Understanding Frailty

Woman using smartwatch

There is no official definition of frailty which leads to inconsistent and conflicting views on this diagnosis. There is currently a lot of research aiming to standardize the definition of frailty and prefrailty, to be able to correctly diagnose the patients, provide adequate treatment, and take potential preventive actions.

Currently, the most often used measures of frailty are Fried phenotype model and Rockwood cumulative deficit model.

Fried phenotype model

Fried phenotype model assesses the patient based on five characteristics – unintentional loss of more than 10lbs (4.5kg) in the past year, self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. Patients with one or two of these characteristics are considered prefrail, those with three or more are considered frail.

To define these five criteria, Fried with his colleagues used data from over five thousand participants of Cardiovascular Health Study, men and women 65 years or older. From this data, they concluded that the frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic disease and disability. Frailty is also more prevalent in women. It was often thought that frailty is synonymous with disability and comorbidity but Fried found that the comorbidity is a risk factor for frailty, and disability is an outcome.

Rockwood cumulative deficit model

Another most used model is Rockwood’cumulative deficit model assumes that accumulation of deficits, such as loss of hearing, low mood, tremor, dementia, etc., increase the ‘frailty index’ and thus increase the risk of adverse outcomes.

Predictors, outcomes, and prevention

Loosely, the term frailty describes an elderly individual with physical and cognitive impairments which result or lead to increased dependency. There are many predictors of frailty, clinical as well as pathophysiological, e.g. weakness, anemia, cognitive impairment, insulin resistance, higher levels of inflammatory markers, etc.

Frail individuals are more prone to falls, disability, the need for medical and/or social care. Frailty has a negative impact on all aspect of a person’s life – physical, social, and emotional and thus leads to a lower quality of life and a shorter lifespan. At the same time, it increases the financial burden on the healthcare system and the psychological and emotion burden on affected individuals and their families.

Although there are many factors influencing the onset of the frailty which cannot be influenced and there is no specific treatment of the frailty, there are preventive and therapeutic actions which can be taken to prevent or slow down the functional decline. One of the most promising seems to be exercise and physical treatment targeted at muscles strengthening and balance training.


Sources:

Yaksic, E., Lecky, V., Sharnprapai, S. et al. J Frailty Aging (2019). https://doi.org/10.14283/jfa.2019.4

Lally F, Crome P. Understanding frailty. Postgrad Med J. 2007;83(975):16–20. doi:10.1136/pgmj.2006.048587

Fried, Linda P., Catherine M. Tangen, Jeremy D. Walston, Anne B. Newman, Calvin Hirsch, John S. Gottdiener, Theresa Seeman, Russell Tracy, Willem Johan Kop, Gregory Burke and Mary Ann Mcburnie. “Frailty in older adults: evidence for a phenotype.” The journals of gerontology. Series A, Biological sciences and medical sciences 56 3 (2001): M146-56 .

Turner G., Introduction to Frailty, Fit for Frailty Part 1, available online: https://www.bgs.org.uk/resources/introduction-to-frailty

Gill TM et al. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002 Oct 3; 347:1068-74.

Leave a Comment