People who self-identify as Hispanic/Latino (hereafter referred to as Hispanics) are the fastest-growing group of older adults (aged 65 years and above) in the U.S. Between 2018 and 2040, this group is estimated to increase by 175%.1 The impact of structural and determinants of health (SDoH) and health disparities on adverse health outcomes will likely be magnified as more Hispanics age, highlighting the need for culturally-tailored care for these clients.2 Hence, there is a need to understand the geriatric syndromes, such as frailty, that can affect older Hispanics.

Frailty is a medical and biological syndrome of decreased physiological reserve and increased vulnerability to stressors, predisposing to adverse health outcomes of significant public health relevance.3 The global impact of frailty is expected to increase as the population ages.4 Frailty among older adults leads to increased healthcare use and other related costs, resulting in a more significant economic impact in comparison to non-frail older adults.5,6 This information suggests that frailty's economic and psychosocial impact could be even higher among older Hispanics living in the U.S. due to the additional barriers to accessing and receiving care, which may exacerbate other health disparities and inequities.2,7

Among older Hispanic people living in the U.S., frailty has been mostly studied as a physical syndrome.3 The Fried Frailty Phenotype (FFP), that is extensively used in geriatrics, defines frailty as having at least three of the following features: exhaustion, reduced muscle strength, low physical activity, slow walking speed, and unintentional weight loss.3 Other conceptual definitions are based on the Cumulative Deficit Model of Frailty (CDMF), which defines frailty as a state of vulnerability that arises from the cumulative effects of age-related deficits.8,9 In addition, frailty among older Hispanics is associated with adverse health outcomes, including increased risk of cognitive decline, falls, increased use of healthcare services and hospitalizations, poor quality of life, and mortality.10, 11, 12, 13, 14, 15

Some studies suggest that frailty is a complex phenomenon with multiple domains beyond the physical.16 The Integral Model of Frailty17 illustrates the complexity of frailty and describes the pathway from life-course determinants and comorbidities to frailty and adverse outcomes. The model includes three dimensions of frailty: physical, psychological, and social.17 Among these domains, psychological and social frailty are the least explored in older Hispanic adults.18

A preliminary search for existing literature on the topic was conducted. However, no systematic or scoping review on the topic was found. According to Aranda et al. (2011), the information available about frailty in older Hispanics living in the U.S. is drawn mainly from two studies: the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (HEPESE) and the San Antonio Longitudinal Study of Aging (SALSA). The HEPESE is a longitudinal study among community-dwelling Mexican Americans aged 65 and older living in the Southwestern states.19 This study includes data from a nationally representative sample from Texas, California, New Mexico, Colorado, and Arizona. Nine waves of data have been collected from 1993 to 2016, with a total sample of 12,625 participants.11 The SALSA was a cohort study aimed to examine the disablement process among Mexican Americans and Euro-American descendants based on the information provided by the oldest persons who participated previously in the San Antonio Heart Study (SAHS). This study primarily focused on exploring diabetes and cardiovascular disease and was conducted in two phases between 1979 and 1988.20

This scoping review aims to identify the available evidence about frailty among older Hispanics living in the U.S. and to synthesize these insights using the Integral Model of Frailty.17 This model is be used as a framework for structuring the information in terms of 1) Characteristics and prevalence of frailty, (2) Life course determinants of frailty, (3) Comorbidities associated with frailty, and (4) Adverse outcomes of frailty. By doing so, this scoping review aims to establish an integrated knowledge base of frailty among older Hispanics living in the U.S. that outlines opportunities for future research and provides guidelines for practice and policy.