From the Guidelines
Frailty is a clinical state characterized by heightened vulnerability to adverse health outcomes as a result of physiological decline in multiple organ systems, and it is a major threat to the quality of life and functional independence of older adults. According to the most recent study 1, frailty is a non-compulsory part of the ageing process and can be identified through various assessment methods, including the frailty phenotype and the Clinical Frailty Scale. The condition is common, affecting up to 12% of community-dwelling older adults, and its prevalence increases to over 40% in long-term care settings 1.
The development of frailty is influenced by complex interactions between aging, disease processes, and lifestyle factors, leading to progressive decline in multiple physiological systems, including muscle mass, bone density, and cognitive function 1. Identifying frailty in older populations has several advantages, including guiding treatment decision-making and outcome prediction, as well as informing the development of community-based interventions targeting the condition's prevention and management 1.
Recent studies have highlighted the importance of exercise and physical activity in preventing and managing frailty, with strength-based training being the most effective strategy to combat frailty 1. Other promising interventions include computerised-based training, exergames, inspiration and body vibrational training, muscle power training, and dance 1. Additionally, comprehensive geriatric assessment and multidisciplinary care approaches are often necessary to address the multiple dimensions of frailty and improve outcomes 1.
It is essential to note that frailty status can fluctuate substantially, and this change is more predictive of mortality than current frailty status 1. Therefore, early identification and intervention are crucial to slow progression or even reverse mild frailty. The most effective approach to managing frailty involves a combination of structured exercise programs, nutritional support, vitamin D supplementation, and medication reviews, as well as comprehensive geriatric assessment and multidisciplinary care 1.
From the Research
Definition of Frailty
- Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes 2.
- It is a state of increased vulnerability across multiple health domains that leads to adverse health outcomes, including falls, disability, hospitalizations, and death 3.
- Frailty is characterized by loss of muscle strength and impaired physical function, and is associated with increased falls, hospitalisation and death 4.
Characteristics of Frailty
- The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss 2.
- Symptoms of frailty include generalized weakness, exhaustion, slow gait, poor balance, decreased physical activity, cognitive impairment, and weight loss 3.
- Frailty may initially be overlooked or incorrectly identified as part of the normal aging process because of the variable nature of the presentation and diagnosis 3.
Causes and Risk Factors of Frailty
- Chronic inflammation is likely a key pathophysiologic process that contributes to the frailty syndrome directly and indirectly through other intermediate physiologic systems, such as the musculoskeletal, endocrine, and hematologic systems 2.
- The complex multifactorial etiologies of frailty also include obesity and specific diseases 2.
- Nutritional deficiencies and low physical activity are common in this age group due to ill health, disability and reductions in enthusiasm, food intake and therefore, energy availability 4.
Diagnosis and Assessment of Frailty
- A comprehensive geriatric assessment can identify risk factors and symptoms that suggest frailty 3.
- Several validated frailty assessment tools can evaluate a patient for frailty, and patients are diagnosed as not-frail, prefrail, or frail 3.
- Patients with a larger number of frail attributes are at higher risk of poor outcomes 3.
Management and Prevention of Frailty
- Exercise and comprehensive geriatric interdisciplinary assessment and treatment are key interventions for frailty 2.
- Physical activity and balance exercises may be suitable for patients who are less frail, while palliative care and symptom control may be appropriate for those who are more frail 3.
- Nutrition and physical activity interventions can improve clinical and physical outcomes in older adults with frailty, and strong recommendations include optimizing dietary intake, performing physical activity, and adopting interventions that combine nutrition and physical activity 5.