Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-12T20:06:29.447Z Has data issue: false hasContentIssue false

The conspicuous absence of the social, emotional and political aspects of frailty: the example of the White Book on Frailty

Published online by Cambridge University Press:  20 June 2019

Amanda M. Grenier*
Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
*Corresponding author. Email:


Over the last 15 years, frailty has become a dominant discourse on late life. Taken-for-granted knowledge and practice can be seen in initiatives such as the International Association of Gerontology and Geriatrics’ White Book on Frailty. This paper begins with an overview of key themes on frailty from the biomedical literature, followed by critical literature in the social sciences and humanities. It discusses the tensions within the biomedical field, frailty as a social construction and ‘social imaginary’, practices of frailty as historically linked to political systems of care, and frailty as an emotional and relational experience. It then draws on a critical discourse analysis to assess the 2016 White Book on Frailty. Drawing on the idea of ‘significant absences’, the paper highlights the gaps that exist where the social and emotional understandings and political readings of frailty are concerned. The paper concludes by outlining the need to recognise the ‘politics of frailty’ including the power relations that are deeply embedded in the knowledge and practices surrounding frailty, and to incorporate older people's experience and ideas of vulnerability into research, policy and care practice.

Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Age, UK (2015) Don't call me frail – new research shows that using the word ‘frailty’ could be stopping older people accessing vital services. Blog entry. Available at the -word-frailty-could-stop-older-people-accessing-vital-services/.Google Scholar
Anderson, C and McLachlan, S (2016) Transformative research as knowledge mobilization: transmedia, bridges and layers. Action Research 14, 295317.CrossRefGoogle Scholar
Baars, J, Dohmen, J, Grenier, A and Phillipson, C (eds) (2013) Ageing, Meaning and Social Structure: Connecting Critical and Humanistic Gerontology. Bristol, UK: Policy Press.CrossRefGoogle Scholar
Baltes, PB and Smith, J (2002) New frontiers in the future of aging: from successful aging of the young old to the dilemmas of the fourth age. Keynote paper from the Valencia Forum, International Association of Gerontology, April 1–4, Valencia, Spain.Google Scholar
Becker, G (1994) The oldest old: autonomy in the face of frailty. Journal of Aging Studies 8, 5976.CrossRefGoogle ScholarPubMed
Biggs, S (2001) Toward critical narrativity: stories of aging in contemporary social policy. Journal of Aging Studies 15, 303316.CrossRefGoogle Scholar
Bortz, WMI (2002) A conceptual framework of frailty: a review. Journals of Gerontology: Medical Sciences 57A, 283288.CrossRefGoogle Scholar
BritainThinks (2015) Frailty: Language and Perceptions (Report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society). Available at Scholar
Bytheway, B (2011) Unmasking Age: The Significance of Age for Social Research. Bristol, UK: Policy Press.CrossRefGoogle Scholar
Clegg, A, Young, J, Iliffe, S, Rikkert, MO and Rockwood, K (2013) Frailty in elderly people. Lancet 381, 752762.CrossRefGoogle ScholarPubMed
Cole, TR, Ray, RE and Kastenbaum, R (2010) A Guide to Humanistic Studies in Aging: What Does it Mean to Grow Old? New York, NY: Johns Hopkins.Google Scholar
Dillaway, HE and Byrnes, M (2009) Reconsidering successful aging. A call for renewed and expanded academic critiques and conceptualizations. Journal of Applied Gerontology 28, 702722.CrossRefGoogle Scholar
Estes, CL (1993) The aging enterprise revisited. The Gerontologist 33, 292298.CrossRefGoogle ScholarPubMed
Estes, CL (2001) Social Policy and Aging: A Critical Perspective. Thousand Oaks, CA: Sage.Google Scholar
Estes, C, Biggs, S and Phillipson, C (2003) Social Theory, Social Policy and Ageing: A Critical Introduction. Maidenhead, UK: Open University Press.Google Scholar
Fairclough, N (2001) Critical discourse analysis as a method in social scientific research. In Wodak, R and Meyer, M (eds), Methods of Critical Discourse Analysis. London: Sage, pp. 121138.Google Scholar
Fried, L, Tangen, C, Walston, J, Newman, A, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, W, Burke, G and McBurnie, M (2001) Frailty in older adults: evidence for a phenotype. Journals of Gerontology: Biological Sciences and Medical Sciences 56A, 146157.CrossRefGoogle Scholar
Fried, LP, Hadley, EC, Walston, JD, Newman, AB, Guralnik, JM, Studenski, S, Harris, TB, Ershler, WB and Ferrucci, L (2005) From bedside to bench: research agenda for frailty. Science of Aging Knowledge Environment 2005, 31, pe24.CrossRefGoogle ScholarPubMed
Gadow, S (1983) Frailty and strength: the dialectic in aging. The Gerontologist 23, 144147.CrossRefGoogle Scholar
Gilleard, C and Higgs, P (2010) Aging without agency: theorizing the fourth age. Aging & Mental Health 14, 121128.CrossRefGoogle ScholarPubMed
Gilleard, C and Higgs, P (2011) Ageing abjection and embodiment in the fourth age. Journal of Aging Studies 25, 135142.CrossRefGoogle Scholar
Gilleard, C and Higgs, P (2013) The fourth age and the concept of a ‘social imaginary’: a theoretical excursus. Journal of Aging Studies 27, 368376.CrossRefGoogle ScholarPubMed
Government of British Columbia (2018) Fall Prevention. Available at gov.bc/fallprevention.Google Scholar
Government of Ontario (2013) More Physiotherapy, Exercise and Falls Prevention for Seniors. Ministry of Health and Long-term Care. Available at Scholar
Grenier, AM (2005) The contextual and social locations of older women's experiences of disability and decline. Journal of Aging Studies 19, 131146.CrossRefGoogle Scholar
Grenier, A (2006) The distinction between being and feeling frail: exploring emotional experiences in health and social care. Journal of Social Work Practice: Psychotherapeutic Approaches in Health, Welfare and the Community 20, 299313.CrossRefGoogle Scholar
Grenier, A (2007) Constructions of frailty in the English language, care practice and the lived experience. Ageing & Society 27, 425445.CrossRefGoogle Scholar
Grenier, A (2012) Transitions and the Lifecourse: Challenging the Constructions of ‘Growing Old’. Bristol, UK: Policy Press.CrossRefGoogle Scholar
Grenier, A and Hanley, J (2007) Older women and ‘frailty’: aged, gendered and embodied resistance. Current Sociology 55, 211228.CrossRefGoogle Scholar
Grenier, A, Lloyd, L and Phillipson, C (2017) Precarity in late life: rethinking dementia as a ‘frailed’ old age. Sociology of Health & Illness 39, 318330.CrossRefGoogle ScholarPubMed
Gullette, MM (1997) Declining to Decline: Cultural Combat and the Politics of Midlife. Charlottesville, VA: University Press of Virginia.Google Scholar
Hendricks, J (2004) Public policies and old age identity. Journal of Aging Studies 18, 245260.CrossRefGoogle Scholar
Higgs, P and Gilleard, C (2015) Rethinking Old Age: Theorising the Fourth Age. London: Palgrave Macmillan.CrossRefGoogle Scholar
Holman, C, Meyer, J and Cotter, A (2004) The complexity of loss in continuing care institutions for older people: a review of the literature. Illness, Crisis and Loss 12, 3851.CrossRefGoogle Scholar
Ipsos Mori for Age UK (2014) Understanding the Lives of Older People Living with Frailty: A Qualitative Investigation. Available at Scholar
Kafer, A (2013) Feminist, Queer, Crip. Bloomington, IN: Indiana University Press.Google Scholar
Katz, S (1996) Disciplining Old Age: The Formation of Gerontological Knowledge. Charlottesville, VA: University of Virginia Press.Google Scholar
Katz, S (2011) Hold on! Falling, embodiment, and the materiality of old age. In Casper, MJ and Currah, P (eds), Corpus: An Interdisciplinary Reader on Bodies and Knowledge. New York, NY: Palgrave Macmillan, pp. 187205.CrossRefGoogle Scholar
Katz, S (2018) Aging in Everyday Life: Embodied Materialities. Bristol, UK: Policy Press.CrossRefGoogle Scholar
Katz, S and Calasanti, T (2015) Critical perspectives on successful aging: does it ‘appeal more than it illuminates’? The Gerontologist 55, 2633.CrossRefGoogle Scholar
Kaufman, SR (1994 a) Old age, disease, and the discourse on risk: geriatric assessment in US health care. Medical Anthropology Quarterly 8, 430447.CrossRefGoogle Scholar
Kaufman, SR (1994 b) The social construction of frailty: an anthropological perspective. Journal of Aging Studies 8, 4558.CrossRefGoogle Scholar
Kaufman, S and Becker, G (1996) Frailty, risk, and choice: cultural discourses and the question of responsibility. In Smyer, M, Schaie, KW and Kapp, MB (eds), Older Adults’ Decision-making and the Law. New York, NY: Springer, pp. 4871.Google Scholar
Lloyd, L (2015) The fourth age. In Twigg, J and Martin, W (eds), Routledge Handbook of Cultural Gerontology. Abingdon, UK: Routledge, pp. 261268.Google Scholar
Lloyd, L, Calnan, M, Cameron, A, Seymour, J and Smith, R (2014) Identity in the fourth age: perseverance, adaptation and maintaining dignity. Ageing & Society 34, 119.CrossRefGoogle Scholar
Lustbader, W (2000) Thoughts on the meaning of frailty. Generations 23, 2124.Google Scholar
Manthorpe, J, Iliffe, S, Harris, J, Moriarty, J and Stevens, M (2018) Frailty and social care: over or under-familiar terms? Social Policy & Society 17, 2333.CrossRefGoogle Scholar
Markle-Reid, M and Browne, G (2003) Conceptualizations of frailty in relation to older adults. Journal of Advanced Nursing 44, 5868.CrossRefGoogle ScholarPubMed
Marston, G (2004) Social Policy and Discourse Analysis: Policy Change in Public Housing. Farnham, UK: Ashgate Publishing.Google Scholar
McMahon, M (1996) Significant absences. Qualitative Inquiry 2, 320336.CrossRefGoogle Scholar
Morley, JE, Vellas, B, van Kan, GA, Anker, SD, Bauer, JM, Bernabei, R, Cesari, M, Chumlea, WC, Doehner, W, Evans, J, Fried, LP, Guralnik, JM, Katz, PR, Malmstrom, TK, McCarter, RJ, Gutierrez Robledo, LM, Rockwood, K, von Haehling, S, Vandewoude, MF and Walston, J (2013) Frailty consensus: a call to action. Journal of the American Medical Directors Association 14, 392397.CrossRefGoogle ScholarPubMed
Nicholson, C, Meyer, J, Flatley, M, Holman, C and Lowton, K (2012) Living on the margin: understanding the experience of living and dying with frailty in old age. Social Science & Medicine 75, 14261432.CrossRefGoogle ScholarPubMed
O'Shea, D (2017) Frailty is the most problematic expression of population ageing. British Geriatrics Society Blog, April 21. Available at Scholar
Pickard, S (2009) Governing old age: the ‘case managed’ older person. Sociology 43, 6784.CrossRefGoogle Scholar
Pickard, S (2014) Frail bodies: geriatric medicine and the constitution of the fourth age. Sociology of Health & Illness 36, 549563.CrossRefGoogle ScholarPubMed
Pickard, S (2018) Health, illness and frailty in old age: a phenomenological exploration. Journal of Aging Studies 47, 2431.CrossRefGoogle ScholarPubMed
Priestley, M (2003) Disability: A Life Course Approach. Cambridge: Polity Press.Google Scholar
Rockwood, K (2013) Frailty a complex condition we must face up to. The Chronicle Herald. Available at Scholar
Rockwood, K, Fox, RA, Stolee, P, Robertson, D and Beattie, BL (1994) Frailty in elderly people: an evolving concept. Canadian Medical Association Journal 150, 489495.Google Scholar
Rockwood, K and Mitnitski, A (2007) Frailty in relation to the accumulation of deficits. Journals of Gerontology: Biological Sciences and Medical Sciences 62A, 722727.CrossRefGoogle Scholar
Rodriguez-Mañas, L and Fried, LP (2015) Frailty in the clinical scenario. The Lancet 385, e7e9.CrossRefGoogle ScholarPubMed
Sayce, L (2001) Social inclusion and mental health. Psychiatric Bulletin 25, 121123.CrossRefGoogle Scholar
Stevenson, A (ed.) (2010) White book. In Oxford Dictionary of English. Oxford: Oxford University Press. Available at Scholar
Taylor, BC (1992) Elderly identity in conversation producing frailty. Communication Research 19, 493515.CrossRefGoogle Scholar
Tinker, A, McCreadie, C, Wright, F and Salvage, A (1994) The Care of Frail Elderly People in the United Kingdom. London: HMSO.Google Scholar
Tomkow, L (in press) The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice. Ageing & Society. Available online doi:10.1017/S0144686X18001319.CrossRefGoogle Scholar
Townsend, P (1981) The structured dependency of the elderly: a creation of social policy in the twentieth century. Ageing & Society 1, 528.CrossRefGoogle Scholar
Turner, G and Clegg, A (2014) Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK, and Royal College of Practitioners report. Age and Ageing 43, 744747.CrossRefGoogle ScholarPubMed
Twigg, J (2006) The Body in Health and Social Care. New York, NY: Palgrave Macmillan.CrossRefGoogle Scholar
Twigg, J and Martin, W (2015) The challenge of cultural gerontology. The Gerontologist 55, 353359.CrossRefGoogle ScholarPubMed
van Dijk, TA (2001) Critical discourse analysis. In Van Dink, TA (ed.), The Handbook of Discourse Analysis. Hoboken, NJ: Blackwell, pp. 352371.Google Scholar
Vellas, B, Cesari, M and Li, J (eds) (2016) White Book on Frailty (ebook). Available at Scholar
Vernon, M (2016) Opening statement, National Clinical Director for Integration and the Frail Elderly (NHS England). Available at Scholar
Woodward, K (2015) Feeling frail and national statistical panic: Joan Didion in Blue Nights and the American economy at risk. Age, Culture, Humanities: An Interdisciplinary Journal 2, 347367.Google Scholar
Young, J (2014) We must recognise frailty as a long term condition. NHS England Blog, May 7. Available at Scholar