The Frailty Syndrome: Definition and Natural History

Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-700, Baltimore, MD 21205-1179, USA.
Clinics in Geriatric Medicine (Impact Factor: 3.19). 02/2011; 27(1):1-15. DOI: 10.1016/j.cger.2010.08.009
Source: PubMed


This article reviews the current state of knowledge regarding the epidemiology of frailty by focusing on 6 specific areas: (1) clinical definitions of frailty, (2) evidence of frailty as a medical syndrome, (3) prevalence and incidence of frailty by age, gender, race, and ethnicity, (4) transitions between discrete frailty states, (5) natural history of manifestations of frailty criteria, and (6) behavior modifications as precursors to the development of clinical frailty.

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    • "The frailty phenotype postulates that five indicators of physical functioning (unintentional weight loss, exhaustion, slow walking speed, low grip strength, and low physical activity) are related to each other in a cycle of frailty. Several countries have carried out studies based on the frailty criteria developed by Fried et al. [4]. For example, since 2008 several studies have been published in Spain estimating the prevalence of frailty in communities of elderly persons using modified Fried criteria [5-10]. "
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    ABSTRACT: This study aimed to estimate the prevalence and associated factors related to frailty, by Fried criteria, in the elderly population in a rural area in the Andes Mountains, and to analyze the relationship of these with comorbidity and disability. A cross-sectional study was undertaken involving 1878 participants 60 years of age and older. The frailty syndrome was diagnosed based on the Fried criteria (weakness, low speed, low physical activity, exhaustion, and weight loss). Variables were grouped as theoretical domains and, along with other potential confounders, were placed into five categories: (a) demographic and socioeconomic status, (b) health status, (c) self-reported functional status, (d) physical performance-based measures, and (e) psychosocial factors. Chi-square, ANOVA, and multinomial logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest. The prevalence of frailty was 12.2%. Factors associated with frailty were age, gender, health status variables that included self-perceived health and number of chronic conditions, functional covariate variables that included disability in activities in daily living (ADL), disabilities in instrumental ADL, chair stand time, and psychosocial variables that included depressive symptoms and cognitive impairment. Higher comorbidity and disability was found in frail elderly people. Only a subset of frail elderly people (10%) reported no disease or disability. A relevant number of elderly persons living in rural areas in the Andes Mountains are frail. The prevalence of frailty is similar to that reported in other populations in the Latin American region. Our results support the use of modified Cardiovascular Health Study criteria to measure frailty in communities other than urban settings. Frailty in this study was strongly associated with comorbidities, and frailty and comorbidity predicted disability.
    Full-text · Article · Jan 2014 · BMC Geriatrics
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    • "living in the community have OH (Feldstein & Weder, 2012; Figueroa et al., 2010; Gupta & Lipsitz, 2007; Kobayashi & Yamada, 2011; Shibao et al., 2007). The common symptoms of OH predispose older people to have a high risk of falling, which starts the vicious circle of injury, fracture, disability, and ensuing frailty (Gupta & Lipsitz, 2007; Shibao et al., 2007; Xue, 2011). "
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    ABSTRACT: To enhance awareness of orthostatic hypotension (OH) in older populations, and guide primary care nurse practitioners (NPs) in the assessment and management of patients with OH. Electronic data collection was conducted on studies and reviews that were published between 2005 and 2012 in English, and contained information related to the purpose of this article from following databases: PubMed, Scopus, and MEDLINE. OH is a syndrome that is accompanied by unfavorable symptoms such as dizziness, and headaches and can impede the individual's daily activities and quality of life. The prevalence of OH is higher in older people because of comorbidities, polypharmacy, and physiological changes that occur with aging. OH is diagnosed with serial blood pressure measurements and the primary goal of management is to relieve unfavorable symptoms and enhance patient safety. Pharmacological management is considered when nonpharmacological interventions fail. OH is not a problem to be taken lightly as it is highly related to the risk of falling and cardiovascular problems, as well as increasing morbidity and mortality rates. NPs can contribute to improving the quality of life for older adults and reducing adverse consequences by understanding OH and adequately managing it.
    Preview · Article · Sep 2013 · Journal of the American Association of Nurse Practitioners
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    • "These are exceptional centenarians who experience minimal physical impairment [3] along with healthy minds and bodies [4] [5]. However, many individuals experience more rapid functional declines in their 60's or 70's, sometimes afflicted with the " frailty syndrome " —defined as a lack in general strength and unusual susceptibility to disease or to other infirmity [6]—and these individuals often suffer from multiple agerelated morbidities such as cardiovascular disease, neurodegenerative diseases, diabetes, and cancer [7]. The majority of individuals lie between these two extreme scenarios, with an average life expectancy of 81 years old in North America [8]. "
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    ABSTRACT: Compelling evidence suggests that both biological and psychosocial factors impact the process of aging. However, our understanding of the dynamic interplay among biological and psychosocial factors across the life course is still fragmentary. For example, it needs to be established how the interaction of individual factors (e.g., genetic and epigenetic endowment and personality), behavioral factors (e.g., physical activity, diet, and stress management), and psychosocial experiences (e.g., social support, well-being, socioeconomic status, and marriage) in perinatal, childhood, and adulthood influence health across the aging continuum. This paper aims to outline potential intersection points serving as an interface between biological and psychosocial factors, with an emphasis on the mitochondrion. Mitochondria are cellular organelles which play a critical role in cellular senescence. Both chronic exposure to psychosocial stress and genetic-based mitochondrial dysfunction have strikingly similar biological consequences; both predispose individuals to adverse age-related health disorders and early mortality. Exploring the interactive nature of the factors resulting in pathways to normal healthy aging, as well as those leading to morbidity and early mortality, will continue to enhance our ability to translate research into effective practices that can be implemented throughout the life course to optimise the aging process.
    Full-text · Article · Sep 2011 · Journal of aging research
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