications, usage of the term surged—first in 2019, after the 2017 consensus, and again in 2022, peaking around that year before showing a slight decline or stabilization thereafter. “Syndrome” appeared intermittently, with minor fluctuations.

Across the corpus, a broad range of descriptors was used (Figure 5). The dominance of “Geriatric Syndrome” (428 mentions) and “Clinical Syndrome” (275 mentions), alongside a long tail of infrequently used terms such as “Medical Syndrome” or “Multidimensional Syndrome”, indicates a prevailing biomedical orientation. Thus, nearly all studies appropriately conceptualized frailty as a state or syndrome, whereas only a very small minority explicitly labeled it as a disease or pathological entity, reflecting a strong consensus on this foundational point.

FIGURE 5.

FIGURE 5

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Overall distribution of English‐translated terminology used to define frailty. The original Chinese‐language terms are in Appendix S2. The size and frequency (color) legends both denote the number of articles included in each classification.

4.5. Non‐Biomedical Perspectives

Conceptual analysis revealed a persistent dominance of the biomedical perspective in Chinese‐language definitions of frailty (Figure 6). Over the study period, biomedical‐oriented definitions increased substantially, from a small number of publications in 2014 to 399 articles in 2024, consistently accounting for the majority of studies.

FIGURE 6.

FIGURE 6

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Annual distribution of psychological and social perspectives in Chinese‐language definitions of frailty (2014–2024). Percentages indicate the proportion of total definitions represented by each perspective in a given year.

Psychological and social perspectives remained comparatively marginal: articles addressing psychological aspects rose from none in 2014 to 28 in 2024, while those incorporating social dimensions increased from none to 30. Together, these perspectives accounted for only 4%–8% of annual publications, without a sustained increase in their proportional share of publications.

4.6. Alignment With the Other Five Biomedical Features of Frailty

Excluding its non‐diagnostic status, which was addressed above, alignment with the other five recognized biomedical features of frailty revealed a clear imbalance in emphasis across Chinese‐language publications (Figure 7).

FIGURE 7.

FIGURE 7

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Temporal trends in the conceptual coverage of five frailty features in Chinese‐language literature (2014–2024).

Features related to vulnerability and stress dependence were frequently discussed in conjunction with geriatric syndromes, forming a stable conceptual cluster representing approximately 70%–90% of articles each year. This pattern reflects the frequent association of frailty with acute health events, hospitalization, or physical stressors such as infection or surgery.

In contrast, the features of dynamism and reversibility were seldom highlighted. References to frailty as a dynamic process rarely exceeded 8% annually, while discussions of reversibility, almost absent before 2016, increased gradually from 6.2% in 2016 to 16.2% by 2024.

5. Discussion

This review systematically examined how frailty has been defined in Chinese‐language biomedical literature between 2014 and 2024, with particular attention to definitional sources, conceptual emphases, and temporal evolution. By categorizing definitions as original, cited from Chinese‐language sources, or from international literature, and by analyzing the presence of six widely recognized biomedical conceptual features (non‐diagnostic nature, vulnerability, stress dependence, relation to geriatric syndromes, dynamism, and reversibility), the study mapped how Chinese‐language biomedical scholars have adopted, adapted, and contextualized frailty over a decade.

5.1. Overview of Main Findings

Over the period, publication activity increased sharply, which reflects the rapid institutional growth of Chinese geriatric medicine and rising scholarly attention to aging [38, 39]. For example, since 2011 the Chinese government has actively promoted the development of geriatric medicine, leading to the establishment of geriatric departments in nearly all tertiary hospitals by 2013 and their subsequent expansion into secondary hospitals following a national policy introduced in 2017 [40]. This institutional growth reflects both the maturation of geriatrics as a medical specialty and China's national commitment to healthy aging, thereby providing a strong foundation for continued conceptual innovation and practical advancement in biomedical frailty care and research.

In Chinese‐language frailty research, internationally derived definitions have remained predominant, and even though citations to Chinese‐language sources rose markedly after 2018, our findings indicate a continued reliance on established international models such as those by Fried and Rockwood. Definitional discourse was concentrated among a limited group of leading scholars and institutions, with national consensus statements serving as major reference points.

5.2. Conceptual Framing and Terminology

Most authors described frailty in alignment with global biomedical consensus as a state or syndrome, and only a small number of papers mischaracterised it as a disease or single diagnostic entity. The adoption of the standardized Chinese‐language frailty term after 2018 marked a step toward linguistic uniformity, but it did not fundamentally change the underlying conceptual orientation. The prevailing interpretation remained biomedical, with emphasis on loss of physiological reserve and functional decline.

Although recent studies have begun to incorporate psychological and social dimensions—such as emotional well‐being, cognitive status, and social isolation—these aspects currently remain secondary in volume. As a result, while international literature increasingly defines frailty as a multidimensional biopsychosocial condition [41], the Chinese‐language discourse continues to present opportunities for cross‐cultural synthesis and the development of more comprehensive conceptualisations.

5.3. Biomedical Features and Evidence Gaps

Analysis of definitional features demonstrated strong consensus that frailty is not a diagnosis but a syndrome/state of heightened vulnerability. Vulnerability and stress dependence were consistently emphasized, often in conjunction with geriatric syndromes, in reflection of the clinical context in which frailty is most often identified. By contrast, the concepts of dynamism and potential reversibility were only occasionally discussed. Mentions of frailty as a dynamic process rarely exceeded 8% of publications per year, and references to reversibility—almost absent before 2016—rose modestly to 16% by 2024. However, this may signal an emerging recognition of frailty's potential for improvement and recovery. As Chinese‐language longitudinal and interventional research continues to develop, opportunities will increase to explore rehabilitation‐oriented approaches and to conceptualize frailty as a potentially modifiable condition rather than a fixed trajectory of decline.

5.4. Unique Chinese‐Language Perspectives

International research, particularly in the English language, tends to conceptualize frailty as dynamic and potentially reversible, which emphasizes early detection, proactive management and multidisciplinary rehabilitation [42, 43, 44]. Although this perspective is less prominent in the Chinese‐language literature, studies frequently highlight social vulnerability, family support, and community structures as influential contextual factors, reflecting collectivist traditions and ongoing demographic transition in frailty conceptualisation. Indeed, Chinese health policy emphasizes risk identification and family‐ and community‐based support [45]. Taken together, this policy orientation may provide a complementary foundation for the development of comprehensive and culturally responsive frailty strategies.

Furthermore, a limited body of scholarship integrates insights from TCM, which offers a complementary perspective centred on holistic balance and individual constitution. Within TCM, frailty is often conceptualized as deficiency‐fatigue or deficiency of healthy qi [46, 47, 48, 49]. These concepts resonate with biomedical notions of reduced physiological reserve but extend them by situating frailty within an energetic and systemic framework that emphasizes restoration and harmony. Interventions such as herbal therapy, tailored dietary practices, and exercise reflect an orientation toward recovery and rebalancing, aligning with contemporary global recognition of frailty's potential reversibility [50]. Although quantitative evidence for TCM‐based approaches remains limited, their philosophical depth uniquely enriches the conceptual landscape of the Chinese‐language literature, illustrating that frailty is both a biomedical and cultural construct, and revealing both divergence and convergence with the international literature.

5.5. Conceptual Evolution and Implications

The period from 2014 to 2024 has seen notable conceptual consolidation and gradual diversification in the Chinese‐language literature on frailty. International models—particularly those by Fried and Rockwood—continue to dominate; however, the emergence of national consensus statements and the growing citation of Chinese‐language sources suggest increasing confidence in locally grounded frameworks. While terminological standardization has reduced linguistic ambiguity, substantial conceptual heterogeneity remains.

The sustained emphasis on vulnerability and stress dependence, coupled with limited attention to dynamism and potential reversibility, may constrain the development of proactive or rehabilitative interventions. Nevertheless, recent publications signal a growing, culturally informed engagement with these underrepresented dimensions. Further integration of international paradigms with local sociocultural contexts and traditional medical insights could support the development of more holistic and contextually grounded models of frailty. These patterns carry important policy implications, suggesting that frailty frameworks and clinical guidelines should move beyond static risk categorization toward prevention‐oriented and rehabilitation‐focused approaches that are responsive to local health systems and cultural contexts. Given the absolute size and continued growth of the Chinese‐speaking older population, addressing these issues should be a priority for public health and health and social care policy.

5.6. Limitations

This review has several limitations that should be acknowledged. First, it was restricted to Chinese‐language publications, which may have excluded relevant bilingual or English‐language studies authored by Chinese scholars. Second, the search period (2014–2024), while comprehensive for the past decade, may not fully capture publications emerging in late 2024 or early 2025. Third, manual coding and classification of definitions, although carefully verified, inevitably involve an element of subjective interpretation by the first author (Haodong Wei). Finally, the review focused on conceptual definitions rather than operational or measurement frameworks; as such, it does not assess the practical implementation of frailty identification tools in clinical settings. Despite these constraints, the study provides the most systematic overview to date of how frailty has been defined and conceptualized in Chinese‐language biomedical literature. It offers a valuable foundation for future re‐evaluation and comparative research.

5.7. Future Directions and Conclusion

Future Chinese‐language research on frailty should prioritize a more holistic and multidimensional approach. Integrating biomedical, psychological, and social dimensions within definitional frameworks will be essential to better reflect the multidimensional nature of frailty and align research with global conceptual trends. In parallel, longitudinal and interventional studies are needed to explore the dynamics and potential reversibility of frailty [51], providing empirical evidence for preventative and rehabilitative strategies that move beyond descriptive analyses. Strengthening collaboration between biomedical and traditional TCM scholars could further enhance cultural and clinical relevance, which could enable the development of integrated assessment tools and personalized intervention models that better resonate with local healthcare practices. In addition, cross‐cultural comparative studies should be undertaken to harmonize Chinese‐language and international conceptualisations of frailty. Such efforts could facilitate the exchange of theoretical perspectives while maintaining sensitivity to local contexts.

Author Contributions

Haodong Wei: conceptualization, methodology, literature search, data curation, formal analysis, bibliometric analysis, writing – original draft. David Mockler: methodology, literature search strategy, data source identification, writing – review and editing. Giulia Cavrini: interpretation of findings, bibliometric analysis, writing – review and editing. Nathan W. Hill: conceptualization, contextual interpretation, writing – review and editing. Daniel Kam Yin Chan: interpretation of findings, writing – review and editing. Román Romero Ortuño: conceptualization, methodology, supervision, interpretation of findings, writing – review and editing. All authors approved the final manuscript and agreed to be accountable for all aspects of the work.

Funding

The authors have nothing to report.

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Appendix S1: agm270091‐sup‐0001‐Appendix‐1.docx.

AGM2-9--s003.docx (15.6KB, docx)

Appendix S2: agm270091‐sup‐0002‐Appendix‐2.docx.

AGM2-9--s002.docx (25.4KB, docx)

Appendix S3: agm270091‐sup‐0002‐Appendix‐3.xlsx.

AGM2-9--s001.xlsx (106.1KB, xlsx)

Acknowledgments

The authors have nothing to report.

Data Availability Statement

The Chinese terms and their English translations used to define frailty are included in the Supporting Information (Appendix S2). The full list of screened articles included in this review is available in Appendix S3 as Supporting Information.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix S1: agm270091‐sup‐0001‐Appendix‐1.docx.

AGM2-9--s003.docx (15.6KB, docx)

Appendix S2: agm270091‐sup‐0002‐Appendix‐2.docx.

AGM2-9--s002.docx (25.4KB, docx)

Appendix S3: agm270091‐sup‐0002‐Appendix‐3.xlsx.

AGM2-9--s001.xlsx (106.1KB, xlsx)

Data Availability Statement

The Chinese terms and their English translations used to define frailty are included in the Supporting Information (Appendix S2). The full list of screened articles included in this review is available in Appendix S3 as Supporting Information.

Articles from Aging Medicine are provided here courtesy of Wiley

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