Disproportionate pace of evidence-based care implementation in pediatric-onset multiple sclerosis: consequences and opportunities.

Frailty is characterized by increased dependency due to declining physical function, diminished physiological capacity, and reduced adaptability to stressors []. Individuals who are classified as frail often experience negative outcomes, such as increased rates of hospitalization, loss of independence, and premature death []. Frailty has recently been conceptualized as a multidimensional and fluid phenomenon, incorporating physical, psychological, and social domains, which has led to a broader comprehension of aging-related vulnerability []. This expanded perspective aligns with holistic nursing principles and facilitates more comprehensive assessment and care strategies []. Managing multidimensional frailty necessitates a holistic perspective that incorporates physical, mental, and social aspects in clinical assessments and care planning []. Multidimensional frailty is increasingly understood to reflect impairments across physical, psychological, and social domains, rather than being limited to physical decline alone []. Multidimensional frailty consists of three main domains: physical, psychological, and social frailty. First, physical frailty is significantly correlated with lower overall and health-related quality of life (QoL) and is associated with negative consequences, including loss of independence, elevated risk of falls and mortality, increased use of healthcare services, and reduced social engagement [-]. Psychological frailty reflects diminished psychological resilience, encompassing depressive symptoms and cognitive impairment [,]. Greater severity of depressive symptoms is associated with reduced physical activity and diminished QoL, particularly in social aspects [,], while cognitive decline negatively affects instrumental activities of daily living, thereby impairing QoL []. Social frailty, which arises from weakened social connections and reduced engagement with the community, includes social isolation, low social support, and poor socioeconomic status []. Social frailty has a strong negative correlation with QoL [] and is also associated with nutritional risk, depression, and cognitive decline []. An examination of prior research indicates that comprehensive consideration of frailty is essential when assessing QoL. According to Statistics Korea, adults aged 65 and older are projected to account for 19.2% of the population in 2024, exceed 20% by 2025, and surpass 30% by 2036 and 40% by 2050 []. This transition to a super-aged society highlights the urgency of early identification and management of frailty, especially to prevent QoL deterioration. As of 2023, single-person elderly households numbered approximately 2.14 million, accounting for 37.8% of all older adult households—an increase from 32.9% in 2015 []. In the same year, 10.8% of Korean adults aged 19 or older perceived older people as the most vulnerable group to discrimination or human rights violations []. This trend reflects not only structural changes in households, but also shifting societal perceptions of aging and vulnerability. One study found that older adults living alone exhibited significantly higher levels of depressive symptoms than those living with others, and that physical inactivity and limited social engagement were significantly associated with depressive symptoms []. These demographic and psychosocial factors underscore the necessity of a multidimensional approach to understanding older adults’ QoL