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| {{Infobox medical condition (new) | | {{Short description|A medical condition characterized by decreased physiological reserve and increased vulnerability to stressors}} |
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| [[File:Altenpflege 04.jpg|thumb|A walker in the apartment of a senior woman]]
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| '''Frailty''' is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among [[old age|older adult]]s. Frailty is a condition associated with [[ageing]], and it has been recognized for centuries. As described by Shakespeare in ''As You Like It'', "the sixth age shifts into the lean and slipper’d pantaloon, with spectacles on nose and pouch on side, his youthful hose well sav’d, a world too wide, for his shrunk shank…". The shrunk shank is a result of loss of muscle with aging. It is also a marker of a more widespread syndrome of frailty, with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss.
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| As a population ages, a central focus of geriatricians and public health practitioners is to understand, and then beneficially intervene on, the factors and processes that put elders at such risk, especially the increased vulnerability to stressors (e.g. extremes of heat and cold, infection, injury, or even changes in medication) that characterizes many older adults.<ref name="Fried_2001">{{cite journal |vauthors=Fried LP, Tangen CM, Walston J, Newman, AB, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, WJ, Burke, G, McBurnie, MA |title=Frailty in older adults: evidence for a phenotype |journal=The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences |date=Mar 2001 |volume=56 |issue=3 |pages=M146-56 |pmid=11253156 |doi=10.1093/gerona/56.3.m146}}</ref>
| | ==Frailty syndrome== |
| | Frailty syndrome is a common geriatric condition characterized by a decline in physiological reserves and increased vulnerability to stressors, leading to adverse health outcomes. It is often seen in older adults and is associated with an increased risk of falls, disability, hospitalization, and mortality. |
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| ==Epidemiology== | | ==Characteristics== |
| Frailty is a common geriatric syndrome. Estimates of frailty's prevalence in older populations may vary according to a number of factors, including the setting in which the prevalence is being estimated – e.g., nursing home (higher prevalence) vs. community (lower prevalence), and the operational definition used for defining frailty. Using the widely used frailty phenotype framework proposed by Fried et al. (2001),<ref name="Fried_2001" /> prevalence estimates of 7–16% have been reported in non-institutionalized, community-dwelling older adults. | | Frailty syndrome is typically identified by a combination of clinical features, including unintentional weight loss, muscle weakness, fatigue, slow walking speed, and low physical activity. These characteristics reflect a state of decreased physiological reserve and resilience, making individuals more susceptible to acute health issues. |
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| The occurrence of frailty increases incrementally with advancing age, and is more common in older women than men, and among those of lower socio-economic status. Frail older adults are at high risk for major adverse health outcomes, including disability, falls, institutionalization, hospitalization, and mortality. | | ==Pathophysiology== |
| | The pathophysiology of frailty syndrome is complex and multifactorial. It involves a combination of age-related changes, chronic diseases, and lifestyle factors. Key mechanisms include: |
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| Epidemiologic research to date has led to the identification of a number of risk factors for frailty, including: (a) chronic diseases, such as cardiovascular disease, diabetes, chronic kidney disease, depression, and cognitive impairment;<ref>{{cite journal |author1=Fried LP |author2=Ferrucci L |author3=Darer J |author4=Williamson JD |author5=Anderson G |title=Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care |journal=J Gerontol A Biol Sci Med Sci |date=March 2004 |volume=59 |issue=3 |pages=255–63 |pmid=15031310}}</ref> (b) physiologic impairments, such as activation of inflammation and coagulation systems,<ref name="Walston 2333–2341">{{cite journal |last1=Walston |first1=J |last2=McBurnie |first2=MA |last3=Newman |first3=A |last4=Tracy |first4=RP |last5=Kop |first5=WJ |last6=Hirsch |first6=CH |last7=Gottdiener |first7=J |last8=Fried |first8=LP|author9= Cardiovascular Health Study |title=Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study |journal=Arch Intern Med |date=Nov 2002 |volume=162 |issue=20 |pages=2333–2341 |pmid=12418947 |doi=10.1001/archinte.162.20.2333}} <!--|accessdate=15 January 2013--></ref> anemia,<ref name="Chaves 2005 729–35">{{cite journal |last1=Chaves |first1=PH |last2=Semba |first2=RD |last3=Leng |first3=SX |last4=Woodman |first4=RC |last5=Ferrucci |first5=L |last6=Guralnik |first6=JM |last7=Fried |first7=LP |title=Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women's Health and Aging Studies I and II |journal=J Gerontol A Biol Sci Med Sci |date=Jun 2005 |volume=60 |issue=6 |pages=729–35 |pmid=15983175 |doi=10.1093/gerona/60.6.729}}</ref><ref name="Roy 67–78">{{cite journal |last=Roy |first=CN |title=Anemia in frailty |journal=Clin Geriatr Med. |date=Feb 2011 |volume=27 |issue=1 |pages=67–78 |pmid=21093723 |doi=10.1016/j.cger.2010.08.005 |pmc=2998908}}</ref> atherosclerosis,<ref>{{cite journal |last1=Chaves |first1=PH |last2=Varadhan |first2=R |last3=Lipsitz |first3=LA |last4=Stein |first4=PK |last5=Windham |first5=BG |last6=Tian |first6=J |last7=Fleisher |first7=LA |last8=Guralnik |first8=JM |last9=Fried |first9=LP |title=Physiological complexity underlying heart rate dynamics and frailty status in community-dwelling older women. |journal=J Am Geriatr Soc |date=Sep 2008 |volume=56 |issue=9 |pages=1698–703 |doi=10.1111/j.1532-5415.2008.01858.x |pmid=19166446 |pmc=2848445}}</ref> autonomic dysfunction,<ref name="Chaves 2005 729–35" /><ref>{{cite journal |last=Varadhan |first=R |author2=Chaves PH |author3=Lipsitz LA |author4=Stein PK |author5=Tian J |author6=Windham BG |author7=Berger RD |author8=Fried LP. |title=Frailty and impaired cardiac autonomic control: new insights from principal components aggregation of traditional heart rate variability indices. |journal=J Gerontol A Biol Sci Med Sci |date=Jun 2009 |volume=64 |issue=6 |pages=682–7 |pmid=19223607 |doi=10.1093/gerona/glp013 |pmc=2679422}}</ref> hormonal abnormalities,<ref name="Cappola 243–8">{{cite journal |last=Cappola |first=AR |author2=Xue QL |author3=Fried LP. |title=Multiple hormonal deficiencies in anabolic hormones are found in frail older women: the Women's Health and Aging studies. |journal=J Gerontol A Biol Sci Med Sci |date=Feb 2009 |volume=64 |issue=2 |pages=243–8 |pmid=19182229 |doi=10.1093/gerona/gln026 |pmc=2655016}}</ref> obesity,<ref>{{cite journal |last=Blaum |first=CS |author2=Xue QL |author3=Michelon E |author4=Semba RD |author5=Fried LP |title=The association between obesity and the frailty syndrome in older women: the Women's Health and Aging Studies |journal=J Am Geriatr Soc |date=Jun 2005 |volume=53 |issue=6 |pages=927–34 |pmid=15935013 |doi=10.1111/j.1532-5415.2005.53300.x|url=https://deepblue.lib.umich.edu/bitstream/2027.42/65446/1/j.1532-5415.2005.53300.x.pdf }}</ref> hypovitaminosis D in men,<ref>{{cite journal |last=Shardell |first=M |author2=Hicks GE |author3=Miller RR |author4=Kritchevsky S |author5=Andersen D |author6=Bandinelli S |author7=Cherubini A |author8=Ferrucci L |title=Association of low vitamin D levels with the frailty syndrome in men and women |journal=J Gerontol A Biol Sci Med Sci |date=Jan 2009 |volume=64 |issue=1 |pages=69–75 |pmid=19164273 |doi=10.1093/gerona/gln007 |pmc=2691187}}</ref> and environment-related factors such as life space and neighborhood characteristics.<ref>{{cite journal |last=Xue |first=QL |author2=Fried LP |author3=Glass TA |author4=Laffan A |author5=Chaves PH |title=Life-space constriction, development of frailty, and the competing risk of mortality: the Women's Health And Aging Study I |journal=Am J Epidemiol |date=Jan 2008 |volume=167 |issue=2 |pages=240–8 |pmid=17906296 |doi=10.1093/aje/kwm270}}</ref> Advances about potentially modifiable risk factors for frailty now offer the basis for translational research effort aimed at prevention and treatment of frailty in older adults. A recent systematic review found that exercise interventions can increase muscle strength and improve physical function; however, results are inconsistent in frail older adults living in the community.<ref>{{Cite journal |last=Cruz-Jentoft |first=Alfonso J. |last2=Landi |first2=Francesco |last3=Schneider |first3=Stéphane M. |last4=Zúñiga |first4=Clemente |last5=Arai |first5=Hidenori |last6=Boirie |first6=Yves |last7=Chen |first7=Liang-Kung |last8=Fielding |first8=Roger A. |last9=Martin |first9=Finbarr C. |date=2014-11-01 |title=Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS) |journal=Age and Ageing |volume=43 |issue=6 |pages=748–759 |doi=10.1093/ageing/afu115 |issn=1468-2834 |pmc=4204661 |pmid=25241753}}</ref>
| | * '''Sarcopenia''': The loss of muscle mass and strength, which is a central component of frailty. |
| | * '''Inflammation''': Chronic low-grade inflammation is often present in frail individuals, contributing to muscle catabolism and other systemic effects. |
| | * '''Endocrine changes''': Alterations in hormone levels, such as decreased testosterone and growth hormone, can affect muscle and bone health. |
| | * '''Nutritional deficiencies''': Poor nutrition can exacerbate muscle loss and weakness. |
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| ==Theoretical understanding== | | ==Diagnosis== |
| Recent work on frailty has sought to characterize both the underlying changes in the body and the manifestations that make frailty recognizable. It is well-agreed upon that declines in physiologic reserves and resilience is the essence of being frail.<ref>{{cite journal |last=Varadhan |first=R |author2=Seplaki CL |author3=Xue QL |author4=Bandeen-Roche K|author4-link=Karen Bandeen-Roche |author5=Fried LP |title=Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty |journal=Mech Ageing Dev. |date=Nov 2008 |volume=129 |issue=11 |pages=666–70 |doi=10.1016/j.mad.2008.09.013 |pmid=18938195 |pmc=2650618}}</ref> Similarly, scientists agree that the risk of frailty increases with age and with the incidence of diseases. Beyond that, there is now strong evidence to support the theory that the development of frailty involves declines in energy production, energy utilization and repair systems in the body, resulting in declines in the function of many different physiological systems. This decline in multiple systems affects the normal complex adaptive behavior that is essential to health <ref name="Fried 1049–57">{{cite journal |last=Fried |first=LP |author2=Xue QL |author3=Cappola AR |author4=Ferrucci L |author5=Chaves P |author6=Varadhan R |author7=Guralnik JM |author8=Leng SX |author9=Semba RD |author10=Walston JD |author11=Blaum CS |author12=Bandeen-Roche K|author12-link=Karen Bandeen-Roche |title=Nonlinear multisystem physiological dysregulation associated with frailty in older women: implications for etiology and treatment |journal=J Gerontol A Biol Sci Med Sci |date=Oct 2009 |volume=64 |issue=10 |pages=1049–57 |pmid=19567825 |doi=10.1093/gerona/glp076 |pmc=2737590}}</ref> and eventually results in frailty typically manifesting as a syndrome of a constellation of weakness, slowness, reduced activity, low energy and unintended weight loss.<ref name="Bandeen-Roche 2006 262–6">{{cite journal |last=Bandeen-Roche |first=K |authorlink=Karen Bandeen-Roche|author2=Xue QL |author3=Ferrucci L |author4=Walston J |author5=Guralnik JM |author6=Chaves P |author7=Zeger SL |author8=Fried LP |title=Phenotype of frailty: characterization in the women's health and aging studies |journal=J Gerontol A Biol Sci Med Sci |date=Mar 2006 |volume=61 |issue=3 |pages=262–6 |pmid=16567375|doi=10.1093/gerona/61.3.262 }} <!--|accessdate=16 January 2013--></ref> When most severe, i.e. when 3 or more of these manifestations are present, the individual is at a high risk of death.
| | Frailty syndrome is diagnosed using various criteria, with the most widely used being the [[Fried Frailty Phenotype]] and the [[Frailty Index]]. The Fried Frailty Phenotype includes five criteria: unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity. A person meeting three or more of these criteria is considered frail. |
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| ==Assessment of geriatric frailty== | | ==Management== |
| The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. Generally speaking, the empirical assessment of geriatric frailty in individuals seeks ultimately to capture this or related features, though distinct approaches to such assessment have been developed in the literature (see de Vries et al., 2011 for a comprehensive review).<ref>{{cite journal |last1=de Vries |first1=NM |last2=Staal |first2=JB |last3=van Ravensberg |first3=CD |last4=Hobbelen |first4=JS |last5=Olde Rikkert |first5=MG |last6=Nijhuis-van der Sanden |first6=MW |title=Outcome instruments to measure frailty: a systematic review |journal=Ageing Research Reviews |date=Jan 2011 |volume=10 |issue=1 |pages=104–114 |pmid=20850567 |doi=10.1016/j.arr.2010.09.001}} <!--|accessdate=16 January 2013--></ref>
| | Management of frailty syndrome involves a multidisciplinary approach aimed at improving physical function and quality of life. Key strategies include: |
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| Two key approaches are discussed below:
| | * '''Exercise programs''': Resistance and aerobic exercises can help improve muscle strength and endurance. |
| | * '''Nutritional support''': Ensuring adequate protein and caloric intake is crucial for maintaining muscle mass. |
| | * '''Medication review''': Polypharmacy should be addressed to minimize adverse drug effects. |
| | * '''Fall prevention''': Implementing measures to reduce the risk of falls, such as home safety assessments and balance training. |
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| ===Linda Fried / Johns Hopkins Frailty Criteria=== | | ==Prognosis== |
| A popular approach to the assessment of geriatric frailty encompasses the assessment of five dimensions that are hypothesized to reflect systems whose impaired regulation underlies the syndrome. These five dimensions are:
| | The prognosis of frailty syndrome varies depending on the severity and the presence of comorbid conditions. Early identification and intervention can improve outcomes and reduce the risk of adverse events. |
| * unintentional weight loss,
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| * exhaustion,
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| * muscle weakness,
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| * slowness while walking, and
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| * low levels of activity.<ref name="Fried_2001" />
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| Corresponding to these dimensions are five specific criteria indicating adverse functioning, which are implemented using a combination of self-reported and performance-based measures. Those who meet at least three of the criteria are defined as “frail”, while those not matching any of the five criteria are defined as “robust”. Additional work on the construct is done by [[Karen Bandeen-Roche|Bandeen-Roche]] et al. (2006),<ref name="Bandeen-Roche 2006 262–6" /> though some of the exact criteria and measures differ (see Table 1 in the paper for this contrast). Other studies in the literature have also adopted the general approach of [[Linda P. Fried]] et al. (2001)<ref name="Fried_2001" /> though, again, the exact criteria and their particular measures may vary. This assessment approach was developed and refined by Fried and colleagues at the Johns Hopkins University’s [http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-on-aging-and-health/ Center on Aging and Health]. This Center is home to [http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-on-aging-and-health/oaic/ Johns Hopkins Claude D. Pepper Older Americans Independence Center], which focuses on frailty research.
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| ===Rockwood Frailty Index=== | | ==Related pages== |
| Another notable approach to the assessment of geriatric frailty (if not also to some degree its conceptualization) is that of Rockwood and Mitnitski (2007)<ref>{{cite journal |last=Rockwood |first=K |author2=Mitnitski A |title=Frailty in relation to the accumulation of deficits |journal=J Gerontol A Biol Sci Med Sci |date=Jul 2007 |volume=62 |issue=7 |pages=722–7 |pmid=17634318 |doi=10.1093/gerona/62.7.722}} <!--|accessdate=16 January 2013--></ref> in which frailty is viewed in terms of the number of health "deficits" that are manifest in the individual, leading to a continuous measure of frailty (see Rockwood, Andrew, and Mitnitski (2007)<ref>{{cite journal |last=Rockwood |first=K |author2=Andrew M |author3=Mitnitski A |title=A comparison of two approaches to measuring frailty in elderly people |journal=J Gerontol A Biol Sci Med Sci |date=Jul 2007 |volume=62 |issue=7 |pages=738–43 |pmid=17634321|doi=10.1093/gerona/62.7.738 }} <!--|accessdate=16 January 2013--></ref> for a contrast of the two approaches). This approach was developed by Dr. Rockwood and colleagues at Dalhousie University.
| | * [[Sarcopenia]] |
| | * [[Geriatrics]] |
| | * [[Chronic disease]] |
| | * [[Polypharmacy]] |
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| ===Four domains of frailty===
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| A four domains of frailty model was proposed in response to an article in the BMJ.<ref>{{cite journal |last1=Soong |first1=J |title=Re: Functional assessment in older people |url=http://www.bmj.com/content/343/bmj.d4681/rr/645724 |publisher=BMJ}}</ref> This conceptualisation could be viewed as blending the phenotypic and index models. Researchers tested this model for signal in routinely collected hospital data,<ref>{{cite journal |last1=Soong |first1=J |last2=Poots |first2=AJ |last3=Scott |first3=S |last4=Donald |first4=K |last5=Woodcock |first5=T |last6=Lovett |first6=D |last7=Bell |first7=D |title=Quantifying the prevalence of frailty in English hospitals |journal=[[BMJ Open]] |date=21 October 2015 |volume=5 |issue=10 |pages=e008456 |doi=10.1136/bmjopen-2015-008456|pmid=26490097 |pmc=4621378 }} {{open access}}</ref> and then used this signal in the development of a frailty model, finding even predictive capability across 3 outcomes of care.<ref>{{cite journal |last1=Soong |first1=J |last2=Poots |first2=A J |last3=Scott |first3=S |last4=Donald |first4=K |last5=Bell |first5=D |title=Developing and validating a risk prediction model for acute care based on frailty syndromes |journal=BMJ Open |date=21 October 2015 |volume=5 |issue=10 |pages=e008457 |doi=10.1136/bmjopen-2015-008457|pmid=26490098 |pmc=4621379 }} {{open access}}</ref> In the care home setting, one study indicated that not all four domains of frailty were routinely assessed in residents, giving evidence to suggest that frailty may still primarily be viewed only in terms of physical health.<ref>{{Cite journal|last=Sunkersing|first=David|last2=Martin|first2=Finbarr C.|last3=Reed|first3=Julie|last4=Woringer|first4=Maria|last5=Bell|first5=Derek|date=2019-03-01|title=What do care home managers believe constitutes an ‘assessment for frailty’ of care home residents in North-West London? A survey|url=https://doi.org/10.1186/s12877-019-1083-5|journal=BMC Geriatrics|volume=19|issue=1|pages=62|doi=10.1186/s12877-019-1083-5|issn=1471-2318|pmc=6397475}}</ref>
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| ===SHARE Frailty Index===
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| The SHARE-Frailty Index (SHARE-FI) was originally developed by Romero-Ortuno (2010) (https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-10-57) and researchers as part of the Survey of Healthy Ageing and Retirement in Europe. It consists of five domains of the frailty phenotype:
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| •Fatigue
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| •Loss of appetite
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| •Grip strength
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| •Functional difficulties
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| •Physical activity
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| The SHARE-FI calculator is freely available to use online.
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| The calculator classifies individuals as 1) frail; 2) pre-frail; and 3) non-frail / robust.
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| The SHARE-FI has good clinical utility as it provides relatively quick assessment of frailty in often time-poor healthcare settings.
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| ==Biological underpinnings==
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| It has been suggested that the biological underpinnings of frailty are multifactorial, involving dysregulation across many physiological systems.<ref name="Fried 1049–57" /> A proinflammatory state,<ref name="Walston 2333–2341" /> sarcopenia,<ref>{{cite journal |last=Ferrucci |first=Luigi |author2=Penninx BW |author3=Volpato S |title=Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. |journal=J Am Geriatr Soc |year=2002 |volume=50 |issue=12 |pages=1947–54 |doi=10.1046/j.1532-5415.2002.50605.x |pmid=12473005 |display-authors=etal}}</ref> anemia,<ref name="Chaves 2005 729–35" /><ref name="Roy 67–78" /> relative deficiencies in anabolic hormones (androgens and growth hormone)<ref name="Cappola 243–8" /> and excess exposure to catabolic hormones (cortisol),<ref>{{cite journal |last=Varadhan |first=Ravi |author2=Walston J |author3=Cappola AR |author4=Carlson MC |author5=Wand GS |author6=Fried LP |title=Higher Levels and Blunted Diurnal Variation of Cortisol in Frail Older Women. |journal=J Gerontol A Biol Sci Med Sci |year=2008 |volume=63 |issue=2 |pages=190–195 |doi=10.1093/gerona/63.2.190}}</ref> insulin resistance,<ref>{{cite journal |last=Barzilay |first=JI |author2=Blaum C |author3=Moore T |title=Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. |journal=Arch Intern Med |year=2007 |volume=167 |issue=7 |pages=635–641 |doi=10.1001/archinte.167.7.635 |pmid=17420420 |display-authors=etal}}</ref> glucose levels,<ref>{{cite journal |last=Zaslavsky |first=O |author2=Walker R |author3=Crane PK |title=Glucose levels and Risk of Frailty. |journal=J Gerontol A Biol Sci Med Sci |year=2016 |volume=71 |issue=9 |pages=1223–1229 |doi=10.1093/gerona/glw024|pmid=26933160 |pmc=4978362 }}</ref> compromised altered immune function,<ref>{{cite journal |last=Wang |first=George C |author2=Talor MV |author3=Rose NR |title=Thyroid autoantibodies are associated with a reduced prevalence of frailty in community-dwelling older women. |journal=J Clin Endocrinol Metab |year=2010 |volume=95 |issue=3 |pages=1161–8 |doi=10.1210/jc.2009-1991 |pmid=20061418 |display-authors=etal|pmc=2841533 }}</ref><ref>{{cite journal |last=Yao |first=X |author2=Li H |author3=Leng SX. |title=Inflammation and immune system alterations in frailty. |journal=Clin Geriatr Med. |year=2011 |volume=27 |issue=1 |pages=79–87 |pmid=21093724 |doi=10.1016/j.cger.2010.08.002 |pmc=3011971}}</ref> micronutrient deficiencies and oxidative stress<ref>{{cite journal |last=Semba |first=Richard D. |author2=Ferrucci L |author3=Sun K |author4=Walston J |author5=Varadhan R |author6=Guralnik JM |author7=Fried LP. |title=Oxidative stress and severe walking disability among older women. |journal=Am J Med |date=Dec 2007 |volume=120 |issue=12 |pages=1084–9 |pmid=18060930 |doi=10.1016/j.amjmed.2007.07.028 |pmc=2423489}}</ref> are each individually associated with a higher likelihood of frailty. Additional findings show that the risk of frailty increases with the number of dysregulated physiological systems in a nonlinear pattern, independent of chronic diseases and chronologic age, suggesting synergistic effects of individual abnormalities that on their own may be relatively mild.<ref name="Fried 1049–57" /> The clinical implication of this finding is that interventions that affect multiple systems may yield greater, synergistic benefits in prevention and treatment of frailty than interventions that affect only one system.
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| Associations between specific disease states are also associated with and frailty have also been observed, including cardiovascular disease, [[diabetes mellitus]], [[chronic kidney disease]] and other diseases in which inflammation is prominent. To the extent that dysregulation across several physiologic systems underlie the pathogenesis of the frailty, specific disease states are likely concurrent manifestations of the underlying impaired physiologic function and regulation. It is possible that clinically measurable disease states can manifest themselves or be captured prior to the onset of frailty. No single disease state is necessary and sufficient for the pathogenesis of frailty, since many individuals with chronic diseases are not frail. Therefore, rather than being dependent on the presence of measurable diseases, frailty is an expression of a critical mass of physiologic impairments.
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| ==Components==
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| ===Sarcopenia===
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| [[Sarcopenia]] (from the Greek meaning "poverty of flesh") refers to loss of muscle mass and low muscle function (strength or performance)<ref>{{cite journal |last=Cruz-Jentoft |first=Alfonso J. |last2=Baeyens |first2=Jean Pierre |last3=Bauer |first3=Jürgen M. |last4=Boirie |first4=Yves |last5=Cederholm |first5=Tommy |last6=Landi |first6=Francesco |last7=Martin |first7=Finbarr C. |last8=Michel |first8=Jean-Pierre |last9=Rolland |first9=Yves |date=2017-01-19 |title=Sarcopenia: European consensus on definition and diagnosis |journal=Age and Ageing |volume=39 |issue=4 |pages=412–423 |doi=10.1093/ageing/afq034 |issn=0002-0729 |pmc=2886201 |pmid=20392703}}</ref> that occurs as a result of old age. It is characterized first by a decrease in muscle mass, which causes weakness and frailty. However, this loss of muscle mass may be caused by different cellular mechanisms than those that cause [[muscle atrophy]]. For example, during sarcopenia, there is a replacement of [[muscle fibres]] with [[fat]] and an increase in [[fibrosis]].
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| ===Osteoporosis===
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| [[File:OsteoCutout.png|thumb|upright|Osteoporosis causes a hunched-over appearance in some people.]]
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| [[Osteoporosis]] is an age-related disease of [[bone]] that leads to an increased risk of [[bone fracture|fracture]]. In osteoporosis the [[bone mineral density]] (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the [[World Health Organization]] (WHO) in women as a bone mineral density 2.5 [[standard deviation]]s below peak bone mass (20-year-old healthy female average) as measured by [[Dual energy X-ray absorptiometry|DXA]]; the term "established osteoporosis" includes the presence of a [[fragility fracture]].<ref name="WHO1994">{{cite journal |author=WHO |title=Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group |journal=World Health Organization Technical Report Series |volume=843 |issue= |pages=1–129 |year=1994 |pmid=7941614 |doi=}}</ref>
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| Osteoporosis is most common in women after [[menopause]], when it is called ''postmenopausal osteoporosis'', but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other [[Chronic (medicine)|chronic]] diseases or as a result of medications, specifically [[glucocorticoid]]s, when the disease is called steroid- or [[glucocorticoid-induced osteoporosis]] (SIOP or GIOP). Given its influence in the risk of fragility fracture, osteoporosis may significantly affect [[life expectancy]] and [[quality of life]].
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| ===Muscle weakness===
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| [[Muscle weakness]], also known as muscle fatigue, (or "lack of strength") refers to the inability to exert force with one's skeletal [[muscle]]s. Weakness often follows [[muscle atrophy]] and a decrease in activity, such as after a long bout of bedrest as a result of an illness. There is also a gradual onset of muscle weakness as a result of sarcopenia - the age-related loss of skeletal muscle.
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| [[File:Bathtub balance seat.jpg|thumb|left|Muscle weakness makes it difficult to perform everyday activities, like getting into a bathtub.]]
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| A test of strength is often used during a [[diagnosis]] of a muscular disorder before the [[etiology]] can be identified. Such etiology depends on the type of muscle weakness, which can be true or perceived as well as variable topically. True weakness is substantial, while perceived rather is a sensation of having to put more effort to do the same task.<ref>[http://www.selmanholman.com/SHAweb_tools.htm Muscle Weakness Coding Checklist by Jun Mapili, PT, MAEd] {{webarchive|url=https://web.archive.org/web/20140714214636/http://www.selmanholman.com/SHAweb_tools.htm |date=2014-07-14 }}</ref> On the other hand, various topic locations for muscle weakness are central, neural and peripheral. Central muscle weakness is an overall exhaustion of the whole body, while peripheral weakness is an exhaustion of individual muscles. Neural weakness is somewhere between.
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| ===Healing power===
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| Physical injuries heal slower and are more likely to leave permanent scars in older people.
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| Aged people recover slower and are lesser likely to completely recover from physical injuries and accidents.<ref name=nbcinlmnih_gov>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217450/ “On the Fatal Crash Experience of Older Drivers” by Richard Kent, Basem Henary, and Fumio Matsuoka. (Annual Proceedings / Association for the Advancement of Automotive Medicine)]</ref>
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| ==Surgical outcomes==
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| Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Frailty more than doubles the risk of morbidity and mortality from surgery and cardiovascular conditions.<ref name="pmid24291279">{{cite journal |vauthors=Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, Popma JJ, Ferrucci L, Forman DE |title=Frailty assessment in the cardiovascular care of older adults |journal=[[Journal of the American College of Cardiology]] |volume=63 |issue=8 |year=2014 |pages=747–762 |doi=10.1016/j.jacc.2013.09.070 |pmid=24291279|pmc=4571179 }}</ref> Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.<ref name="Frailty">{{cite journal
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| |vauthors=Makary MA, Segev DL, Pronovost PJ, etal |title=Frailty as a predictor of surgical outcomes in older patients
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| |journal=J. Am. Coll. Surg.
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| |volume=210
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| |issue=6
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| |pages=901–8
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| |date=June 2010
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| |pmid=20510798
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| |doi=10.1016/j.jamcollsurg.2010.01.028
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| |lay-url=http://newoldage.blogs.nytimes.com/2010/12/28/who-thrives-after-surgery/?hpw
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| |laydate=28 December 2010}}</ref>
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| The most widely used frailty scale consists of five items:<ref name="Fried_2001" />
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| *unintentional weight loss >4.5 kg in the past year
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| *<20th population centile for grip strength
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| *self-reported exhaustion
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| *low physical activity such that persons would only rarely undertake a short walk
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| *slowed walking speed, defined as lowest population quartile on 4 minute walking test.
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| A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes.<ref name="Frailty" /> Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
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| == See also ==
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| * [[Disability]]
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| * [[Physiological functional capacity]]
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| * [[Frailty index]]
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| ==References==
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| {{Reflist}}
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| {{DEFAULTSORT:Frailty Syndrome}}
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| [[Category:Geriatrics]] | | [[Category:Geriatrics]] |
| [[Category:Gerontology]] | | [[Category:Medical conditions]] |
A medical condition characterized by decreased physiological reserve and increased vulnerability to stressors
Frailty syndrome
Frailty syndrome is a common geriatric condition characterized by a decline in physiological reserves and increased vulnerability to stressors, leading to adverse health outcomes. It is often seen in older adults and is associated with an increased risk of falls, disability, hospitalization, and mortality.
Characteristics
Frailty syndrome is typically identified by a combination of clinical features, including unintentional weight loss, muscle weakness, fatigue, slow walking speed, and low physical activity. These characteristics reflect a state of decreased physiological reserve and resilience, making individuals more susceptible to acute health issues.
Pathophysiology
The pathophysiology of frailty syndrome is complex and multifactorial. It involves a combination of age-related changes, chronic diseases, and lifestyle factors. Key mechanisms include:
- Sarcopenia: The loss of muscle mass and strength, which is a central component of frailty.
- Inflammation: Chronic low-grade inflammation is often present in frail individuals, contributing to muscle catabolism and other systemic effects.
- Endocrine changes: Alterations in hormone levels, such as decreased testosterone and growth hormone, can affect muscle and bone health.
- Nutritional deficiencies: Poor nutrition can exacerbate muscle loss and weakness.
Diagnosis
Frailty syndrome is diagnosed using various criteria, with the most widely used being the Fried Frailty Phenotype and the Frailty Index. The Fried Frailty Phenotype includes five criteria: unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity. A person meeting three or more of these criteria is considered frail.
Management
Management of frailty syndrome involves a multidisciplinary approach aimed at improving physical function and quality of life. Key strategies include:
- Exercise programs: Resistance and aerobic exercises can help improve muscle strength and endurance.
- Nutritional support: Ensuring adequate protein and caloric intake is crucial for maintaining muscle mass.
- Medication review: Polypharmacy should be addressed to minimize adverse drug effects.
- Fall prevention: Implementing measures to reduce the risk of falls, such as home safety assessments and balance training.
Prognosis
The prognosis of frailty syndrome varies depending on the severity and the presence of comorbid conditions. Early identification and intervention can improve outcomes and reduce the risk of adverse events.
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