In 2019, the Canadian Frailty Network (CFN) introduced the AVOID Frailty framework as an evidence-informed health promotion tool to help older adults maintain health and independence (Rasiah et al., Reference Rasiah, Prorok, Adekpedjou, Barrie, Basualdo, Burns, De Paul, Donnelly, Doyle, Frank, Dolsen, Giguère, Hsiung, Kim, McDonald, O’Grady, Patey, Puxty, Racey and Muscedere2022). Frailty is broadly defined as an age-related state of increased vulnerability to adverse health outcomes resulting from cumulative declines across multiple physiological systems (Clegg et al., Reference Clegg, Young, Iliffe, Rikkert and Rockwood2013. AVOID is an acronym highlighting five modifiable lifestyle domains that can reduce the risk of frailty: activity, vaccination, optimize medications, interact, and diet (Rasiah et al., Reference Rasiah, Prorok, Adekpedjou, Barrie, Basualdo, Burns, De Paul, Donnelly, Doyle, Frank, Dolsen, Giguère, Hsiung, Kim, McDonald, O’Grady, Patey, Puxty, Racey and Muscedere2022). In practice, the AVOID Frailty campaign encourages older adults to take control of their health by engaging in evidence-based behaviours that reduce the risk of frailty (Puts et al., Reference Puts, Toubasi, Andrew, Ashe, Ploeg, Atkinson, Ayala, Roy, Rodríguez Monforte, Bergman and McGilton2017). This approach is delivered through community-based healthy aging programs across Canada, with the intent of preventing frailty or slowing its progression so that older adults can stay independent longer.

Each element of AVOID is grounded in geriatric health research (Ueshima et al., Reference Ueshima, Nagano, Wakabayashi, Maeda and Arai2025). Indeed, regular physical activity helps older adults remain mobile and can even reverse aspects of frailty (Kolle et al., Reference Kolle, Lewis, Lalonde and Backman2023); vaccinations bolster immunity, reducing the likelihood of infections that might otherwise cause hospitalizations or cascading health declines (Ciarambino et al., Reference Ciarambino, Crispino, Buono, Giordano, Trama, Iodice, Leoncini and Giordano2023); optimizing medications minimizes adverse drug interactions (e.g., dizziness, confusion) that can contribute to falls and frailty (Oboh, Reference Oboh2024); social engagement is independently associated with reduced frailty incidence and progression in older adults, and social interactions promote health and well-being through a wide variety of mechanisms and have shown to reduce premature morbidity with effect sizes exceeding or rivaling obesity, sedentary living, poor air quality, and even smoking (Freedman & Nicolle, Reference Freedman and Nicolle2020; Smith et al., Reference Smith, Holt-Lunstad and Kawachi2023); and, finally, adequate diet and nutrition – especially sufficient protein, vitamin D, calcium, and overall caloric intake – helps preserve muscle and bone strength while also supporting cognitive function, modulating inflammation, and bolstering immune competence, thereby lowering the risk of frailty (Rashidi Pour Fard et al., Reference Rashidi Pour Fard, Amirabdollahian and Haghighatdoost2019). In short, AVOID Frailty translates gerontological evidence into an easy-to-remember checklist for healthy aging behaviors and has been used in public health campaigns to empower older Canadians and their caregivers (Rasiah et al., Reference Rasiah, Prorok, Adekpedjou, Barrie, Basualdo, Burns, De Paul, Donnelly, Doyle, Frank, Dolsen, Giguère, Hsiung, Kim, McDonald, O’Grady, Patey, Puxty, Racey and Muscedere2022).

While AVOID Frailty provides valuable guidance, the negative framing of avoidance raises questions about whether this tool aligns with health promotion best practices and standards for community-based public health. A robust body of research now shows that positive ‘gain’ framing encourages greater adherence to health promotion and prevention behaviours (Gallagher & Updegraff, Reference Gallagher and Updegraff2012; Mikels et al., Reference Mikels, Young, Liu and Stine-Morrow2021; Rothman et al., Reference Rothman, Desmarais, Lenne and Elliot2020). For example, Notthoff et al. (Reference Notthoff, Klomp, Doerwald and Scheibe2016) found that messages stressing the benefits of walking motivated older adults far more than messages warning of the risks of inactivity. Participants not only reported greater motivation to join exercise programs when the programs were described in positive terms, but also remembered the gain-framed messages more clearly (Notthoff et al., Reference Notthoff, Klomp, Doerwald and Scheibe2016).

The phrase ‘AVOID Frailty’ may carry unintended negative connotations. The word ‘avoid’ implicitly focuses on a negative outcome, that is, frailty (Clegg et al., Reference Clegg, Young, Iliffe, Rikkert and Rockwood2013). Moreover, the term ‘frailty’ itself can be problematic when communicating with older adults (Durepos et al., Reference Durepos, Sakamoto, Alsbury, Hewston, Borges and Takaoka2022). Research on seniors’ perceptions of the term finds that many older adults dislike the label ‘frail/frailty’, seeing it as stigmatizing and tied to negative stereotypes of aging. In a recent scoping review, community-dwelling older people reported that being called ‘frail’ felt generalizing and disempowering, and some explicitly avoided using the term (Archibald et al., Reference Archibald, Lawless, Ambagtsheer and Kitson2020; Warmoth et al., Reference Warmoth, Lang, Phoenix, Abraham, Andrew, Hubbard and Tarrant2016). Thus, a well-intentioned slogan like ‘AVOID Frailty’ might inadvertently provoke defensiveness or pessimism – the opposite of the intention of the framework: to empower older individuals. This does not mean the AVOID framework should be discarded, but it suggests an opportunity to reframe the messaging in more positive, aspirational terms that resonate with the target audience’s values.

To preserve the evidence-based substance of AVOID, while shedding any negative overtones, positively framed alternatives should be explored. One possible alternative is the THRIVE Strategy for Lifelong Wellness . Below, we detail each component of THRIVE:

• • T – Train Your Body: Stay physically active to build strength, balance, and endurance.

• • H – Help Your Immune System: Use preventive health measures – especially vaccination – to bolster your immunity. ^{Footnote 1}

• • R – Review Your Medications: Work with health professionals to ensure your medications are appropriate and necessary.

• • I – Interact with Others: Stay socially engaged with friends, family, and community.

• • V – Vary Your Diet: Eat a varied, balanced diet rich in nutrients to fuel your body.

• • E – Engage Your Mind: Stay mentally active and cultivate emotional well-being as part of your wellness routine.

Importantly, the THRIVE Strategy for Lifelong Wellness adds this final pillar (i.e., engaging your mind) based on mounting evidence that shows that the mind and body are deeply interconnected in aging. Frailty and cognition share a bidirectional relationship: physical frailty increases the risk of incident cognitive decline (Avila-Funes et al., Reference Avila-Funes, Amieva, Barberger-Gateau, Le Goff, Raoux, Ritchie, Carrière, Tavernier, Tzourio, Gutiérrez-Robledo and Dartigues2009; Boyle et al., Reference Boyle, Buchman, Wilson, Leurgans and Bennett2010; Jürschik et al., Reference Jürschik, Nunin, Botigué, Escobar, Lavedán and Viladrosa2012) and modifies the risk of progression to dementia even in the presence of neuropathological changes (Wallace et al., Reference Wallace, Theou, Godin, Andrew, Bennett and Rockwood2019), while cognitive impairment is itself an independent risk factor for the development of frailty (Robertson et al., Reference Robertson, Savva and Kenny2013; Vatanabe et al., Reference Vatanabe, Pedroso, Teles, Ribeiro, Manzine, Pott-Junior and Cominetti2022). On a more positive note, engaging in cognitively stimulating activities (reading, meditation, learning new skills) is associated with slower cognitive decline and may delay the onset of dementia symptoms (Tam et al., Reference Tam, Chan, Cheung, Ho, Tang, Christensen, Tse and Kwan2022). Furthermore, mental and emotional well-being has direct effects on physical health outcomes. A quantitative review of longitudinal studies concluded that positive psychological well-being (e.g., optimism and life satisfaction) is linked to a lower risk of mortality – even after controlling for negative affect and health status (Chida & Steptoe, Reference Chida and Steptoe2008). In other words, seniors who feel good about life tend to live longer and healthier, likely due to better stress regulation (lower cortisol, less chronic inflammation) and more health-promoting behaviors (Steptoe et al., Reference Steptoe, Wright, Kunz-Ebrecht and Iliffe2006). Conversely, depression and chronic stress can accelerate physical decline; for example, depression in older adults is a risk factor for frailty and has been associated with worse outcomes after cardiac events (Zhao et al., Reference Zhao, Liu, Tyrovolas and Mutz2022). By explicitly including mental engagement in the wellness framework, we acknowledge healthy aging as holistic and multidimensional: involving cognitive vitality, emotional resilience, and a sense of purpose. This addition is well supported by gerontological research and aligns with older adults’ own views that meaningful activities and a positive mindset are key ingredients of ‘aging well’ (Waddell et al., Reference Waddell, Van Doorn, Power and Statham2025).

In addition to adding the ‘engage your mind’ pillar, the THRIVE strategy also reframes the overall approach as promoting lifelong wellness rather than ‘healthy aging’. This subtle shift in language can have significant implications for engagement and inclusivity. Many individuals in mid-life or early older age do not readily identify with terms like ‘aging’ or ‘senior’, which they may associate with frailty or decline only in very advanced age (Löckenhoff et al., Reference Löckenhoff, De Fruyt, Terracciano, McCrae, De Bolle, Costa, Aguilar-Vafaie, Ahn, Ahn, Alcalay, Allik, Avdeyeva, Barbaranelli, Benet-Martinez, Blatný, Bratko, Brunner-Sciarra, Cain, Crawford and Yik2009; Waddell et al., Reference Waddell, Van Doorn, Power and Statham2025). Public health outreach that explicitly mentions ‘aging’ can inadvertently alienate adults in their 50s, 60s, or even 70s who feel ‘that doesn’t apply to me’. By contrast, ‘wellness’ is a broadly appealing concept that transcends age brackets – it speaks to thriving at any age and thus invites people to adopt healthy practices throughout their life course. The behaviors that support healthy aging (exercise, good diet, social ties, etc.) are largely the same behaviors that promote health in mid-life and even earlier, so positioning them as strategies for ‘lifelong wellness’ reinforces that it is never too early (or too late) to invest in one’s well-being.

Furthermore, wellness implies a holistic state of well-being, not merely the absence of disease, but the presence of physical fitness, mental fulfillment, and social connection. The term ‘health’ can sometimes be interpreted narrowly (focusing on medical issues or the absence of illness), whereas ‘wellness’ conveys a more positive, proactive pursuit of optimal quality of life (Langevin, Reference Langevin2024). For example, a senior who manages multiple chronic conditions can still achieve wellness by engaging in meaningful activities, whereas ‘healthy aging’ might seem out of reach or too medically oriented for them. Community programs and geriatric care initiatives have increasingly adopted this broader framing. For example, a policy review noted that some leaders favor the term ‘lifelong wellness’ as a more inclusive model than ‘healthy aging’, to ensure older adults of all backgrounds see themselves reflected and to reduce age-related stigma (Leutz et al., Reference Leutz, Driscoll and Slodden2009). By reframing our frailty prevention strategy as one of lifelong wellness, we send an empowering message: the goal is not just to add years to life, but life to years, at every stage. This resonates better with the aspirational mindset of today’s older adults, who often reject one-dimensional narratives of decline and instead strive to continue growing, learning, and thriving well into later life.

In conclusion, the AVOID Frailty framework has been a valuable tool in promoting healthy behaviors for aging, and its core components remain strongly supported by scientific evidence. However, to maximize its impact and acceptance, reframing the messaging from a deficit-based (‘avoid frailty’) to an asset-based orientation is recommended. The THRIVE Strategy for Lifelong Wellness offers one possible, positively framed alternative that preserves the actionable guidance while emphasizing the gains of wellness rather than fear of frailty. Coupled with a shift in language towards lifelong wellness, this reframing can broaden the appeal of healthy aging initiatives to engage adults across the lifespan. It aligns with the ethos of modern public health and gerontology, which is to empower individuals to live well at every age. By focusing on thriving instead of merely surviving, we honor the potential for older adults to extend their healthspan and quality of life, rather than only their lifespan. Research, co-design efforts, and evaluation are needed to further advance and improve public health promotion messaging related to aging and frailty; in particular, future work should test the acceptability and comprehension of the THRIVE strategy among diverse adults, including a head-to-head comparison with the existing AVOID Frailty framework.