From the Guidelines
Frailty is a clinical syndrome that requires early identification and comprehensive management to prevent adverse health outcomes, and the most effective strategy to combat frailty is strength-based training, particularly resistance and balance training, as highlighted in a recent narrative review 1. The identification of frailty involves multiple systems, including musculoskeletal, cardiovascular, metabolic, and cognitive functions. The most widely used assessment tools are the Fried Frailty Phenotype and the Clinical Frailty Scale, which identify frailty based on criteria such as unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity 1.
Key Components of Frailty Management
- Comprehensive geriatric assessment
- Exercise interventions, particularly resistance and balance training for 30 minutes, 3 times weekly
- Nutritional support, ensuring adequate protein intake of 1.2-1.5g/kg/day
- Medication review to reduce polypharmacy
- Addressing underlying conditions
Recent Developments in Frailty Research
- Novel biomarkers and biomarker panels for frailty screening and diagnosis
- Use of artificial intelligence to identify frailty
- Investigation of the altered response to medications by older adults with frailty
- Emerging practices, such as meaningful activities, resilience training, optimistic orientation, social participation, and horticulture, which show promise in improving frailty 1. The use of strength-based training, such as resistance and balance training, is the most effective strategy to combat frailty, and it is recommended to be done for 30 minutes, 3 times weekly, as part of a comprehensive management plan 1.
Importance of Early Identification
Early identification of frailty is crucial, as interventions are most effective in pre-frail individuals. The biological basis of frailty involves chronic inflammation, cellular senescence, and mitochondrial dysfunction, creating a cycle of declining physiological function across multiple systems 1.
Future Directions
Future research should focus on the development of cost-effective, community-based interventions to manage and prevent frailty, as well as the implementation and evaluation of these interventions in real-world settings 1.
From the Research
Definition and Characteristics of Frailty
- Frailty is a geriatric syndrome that affects 5% to 17% of older adults, characterized by a state of increased vulnerability across multiple health domains, leading to adverse health outcomes 2
- It is a consequence of the interaction of the aging process and certain chronic diseases, compromising functional outcomes in the elderly and substantially increasing their risk for developing disabilities and other adverse outcomes 3
- Frailty shares the key features of the common long-term conditions: it can be ameliorated but not cured; it is costly at an individual and societal level; it is progressive; it impacts adversely on life experience and it has episodic crises 4
Diagnosis and Assessment of Frailty
- There is no current recommendation for routine screening, but a comprehensive geriatric assessment can identify risk factors and symptoms that suggest frailty 2
- Several validated frailty assessment tools can evaluate a patient for frailty, diagnosing patients as not-frail, prefrail, or frail 2
- Patients with a larger number of frail attributes are at higher risk of poor outcomes 2
Management and Intervention of Frailty
- The management of frail patients must be individualized and tailored to each patient's goals of care and life expectancy 2
- Physical activity and exercise are considered one of the main strategies to counteract frailty-related physical impairment in the elderly 3
- Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work, and can be combined according to need and prescribed as a multicomponent intervention 3
- A team approach is a key component of long-term condition management, incorporating support, follow-up, and behavior change interventions that go beyond the scope of a traditional medical approach 4
- Nutrition intervention, multi-domain intervention, drug administration, social support, and health education are also important aspects of frailty management 5
Prevention of Frailty
- Frailty can be prevented or managed through evidence-based interventions, including exercise, nutrition, and social support 5
- A summary of best evidence for prevention and management of frailty provides guidance for clinical or community medical staff to develop and apply frailty intervention and practice programs for older people 5
- Balance and functional training, with or without strength training, can prevent falls and improve outcomes in individuals with osteoporosis 6