Vulnerability in the Elderly: Frailty
Section snippets
The concepts
It is acknowledged widely that different multifactorial diseases share the same risk factors, both genetic and environmental. Second, multifactorial diseases cluster (ie, patients with one such disease are more likely to develop additional diseases). Multifactorial diseases are the result of multiple risk factors. Examples are depression, cancer, chronic obstructive pulmonary disease, and cardiovascular and endocrine diseases; together they make up the most common disorders in adulthood, and
Frailty and age
The general concept of vulnerability has a specific meaning in the context of the elderly. Frailty can be seen as increasing vulnerability associated with aging. According to Verbrugge [3], frailty can be seen as a syndrome in which more areas of functioning decline with aging. In this way frailty is a precursor state of functional limitations and disability associated with the aging process itself; the comorbidity of chronic diseases; and multiple risk factors, including psychosocial and
Frailty, comorbidity, and disability
Frailty is an aggregate expression of risks that result from age- or disease-associated physiologic accumulation of subthreshold decrements that affect multiple physiologic systems. Although the early stages of this process may be clinically silent, when the losses of reserve reach an aggregate threshold that leads to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral, and biologic markers. Central to the clinical definition of frailty has
Old or frail, what tells us more to guide treatment in the elderly?
Even the risk for individual mortality, which can be seen as the ultimate outcome of age and frailty [14], can be predicted better by frailty than by chronologic age [15]; however, a test of frailty versus chronologic age with self-management abilities (SMAs), a kind of coping skills, as an outcome measure was not available. To study the associations between frailty, SMAs, and age, the author and colleagues [16] first addressed the operationalizations of frailty and SMAs. The bundle of losses
Relation between frailty and case complexity
In the article by de Jonge and colleagues elsewhere in this issue, arguments will be made to divide “complexity” into two clinical concepts—case- and care-complexity—with a linear relation. Generally speaking, the more complex the case, the more complex is the care that is needed. In complex medical situations there always will be a level of uncertainty that has to be managed in clinical care [19]. By disentangling complexity, opportunities are created to solve the most critical problems in
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