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Paper text:
the conceptualization of positive and negative states of aging is contentious at the inter- and intraparadigm level ; lack of consensus exists within and between states .
further , the language used to articulate these states often belies fundamental conceptual commonalities ; within the remit of specific paradigms , researchers may be describing similar phenomena , but framing them in disparate ways .
the pursuit of aging well  or successful aging ( sa)has increased dramatically , with the number of different sa conceptualizations increasing proportionally .
in addition to conceptual issues within the sa paradigm are issues concerning how sa and frailty paradigms coexist conceptually and are articulated in the literature .
working within their respective paradigms , researchers may have lost sight of the larger picture .
sa is focused on positive states , whilst acknowledging the heterogeneity of aging trajectories and variation in key dimensions affected by aging .
there have been more than 100 operational definitions of sa posited , ranging from strictly biomedical models ( i.e. , including only physical and cognitive functioning ) to single - item , self - reported measures of sa .
these models are largely based on the popular rowe & kahn model of sa : low probability of illness , physical / cognitive functioning , and engagement .
sa models are increasingly multidimensional ; a recent systematic review of lay perspectives demonstrates the importance of psychosocial components in definitions of sa .
at a basic level , frailty is concerned with increased vulnerability that develops as a consequence of age - related decline ; however , similar to sa , no consensus definition has emerged . a systematic review of frailty outcome instruments identified eight frailty domains : nutritional status , physical activity , mobility , strength , energy , cognition , mood , and social relations / support . the most prolific frailty model , the fried frailty phenotype , includes weight loss , weakness , exhaustion , low activity level , and slow gait speed . despite conceptual frameworks that advocate multidimensional models of frailty , the most common components of frailty instruments are biomedical ( e.g. , mobility ) , and the least common are psychosocial ( e.g. , social relations / support ) .
frailty models primarily include biomedical measures of health ( e.g. , activities of daily living)as do many sa models  working outside and across disease- and functionally specific domains .
these models endeavor to capture a holistic level of functioning , providing a measure of the general state of the individual .
whilst frailty models focus on health deficits , sa models focus on the fostering of strengths , with a greater emphasis on psychosocial components .
for example , the frailty phenotype does not include psychosocial components amongst its five items , whilst the rowe & kahn model includes engagement amongst its three items .
although there are many shared biomedically focused components of both models ( e.g. , activities of daily living ) , the perspectives adopted by frailty and sa are inherently different .
frailty is primarily concerned with the low end of the functioning continuum , whilst sa is primarily concerned with the high end . as a result of inhabiting opposite ends of a shared functioning continuum , it may be suggested that these concepts are polar opposites . with respect to biomedical aspects of functioning , this is a fair observation ; however , sa has a stronger emphasis on psychosocial components than frailty models .
both sa and frailty include biomedical components ; sa examines the high end , whilst frailty predominately examines the low end of the functioning spectrum .
frailty models emphasize the biomedical realm , whilst sa models emphasize both the biomedical and the psychosocial .
it is imperative that researchers are cognizant of the ways in which their perspectives are contextualized within the literature and within related paradigms , so as to be able to clearly communicate their research and to ensure they are working within the appropriate paradigm to facilitate desired outcomes .
for example , studies examining terminal decline in end - stage renal disease patients may be better suited to examination in a frailty framework , whereas studies examining the well - being fostered in community participation schemes may be better suited to a sa framework . in the interest of collectively moving aging research forward
, researchers must be cognizant of the theoretical framework in which they are working in order to best facilitate the intended outcomes of the study .
the conceptualization of positive and negative states of aging is contentious at the inter- and intraparadigm level ; lack of consensus exists within and between states . working within their respective paradigms , 
 successful aging and frailty researchers may have lost sight of the larger picture . 
 are successful aging researchers describing nonfrail individuals ? 
 are frailty researchers describing unsuccessful aging ? 
 it is imperative that researchers are cognizant of the ways in which their perspectives are contextualized within the literature and within related paradigms , so as to be able to clearly communicate their research and to ensure they are working within the appropriate paradigm to facilitate desired outcomes . 
 here we discuss the similarities and differences between successful aging and frailty in terms of the scope and emphasis of their constituent components and functioning : both sa and frailty include biomedical components ; sa examines the high end , whilst frailty predominately examines the low end of the functioning spectrum . 
 frailty models emphasize the biomedical realm , whilst sa models emphasize both the biomedical and the psychosocial .