WHAT IS FRAILTY? ~ Domenico Pratico, MD, FCPP

Frailty is a medical condition typical of the elderly (>70 years old), characterized by a reduction in the normal functions of the body associated with an increased vulnerability to endogenous and exogenous stressors, which can result in negative health outcomes. It is important to stress that although frailty is often associated with aging, old age alone does not necessarily correlate with it.

Typically, an older patient with frailty presents clinical symptoms such as progressive weakness and fatigue, chronic medical conditions, and reduced tolerance to medical and surgical interventions.

While there is no gold standard for detecting frailty, various screening tools can be used to diagnose or clinically assess the risk of developing the condition in an individual.

Several studies have examined the incidence of frailty, and the results obtained so far suggest that the condition affects approximately 5 to 15% of individuals who are 70 years and older

In general, frail older adults tolerate less and do not adapt easily to stressors such as acute illness, surgical or medical interventions, or trauma compared with younger or non-frail adults. This increased vulnerability contributes to a higher risk of complications during surgical procedures, falls, disability, and ultimately death.

In most cases, the diagnosis of frailty is based on the physical examination of individuals without evaluating their cognitive ability. However, frailty is associated with an increased risk of cognitive decline. Interestingly, the presence of cognitive impairment increases the likelihood of adverse health outcomes in geriatric patients who meet criteria for physical frailty, suggesting that the two conditions can reinforce each other.

Currently, there are no available therapies specifically for frailty patients. However, several interventions seem promising in preventing or reducing the incidence of frailty.

Exercise is probably the best and most established therapeutic approach for frailty. It improves daily activities, gait, bone mineral density, and general well-being while also reducing the risk and number of falls. However, it is important to ensure that whatever physical activity is implemented is at an intensity level easily tolerated by the individual.

In patients with significant weight loss, nutritional supplementation is another approach. However, before starting any intervention, it is essential to check for issues such as chewing or swallowing difficulties, specific dietary deficiencies, or any side effects of medication. Once these factors are ruled out, a nutritional supplementation plan should be implemented under the supervision of a dietitian or physician.

Caring for frail older adults can be very challenging due to their underlying multiple chronic diseases and the potential lack of good social support. An interdisciplinary team-based approach is often crucial to better meet the medical needs of older adults with frailty.

Early diagnosis of frailty and awareness of the associated risks for adverse health outcomes can improve the care for these patients and significantly reduce the emotional and socioeconomic burden of this ever-growing clinical condition, which often remains underestimated.

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Domenico Praticò, MD, is the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research, Professor and Director of the Alzheimer’s Center at Temple, and Professor of Pharmacology at the Lewis Katz School of Medicine at Temple University

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