Frailty is usually defined as an aging-related syndrome of physiological decline, characterized by increased vulnerability to adverse health outcomes. Frail older patients often present with an increased burden of symptoms including weakness and fatigue, medical complexity, and reduced tolerance to medical and surgical interventions.
Deeper dive
A decline in functioning across multiple organ systems and greater risk of adverse outcomes—including falls and fractures, admission to long-term care, and early death are hallmarks of frailty, according to The Lancet. The rapid expansion of the aging population has led to an increasing prevalence of frailty, with further increases anticipated in future, particularly in low-income and middle-income countries.
Although the prevalence of frailty varies with the tool used and with the population studied, several studies show that prevalence ranges from 4 to 16% in community-dwelling men and women aged 65 and older in the United States. Pre-frailty (patients at risk for frailty who fulfill some, not but all, criteria for frailty) has a prevalence ranging from 28 to 44% in those over 65 In 2001, gerontologist Linda Fried and colleagues supported the idea of a “frailty phenotype” by identifying five specific physical characteristics by which it could be standardized:
- Weakness.
- Low energy.
- Slowed walking speed.
- Decreased physical activity.
- Weight loss.
Those with one or two domains are classified as prefrail, and those with three to five domains are considered frail. Other researchers describe frailty as an index of deficits of candidate variables (i.e., a ratio of physical deficits as well as morbidities, disability, and other clinical variables that accumulate and progressively burden an individual). The magnitude and speed at which deficits accumulate can be used to gauge vulnerability and risk.