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A syndrome of vulnerability and physical decline with aging that increases risk for disability, hospitalizations, and death.
Phenotype criteria: shrinking size with weight loss, weakness, poor endurance, slowness and low physical activity.
A phenotype characterized by self-reported weakness, low physical activity, exhaustion, slowness in walking, and unintentional weight loss.
Frailty becomes more common as a population ages and frailty among community dwelling ranges from 11% among those who are 50 to 59 years of age to 51% of those 90 years of age or older.
Frailty is a state of accumulated health deficits.
Older adults identified as frail are more likely to become disabled, have medical comorbidity, and are at increased risk of hospitalization, falls, disability, and death than those not identified as frail.
Frailty is complex, multi dimensional, and cyclical state of diminished physiological reserve their results in decreased resiliency and adaptive capacity, and increased vulnerability to stressors.
Frailty is thought to be a process of accelerated aging at sub, cellular and cellular levels, associated with chronic inflammation, cellular senescence, dysfunction of mitochondria, and deregulated nutrient sensing.
Dysregulated nutrient sensing is implicated in the development of frailty.
Smell decreases with frailty,
Nutrient sensing pathways, involve mTOR, AMPK, and sirtions one and three nutrient scarcity sensors.
The activation of AMPK and sirtuin pathways and the inhibition of mTOR pathway, with caloric restriction offers health and longevity benefits.
Mitochondrial mutations in DNA destabilize respiratory chain complexes, decrease production of cellular energy, increase production of reactive oxygen species and inflammation.
Mitochondrial dysfunction in skeletal muscle is associated with muscle weakness, exercise, intolerance, and fatigue.
Reduced number of mitochondrial DNA copies, which is a marker of mitochondrial depletion, correlates with a frailty phenotype.
Chronic inflammation, may decrease immune responses, increase susceptibility to infections and impair the antibody response after vaccination.
Frailty is associated with altered metabolism, coupled with abnormal stress responses.
Frailty’s chronic inflammation, may be a response to cellular senescence which inhibits growth factor expression, and increases catabolism, which contributes to sarcopenia and frailty.
With frailty cells may secrete pro inflammatory molecules known as senescence associated secretory secretory phenotype.
Aging is associated with hormonal changes, including a decline in anabolic hormones-dehydroepiandrsterone sulfate, testosterone, growth hormone, insulin like growth factor 1 and then increasing catabolic hormones such as cortisol.
These hormonal changes, inhibit growth of scales or muscles, promote loss of resilience, and the ability to recover from stressors promoting frailty.
Its features are exhaustion, weakness, slowness, physical, inactivity, and weight loss, which is the last manifestation.
The presence of frailty is indicated by the presence of all five features above.
The present of five of the above manifestations indicate to risk of death rising sharply, and a chance of reversal diminishing
Prevalence estimated to be 10% in the population aged >60 years and 25% in the population aged ≥80 years.
A multifaceted process that reflects decreased physiologic reserve and elevated vulnerability to stressors, impaired mobility and poor nutritional status.
A clinical syndrome associated with decreased ability to recover from a stressful event due to decline in multiples physiological systems and resulting in poorer health outcomes.
Refers to the accumulation of biological deficits and dysfunctions that occur with age and impairs homeostatic balance.
Inflammatory cytokines such as C-reactive protein, interleukin-6 (IL-6), interleukin-1, tumornecrosis factor (TNF)-α, and TNF soluble receptor 1 and 2 are increased with age and can predict frailty and impairments in mobility and physical function.
Progressive age-related cumulative decline in many physiological systems, conferring vulnerability to stressors and increases the risk of negative health outcomes.
Progressive and often considered irreversible.
Characterized by a heightened susceptibility to perturbationsin the bodies homeostatic systems.
Its progression can be slowed.
Prevalence increases with age, is higher among women, and among residents of long term facilities.
Its precursor is referred to as prefrailty, which can be treated with a return to a state of robustness.
The increased risk for adverse outcomes of disability, hospitalization, and death follows a step-wise pattern of increasing risk according to frailty categorization.
Frailty characteristics:muscle weakness, slowness, low physical activity, exhaustion, and weight loss.
Individuals with ≥3 of these 5 characteristics are categorized as frail, individuals with 1 or 2 are
categorized as pre-frail, and individuals with 0 are classified as nonfrail.
It is associated with falls, fractures, decreased influenza vaccination effectiveness, decreased likelihood of following therapeutic recommendations, increased dependency in activities of daily living, poor quality of life, increased risk of disability, hospitalization, and institutionalization, and shorter survival.
Frailty is estimated to affect 20% of patients age 65 years or older who have undergone percutaneous coronary intervention and 20.7% in patients age 70 or older who have had cardiac catherization.
In frail elderly patients dysphagia is associated with increased odds ratio for aspiration ammonia by a factor of 9.4, but when cerebrovascular disease was also present, the odds ratio increases to 12.9.
Chronic disease(s) has a central role in initiating or worsening frailty.
People with COPD have a twofold odds increase of frailty, and it is associated with a greater likelihood of worsening or progressing of the process.
The frailty phenotype increases vulnerability to stress and places them at higher risk for mortality, hospitalization, and overall just being unwell.
Older adults identified as frail are more likely to become disabled, have medical comorbidity, and are at increased risk of hospitalization, falls, disability, and death than those not identified as frail.
Prevalence estimated to be 10% in the population aged >60 years and 25% in the population aged ≥80 years.
It is suggested that all people > 70 years of age be screened for frailty, but barriers to assessment exist, with a major limitation being the absence of consensus on best criteria and instruments of measurement.
Frailty is potentially reversible to a prefrail or robust status.
State of increased vulnerability to stressors that result from decreased physiological reserves, multi system impairments, limited capacity to maintain homeostasis and to respond to internal and external stresses.
Results in decreased physiological reserve and diminished resistance to stressors.
There is a strong association between diabetes and frailty.
Individuals with diabetes have an 40% increased risk of developing frailty.
Diabetes leads to an accelerated rate of muscle loss, which worsens with increased length of time with diabetes and worse glycemic control.
Inflammation Is a central mechanism underlying frailty and Type 2 Diabetes.
There is an association between frailty and inflammation:it is believed to be responsible for the poor
stress tolerance and lack of physiological resilience observed in older adults with frailty.
Observational studies indicate that metformin reduces mortality and frailty.
Associated with susceptibility to adverse outcomes resulting from diminished reserve and resistance to stressors and is caused by degradation in physiological systems that accumulate with age.
An aggregate expression of risk as a result of aging or disease-related accumulations of subthreshold decrements affecting physiological systems with the result of adverse health.
About 7% of population of elderly (three frailty criteria) are frail and 47% prefrail (1-2 frailty criteria)(Fried LP).
Most commonly observed in older adults, with approximately 10% of individuals in the general population, 65 years or older, are frail.
Indicates increased vulnerability to external stressors.
Frailty may be the largest global problem associated with an aging population.
A predictor of early mortality as it is a precursor of chronic disease.
Skeletal muscle weakness is one of the phrenotypes of frailty and is associated with decreased exercise capability, and physical disabilities.
Skeletal muscle strength is a prognostic factor in community dwellers, and chronic heart failure.
Prevalence substantially increases at the age of 80 and is much higher among nursing home residents.
It is associated with age related diseases such as heart failure, sarcopenia, arthritis, osteoporosis, stroke, fear of falling, confusion, depression, incontinence, cognitive decline, chronic pain, and iatrogenic processes.
Complete tooth loss, dry mouth, and cumulative oral health problems are associated with incidence of frailty independent of socioeconomic factors and comorbidities.
The findings suggest that identifying and managing poor oral health in older people could be important in preventing frailty.
Canadian Study of Health and Aging (CSHA) analyzed 9008 adults over the age of 65 and found the prevalence of frailty 0.7%, 2%, and 4%, respectivley, of patients ages 65 to 74 years, 75 to 84 years, and 85 years and older.
Frail population identified in elderly, female and African Americans(Cigolle CT).
Obesity, insulin resistance, inflammation, and diabetes are associated with and predict frailty.
Frailty common among patients initiating dialysis and is associated with a higher eGFR at dialysis institution, and strongly associated with death and hospitalization (Bao Y et al).
Assessed with the Fried Frailty scale: The presence of three of the following processes including weight loss, exhaustion, weakness, decreased gait speed, diminished physical activity.
Gait speed (less than .8 m/s) has a 99% sensitivity for detecting frailty phenotype.
Frailty is seen in young survivors of cancer or a bone marrow transplant up to age 65 years, as they develop frailty at the same rate as community dwelling elderly.
To date there are no effective interventions to prevent frailty.
No evidence exists that can support the effect of any intervention to prevent or treat frailty.
Exercise intervention reduces frailty primarily to its effect on increasing the physical activity level in study participants, but no effect was observed with regard to gait speed or grip strength.
Many exercise interventions have demonstrated improvement in components of frailty, such as strength, gait speed, and physical activity.
The LIFE study showed exercise intervention did not reduce the frailty incidence.
Regular physical activity is beneficial for frail older adults or those at high risk of frailty and that the adverse effects related to exercise are minimal compared with the potential gains.
The LIFE study intervention did show improvement in the incidence of major mobility disability and ability to rise from a chair.
A study examining the effect of an exercise program consisting of aerobic, strengthening, and
balance exercises on frailty showed no significant reduction in frailty incidence.
Supplementation with vitamin D, n– three fatty acids, sex hormones, or growth hormone have had a little effect on the status of frailty, physical functioning, or activities of daily living.
Exercise alone, or oral nutritional supplementation alone, have equivocal benefits with respect to physical functioning and activities of daily living.