FEATUREFOCUS
MS care has traditionally focused on relapses, MRI changes, and disability progression, which are critically important,”
said Dr. Zanotto.
THE NEED FOR STRUCTURAL CHANGES
A 2025 study on air pollution and frailty found that pollutants, including air pollution, unclean household fuels, and exposure to secondhand smoke increase the risk of frailty. 8 Study authors concluded that there’ s“ an urgent need to raise awareness and establish effective public health strategies to reduce these environmental risks and associated frailty, particularly in light of population aging.”
Dr. Rockwood also points to structural changes like the importance of building design, noting how common it is to enter a building and not be able to find the stairs.“ But it’ s not just for those who want to reduce risk,” said Dr. Rockwood.“ Everyone wants a healthier way to get upstairs. We really have not, up to now, imagined the impact the aging population has on everything. And good design that helps frail older adults navigate space helps everybody navigate space.”
As a geriatric specialist, Dr. Rockwood suggests keeping three things in mind: prevent the preventable, treat the treatable, and care for the caregivers.“ We need to normalize the idea that we rely heavily on caregivers and help them manage their stress,” he urged.
Aging, frailty, and various conditions can overlap, complicating research efforts.“ Various diseases and disciplines have their own patterns of enthusiasm about aging,” said Dr. Rockwood.“ They also have their own specific issues. An important one here is how / whether to distinguish between thinking about impairments in high-order functions— e. g., mobility, instrumental and personal activities of daily living, and the judgment, planning, forward-lookingness, and stick-to-it-iveness that make up executive function. How should we view these? Disease specific? Aging related? Some combination? Often, granting agencies want that sorted before they will fund work on frailty, instead of seeing it as an essential first step in any frailty / impact of population aging inquiry.”
In 2005, Dr. Rockwood wrote this about the difficulties of treating a frail older population with multiple health issues:“ Their multiple, interacting medical and social problems make them frail. Geared to the sophisticated treatment of single problems, our system doesn’ t accommodate the complexity of caring for frail elderly patients, even though that is where much of our demand comes from.” 9
More than two decades later, Dr. Rockwood reports that the shortage of generalists persists,
8 | NARCOMS. org