Comprehensive Model for Physical and Cognitive Frailty: Current Organization and Unmet Needs

Abstract

Aging is characterized by the decline and deterioration of functional cells and results in a wide variety of molecular damages and reduced physical and mental capacity. The knowledge on aging process is important because life expectancy is expected to rise until 2050. Aging cannot be considered a homogeneous process and includes different trajectories characterized by states of fitness, frailty, and disability. Frailty is a dynamic condition put between a normal functional state and disability, with reduced capacity to cope with stressors. This geriatric syndrome affects physical, neuropsychological, and social domains and is driven by emotional and spiritual components. Sarcopenia is considered one of the determinants and the biological substrates of physical frailty. Physical and cognitive frailty are separately approached during daily clinical practice. The concept of motoric cognitive syndrome has partially changed this scenario, opening interesting windows toward future approaches. Thus, the purpose of this manuscript is to provide an excursus on current clinical practice, enforced by aneddoctical cases. The analysis of the current state of the art seems to support the urgent need of comprehensive organizational model incorporating physical and cognitive spheres in the same umbrella.

Clinical, biological and radiological features, 4-week outcomes and prognostic factors in COVID-19 elderly inpatients

“…As in previous cohorts, the most frequent symptoms associated with SARS-CoV-2 infection were fever, cough and dyspnea [17,21]. However, digestive disorders and confusion as isolated symptoms were not rare (16% and 14%, respectively, in our population), highlighting the special attention that clinicians should have in elderly patients [22].…”

“…All SARS-CoV-2 infections were confirmed by RT-PCR from nasopharyngeal swab and/or sputum, with a low Ct (≤20) in 21% of cases and a mild Ct (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) in 28% of cases.…”

The role of the Sunfrail tool in the screening of frailty and in integrated community-hospital care pathways: a retrospective observational study

“…However, this approach brings to light the need for educational programs involving all the actors providing care to older individuals. Actually, the health response to frailty is mainly reactive, targeting its acute late events; for this reason, it is necessary to shift to a “proactive” model, instead to the “reactive” actual one [ 37 ], which obstacles the application of the discussed pathways. In fact, the primary care setting should include programs of screening and subsequent early interventions, to increase the therapeutic margin of these patients [ 38 ].…”

“…In fact, the primary care setting should include programs of screening and subsequent early interventions, to increase the therapeutic margin of these patients [ 38 ]. In this perspective, the Sunfrail may represent a first-line tool in a proactive, community-based, screening program [ 37 ].…”

Frailty and Suicidality in Older Adults: A Mini-Review and Synthesis

“…Frailty's pathogenesis is multifactorial, with factors such as age, multimorbidity with acute and chronic diseases, polypharmacy, and bereavement. Some physical factors, such as inflammatory status, social factors, and psychological factors (such as depression), are also key determinants [22].…”