The Frailty Syndrome: Definition and Natural History
Section snippets
Definition of frailty
Frailty is theoretically defined as a clinically recognizable state of increased vulnerability, resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised. In the absence of a gold standard, frailty has been operationally defined by Fried and colleagues2 as a condition meeting 3 of the 5 phenotypic criteria indicating compromised energetics, namely, low grip strength, low
Natural history of manifestations of frailty criteria
Understanding the points of onset of frailty is vital to early identification of at-risk individuals and intervention on those components that are first affected, when reversal may be most possible. Preclinical detection of early manifestations leading to the frailty syndrome requires an understanding of the natural history of frailty development. The author suggests 2 potential hypotheses as to the natural history of frailty initiation and progression. The author hypothesized that the cycle of
Evidence of frailty as a medical syndrome
A medical syndrome is “a group of signs and symptoms that occur together and characterize a particular abnormality.” To formally evaluate the degree to which the frailty phenotype conforms to the definition of a medical syndrome, Bandeen-Roche and colleagues1 analyzed patterns of co-occurrence of the 5 frailty-defining criteria based on data from a combined sample of women aged 70 to 79 years from the WHAS I and WHAS II. Patterns of criteria co-occurrence that would support the syndrome
Prevalence and incidence of frailty
Based on the frailty criteria developed in the Cardiovascular Health Study (CHS), the overall prevalence of frailty in community-dwelling older adults aged 65 years or older in the United States ranges from 7% to 12%. In the CHS, prevalence of frailty increased with age from 3.9% in the age group of 65 to 74 years to 25% in the age group older than 85 years and was greater in women than in men (8% vs 5%).2 African Americans were more than twice as likely to be frail than Whites in the CHS (13%
Frailty transitions
Epidemiologic data on transitions between frailty states (ie, nonfrail, prefrail, frail) were first reported by Gill and colleagues3 in a 4.5-year longitudinal study of 754 community-living older adults who were 70 years or older. Of the 754 participants, 58% had at least 1 transition between any 2 of the 3 frailty states at one of the 3 follow-up visits 18-months apart during the study; 37%, 22%, and 9% of the participants had 1, 2, and 3 transitions. About one-third (35%) of all 18-month
Behavioral precursors to the development of frailty
An overt state of frailty is believed to be preceded by behavioral adaptation made in response to declining physiologic reserve and capacity with which to meet environmental challenges. The causes of this loss of physiologic reserve are likely to be multifactorial, including both environmental challenges (eg, area deprivation) and intraindividual challenges (eg, age-related physiologic changes). Observations of early behavioral changes during this preclinical phase in older adults in whom
Summary
The recent work on the natural history of frailty has advanced the understanding of the aging process and its potential physiologic correlates. The ongoing debate on the operational definition of frailty, its subdomains (eg, physical vs cognitive), and its relationship with aging, disability, and chronic diseases41, 42, 43, 44, 45 signals that more work is necessary to better define and quantify reserve and resilience, the hallmarks of frailty.16, 46 Despite this debate, researchers and
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