Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-04-30T16:07:14.057Z Has data issue: false hasContentIssue false

Chapter 8 - Frailty

from Section II - Geriatric Syndromes

Published online by Cambridge University Press:  30 June 2022

By
Amy S. Klein  and
Mindy J. Fain
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Frailty is an important geriatric syndrome that is common and commonly missed, and affects more than a third of people over age 85. Frailty is characterized by diminished physiologic reserves and function, leading to decreased capacity to withstand stressors. Frail adults are at a higher risk of dependency, institutionalization, and death. Multiple interventions have been attempted, including physical activity, improving nutrition, and hormonal therapy, but there are no curative interventions for frailty and it is not clear if frailty can be reversed. Several issues have limited the advancement of frailty research and translation into practice, including the lack of consensus regarding the definition of frailty, the proliferation of assessment tools, and the gaps in validated best practice guidance for frail patients. The recognition of frailty, especially in its early stages, offers the possibility of preventing or mitigating adverse clinical outcomes. Older adults who are frail may benefit most from a comprehensive geriatric evaluation to help elucidate a plan of care that is consistent with patient's goals, values, and preferences.

Keywords

frailtyfunctionaldebilitystressordeficitsarcopeniamortalityphenotypedeficitdisability
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 81 - 90
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fried, LP, Tangen, CM, Walston, J, Newman, AB, et al. Frailty in older adults: Evidence for a phenotype. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2001; 56(3):146–157.Google Scholar
Morley, JE, Vellas, B, van Kan, GA, Anker, SD, et al. Frailty consensus: A call to action. Journal of the American Medical Directors Association. 2013; 14(6):392–397.CrossRefGoogle ScholarPubMed
Song, X, Mitnitski, A, Rockwood, K. Prevalence and 10- year outcomes of frailty in older adults in relation to deficit accumulation. Journal of the American Geriatrics Society. 2010; 58(4):681–687.CrossRefGoogle ScholarPubMed
Chen, X, Mao, G, Leng, SX. Frailty syndrome: An overview. Clinical Interventions in Aging. 2014; 9:433–441.Google ScholarPubMed
Morley, JE. Frailty fantasia. Journal of the American Medical Directors Association. 2017; 18(10):813–815.Google Scholar
Whitson, HE, Cohen, HJ, Schmader, KE, Kuchel, G, et al. Physical resilience: Not simply the opposite of frailty. Journal of the American Geriatrics Society. 2018; 66:1459–1461.Google Scholar
Rockwood, K, Andrew, M, Mitnitski, A. A comparison of two approaches to measuring frailty in elderly people. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2007; 62(7):738–743.Google Scholar
Rodriguez-Manas, L, Feart, C, Mann, G, Vina, J, et al. Searching for an operational definition of frailty: A Delphi method based consensus statement: the frailty operative definition-consensus conference project. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2013; 68(1):62–67.Google Scholar
Bandeen-Roche, K, Xue, QL, Ferrucci, L, Walston, J, et al. Phenotype of frailty: characterization in the women’s health and aging studies. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2006; 61(3):262–266.Google Scholar
Xue, QL. The frailty syndrome: Definition and natural history. Clinics in Geriatric Medicine. 2011; 27(1):1–15.CrossRefGoogle ScholarPubMed
Gobbens, RJ, Luijkx, KG, Wijnen-Sponselee, Schols JM. In search of an integral conceptual definition of frailty: Opinions of experts. Journal of the American Medical Directors Association. 2010; 5:338–343.Google Scholar
Theou, O, Brothers, TD, Mitnitski, A, Rockwood, K. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. Journal of the American Geriatrics Society. 2013; 61(9):1537–1551.Google Scholar
Bouillon, K, Kivimaki, M, Hamer, M, Sabia, S, et al. Measures of frailty in population-based studies: An overview. BMC Geriatrics. 2013; 13:64.Google Scholar
Abellan van Kan, G, Rolland, Y, Houles, M, Gillette-Guyonnet, S, et al. The assessment of frailty in older adults. Clinics in Geriatric Medicine. 2010; 26(2):275–286.Google Scholar
Malmstrom, TK, Miller, DK, Morley, JE. A comparison of four frailty models. Journal of the American Geriatrics Society. 2014; 62(4):721–726.CrossRefGoogle ScholarPubMed
Jang, RW, Caraiscos, VB, Swami, N, et al. Simple prognostic model for patients with advanced cancer based on performance status. J Oncol Pract. 2014; 10(5):e335–e341.Google Scholar
Shamliyan, T, Talley, KM, Ramakrishnan, R, Kane, RL. Association of frailty with survival: A systematic literature review. Ageing Research Reviews. 2013; 12(2): 719–736.Google Scholar
Cigolle, CT, Ofstedal, MB, Tian, Z, Blaum, CS. Comparing models of frailty: The Health and Retirement Study. Journal of the American Geriatrics Society. 2009; 57(5):830–839.Google Scholar
Bowles, J, Brooks, T, Hayes-Reams, P, Butts, T, Myers, H, Allen, W, et al. Frailty, family, and church support among urban African American elderly. Journal of Health Care for the Poor and Underserved. 2000; 11(1):87–99.Google Scholar
Ottenbacher, KJ, Ostir, GV, Peek, MK, Snih, SA, et al. Frailty in older Mexican Americans. Journal of the American Geriatrics Society. 2005; 53(9):1524–1531.Google Scholar
Gill, TM, Gahbauer, EA, Han, L, Allore, HG. Trajectories of disability in the last year of life. New England Journal of Medicine. 2010; 362(13):1173–1180.CrossRefGoogle ScholarPubMed
Robertson, DA, Savva, GM, Kenny, RA. Frailty and cognitive impairment: A review of the evidence and causal mechanisms. Ageing Research Reviews. 2013; 12(4):840–851.CrossRefGoogle ScholarPubMed
Borges, MK, Canevelli, M, Cesari, M, Aprahamian, I. Frailty as a predictor of cognitive disorders: A systematic review and meta-analysis. Frontiers in Medicine. 2019; 6(26).CrossRefGoogle ScholarPubMed
Vetrano, DL, Palmer, K, Marengoni, A, Marzetti, E, et al. Frailty and multimorbidity: A systematic review and meta-analysis. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2019; 74(5):659–666.Google Scholar
Denfeld, QE, Winters-Stone, K, Mudd, JO, Gelow, JM, et al. The prevalence of frailty in heart failure: A systematic review and meta-analysis. International Journal of Cardiology. 2017; 236:283–289.Google Scholar
Verlaan, S, Ligthart-Melis, GC, Wijers, S, Cederholm, T, et al. High prevalence of physical frailty among community-dwelling malnourished older adults: A systematic review and meta-analysis. Journal of the American Medical Directors Association. 2017; 18(5):374–382.Google Scholar
Soysal, P, Veronese, N, Thompson, T, Kahl, KG, Fernandes, BS, et al. Relationship between depression and frailty in older adults: A systematic review and meta-analysis. Ageing Research Reviews. 2017; 36:78–87.Google Scholar
Handforth, C, Clegg, A, Young, C, Simpkins, S, et al. The prevalence and outcomes of frailty in older cancer patients: A systematic review. Annals of Oncology: Official Journal of the European Society for Medical Oncology. 2015; 26(6):1091–1101.Google Scholar
Villareal, DT, Chode, S, Parimi, N, Sinacore, DR, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011; 364:1218–1229.Google Scholar
Kalyani, RR, et al. Frailty status and altered glucose-insulin dynamics. J Gerontol Ser A Biol Sci Med Sci. 2012; 67:1300–1306.Google Scholar
Xue, QL, Bandeen-Roche, K, Varadhan, R, Zhou, J, Fried, LP. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women’s Health and Aging Study II. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2008; 63(9):984–990.Google Scholar
Gill, TM, Gahbauer, EA, Allore, HG, Han, L. Transitions between frailty states among community-living older persons. Archives of Internal Medicine. 2006; 166(4):418–423.Google Scholar
Leng, S, Chaves, P, Koenig, K, Walston, J. Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: A pilot study. Journal of the American Geriatrics Society. 2002; 50(7):1268–1271.CrossRefGoogle ScholarPubMed
Mohler, MJ, Fain, MJ, Wertheimer, AM, Najafi, B, Nikolich-Žugich, J. The frailty syndrome: Clinical measurements and basic underpinnings in humans and animals. Experimental Gerontology. 2014; 54:6–13.Google Scholar
Ershler, WB, Keller, ET. Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annual Review of Medicine. 2000; 51:245–270.Google Scholar
Leng, SX, Xue, QL, Tian, J, Huang, Y, Yeh, SH, Fried, LP. Associations of neutrophil and monocyte counts with frailty in community-dwelling disabled older women: results from the Women’s Health and Aging Studies I. Experimental Gerontology. 2009; 44(8):511–516.Google Scholar
Leng, SX, Cappola, AR, Andersen, RE, Blackman, MR, Koenig, K, Blair, M, et al. Serum levels of insulin-like growth factor-I (IGF-I) and dehydroepiandrosterone sulfate (DHEA-S), and their relationships with serum interleukin-6, in the geriatric syndrome of frailty. Aging Clinical and Experimental Research. 2004; 16(2):153–157.Google Scholar
Travison, TG, Nguyen, AH, Naganathan, V, Stanaway, FF, et al. Changes in reproductive hormone concentrations predict the prevalence and progression of the frailty syndrome in older men: The concord health and ageing in men project. Journal of Clinical Endocrinology and Metabolism. 2011; 96(8):2464–2474.Google Scholar
Poehlman, ET, Toth, MJ, Fishman, PS, Vaitkevicius, P, et al. Sarcopenia in aging humans: the impact of menopause and disease. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 1995; 50:73–77.Google Scholar
Clegg, A, Young, J, Iliffe, S, Rikkert, MO, Rockwood, K. Frailty in elderly people. Lancet. 2013; 381(9868):752–762.Google Scholar
Varadhan, R, Walston, J, Cappola, AR, Carlson, MC, Wand, GS, Fried, LP. Higher levels and blunted diurnal variation of cortisol in frail older women. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2008; 63(2):190–195.Google Scholar
Ko, FC. The clinical care of frail, older adults. Clinics in Geriatric Medicine. 2011; 27(1):89–100.Google Scholar
Cruz-Jentoft, AJ, Bahat, G, Bauer, J, Boirie, Y, et al. Sarcopenia: Revised European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People 2. Age and Ageing. 2019; 48:16–31.Google Scholar
Janssen, I, Shepard, DS, Katzmarzyk, PT, Roubenoff, R. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004; 52(1):80–85.Google Scholar
Cawthon, PM, Orwoll, ES, Peters, KE, et al. Strong relation between muscle mass determined by D3-creatine dilution, physical performance, and incidence of falls and mobility limitations in a prospective cohort of older men. J Gerontol A Biol Sci Med Sci. 2019; 74(6):844‐852.Google Scholar
Haehling, SV, Morley, J. An overview of sarcopenia: Facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010; 1:129–133.Google Scholar
Yao, X, Hamilton, RG, Weng, NP, Xue, QL, Bream, JH, Li, H, et al. Frailty is associated with impairment of vaccine-induced antibody response and increase in post-vaccination influenza infection in community-dwelling older adults. Vaccine. 2011; 29(31):5015–5021.Google Scholar
Ridda, I, Macintyre, CR, Lindley, R, Gao, Z, et al. Immunological responses to pneumococcal vaccine in frail older people. Vaccine. 2009; 27(10):1628–1636.Google Scholar
Afilalo, J, Alexander, KP, Mack, MJ, Maurer, MS, Green, P, Allen, LA, et al. Frailty assessment in the cardiovascular care of older adults. Journal of the American College of Cardiology. 2014; 63(8):747–762.Google Scholar
Makary, MA, Segev, DL, Pronovost, PJ, Syin, D, et al. Frailty as a predictor of surgical outcomes in older patients. Journal of the American College of Surgeons. 2010; 210(6):901–908.Google Scholar
Kim, SW. Multidimensional frailty score for the prediction of post-operative mortality risk. JAMA Surgery. 2014; 149(7):633–640.Google Scholar
Joseph, B, Pandit, V, Zangbar, B, Kulvatunyou, N, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients. JAMA Surg. 2014; 149(8):766–772.CrossRefGoogle ScholarPubMed
Fernando, SM, McIsaac, DI, Rochwerg, B, et al. Frailty and invasive mechanical ventilation: Association with outcomes, extubation failure, and tracheostomy. Intensive Care Med. 2019; 45:1742–1752.Google Scholar
Pollack, LR, Goldstein, NE, Gonzalez, WC, et al. The frailty phenotype and palliative care needs of older survivors of critical illness. J Am Geriatr Soc. 2017; 65(6):1168‐1175.Google Scholar
Vermeiren, S, Vella-Azzopardi, R, Beckwée, D, et al. Frailty and the prediction of negative health outcomes: A meta-analysis. J Am Med Dir Assoc. 2016; 17(12):1163.e1–e17.Google Scholar
Handforth, C, Clegg, A, Young, C, Simpkins, S, et al. The prevalence and outcomes of frailty in older cancer patients: A systematic review. Annals of Oncology: Official Journal of the European Society for Medical Oncology. 2015; 26(6):1091–1101.Google Scholar
Cohen, HJ, Smith, D, Sun, CL, et al. Frailty as determined by a comprehensive geriatric assessment-derived deficit-accumulation index in older patients with cancer who receive chemotherapy. Cancer. 2016; 122(24):3865‐3872.Google Scholar
Stow, D, Spiers, G, Matthews, FE, Hanratty, B. What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis. Palliat Med. 2019; 33(4):399–414.Google Scholar
Ernst, KF, Hall, DE, Schmid, KK, et al. Surgical palliative care consultations over time in relationship to systemwide frailty screening. JAMA Surg. 2014; 149(11):1121–1126.Google Scholar
Weening-Dijksterhuis, E, de Greef, MH, Scherder, EJ, Slaets, JP, et al. Frail institutionalized older persons: A comprehensive review on physical exercise, physical fitness, activities of daily living, and quality-of-life. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2011; 90(2):156–168.Google Scholar
Theou, O, Stathokostas, L, Roland, KP, Jakobi, JM, et al. The effectiveness of exercise interventions for the management of frailty: A systematic review. Journal of Aging Research. 2011; 2011:569194.Google Scholar
De Vries, NM, van Ravensberg, CD, Hobbelen, JS, Olde Rikkert, MG, et al. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Research Reviews. 2012; 11(1): 136–149.Google Scholar
Peterson, MJ, Giuliani, C, Morey, MC, Pieper, CF, et al. Physical activity as a preventative factor for frailty: The health, aging, and body composition study. Journals of Gerontology Series A, Biological Sciences and Medical Sciences. 2009; 64(1):61–68.Google Scholar
Gill, TM, Baker, DI, Gottschalk, M, Peduzzi, PN, et al. A program to prevent functional decline in physically frail, elderly persons who live at home. New England Journal of Medicine. 2002; 347(14):1068–1074.Google Scholar
Serra-Prat, M, Sist, X, Domenich, R, Jurado, L, et al. Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: A randomised controlled trial. Age and Ageing. 2017; 46(3):401–407.Google Scholar
Milne, AC, Potter, J, Vivanti, A, Avenell, A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database of Systematic Reviews. 2009; 2:CD003288.Google Scholar
Cawood, AL, Elia, M, Stratton, RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Research Reviews. 2012; 11(2):278–296.Google Scholar
Orrevall, Y. Nutritional support at the end of life. Nutrition. 2015; 31(4):615–616.Google Scholar
Levitt, A, OʼNeil, J. Older adults with unintended weight loss: The role of appetite stimulants. Home Healthc are Now. 2018; 36(5):312–318.Google Scholar
Ward, RE, et al. Association between diet quality and frailty prevalence in the Physicians’ Health Study. J Am Geriatr Soc. 2020; 68:770–776.Google Scholar
Hengeveld, LM, et al. Prospective associations of diet quality with incident frailty in older adults: The health, aging, and body composition study. J Am Geriatr Soc. 2019; 67:1835–1842. doi: 10.1111/jgs.16011.Google Scholar
Lorenzo-Lopez, L, et al. Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr. 2017 (May 15); 17(1):108. doi: 10.1186/s12877-017-0496-2.Google Scholar
Morley, JE. Should frailty be treated with testosterone? Aging Male: The Official Journal of the International Society for the Study of the Aging Male. 2011; 14(1):1–3.Google Scholar
Muir, SW, Montero-Odasso, M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: A systematic review and meta-analysis. Journal of the American Geriatrics Society. 2011; 59(12):2291–2300.Google Scholar
Wong, YY, McCaul, KA, Yeap, BB, Hankey, GJ, et al. Low vitamin D status is an independent predictor of increased frailty and all-cause mortality in older men: The Health in Men Study. Journal of Clinical Endocrinology and Metabolism. 2013; 98(9):3821–3828.Google Scholar
Lamberts, SW. The somatopause: To treat or not to treat? Hormone Research. 2000; 53(Suppl. 3):42–43.CrossRefGoogle ScholarPubMed
Gallagher, P, Ryan, C, Byrne, S, Kennedy, J, O’Mahony, D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics. 2008; 46(2):72–83.Google Scholar
Onder, G, Penninx, BW, Balkrishnan, R, Fried, LP, et al. Relation between use of angiotensin-converting enzyme inhibitors and muscle strength and physical function in older women: An observational study. Lancet. 2002; 359(9310):926–930.CrossRefGoogle ScholarPubMed
Ellis, G, Whitehead, MA, Robinson, D, O’Neill, D, et al. Comprehensive geriatric assessment for older adults admitted to hospital: Meta-analysis of randomised controlled trials. BMJ (Clinical Research Ed). 2011; 343:d6553.Google Scholar
Kawryshanker, S, Raymond, W, Ingram, K. Effect of frailty on functional gain, resource utilization, and discharge destination: An observational prospective study in a GEM ward. Current Gerontology and Geriatric Research. 2014; 2014:357857.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×