|Year : 2017 | Volume
| Issue : 2 | Page : 71
Frailty syndrome in older adults
Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||20-Apr-2017|
Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur - 795 004
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ngangbam T. Frailty syndrome in older adults. J Med Soc 2017;31:71
Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes including falls, incident disability, hospitalization, and mortality. Identification of older individuals who are frail or at risk of becoming frail with appropriate subsequent evaluation and intervention constitutes a cornerstone of geriatric medicine.
Frailty is conceptually defined as a clinically recognizable state of older adults with increased vulnerability, resulting from age-associated declines in physiologic reserve and function across multiple organ systems, such that the ability to cope with everyday or acute stressors is compromised.
Frailty is operationalized as a syndrome meeting three or more of five phenotypic criteria: weakness as measured by low grip strength, slowness by slowed walking speed, low level of physical activity, low energy or self-reported exhaustion, and unintentional weight loss. In prefrail stage, only one or two criteria are present and it identifies a subset at high risk of progressing to frailty. Older individuals with none of the above five criteria are classified as nonfrail. It is important to distinguish frailty from disability and comorbidity, which are two other prevalent conditions in older adults. Disability indicates established loss of function, for example, mobility, while frailty indicates increased vulnerability to loss of function. Similarly, comorbidity (the number of diagnoses present) is not equivalent to frailty; it is quite possible to have several diagnoses without major impact on homeostatic reserve.
The overall prevalence of frailty in older adults aged ≥ 65 years in the United States is 7%–12% and >25% in older adults >85 years, and the prevalence is more in third world countries and among females.
Chronic inflammation is likely a key underlying mechanism that contributes to frailty directly and indirectly through other intermediate pathophysiologic processes. Sarcopenia is another pathophysiologic contributor to frailty and is defined as the loss of muscle mass and strength which can occur rapidly after the age of 50 years. The frailty syndrome has also been shown to have direct relationships with osteopenia and osteoporosis.
Interventions for frailty syndrome should aim to prevent, delay, reverse, or reduce the severity of frailty and to prevent or reduce adverse health outcomes in those whose frailty is not reversible. To date, exercise is the interventional modality that has most consistently shown benefit in treating frailty. Nutritional intervention is another nonpharmacological modality that may correct nutritional deficits, including that of micronutrients, and address weight loss of the frailty syndrome.
Frail older people particularly benefit from a clinical approach that addresses both precipitating acute illness and their underlying loss of reserve. Establishing a level of frailty also helps in further investigation, management, and rehabilitation of these patients. It is important to tailor interventions to the individual, incorporating patient preferences and stage on the spectrum of frailty. Palliative care approaches may be considered in the frailest subset of older adults.
Clinical geriatric evaluation teams and specialized programs can play an important role in improving the quality of life for older adults.
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