Defining frailty — the holy grail of geriatric medicine

Conroy, Simon

doi:10.1007/s12603-009-0050-9

Cited by 40 publications

(25 citation statements)

References 7 publications

(3 reference statements)

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“…Frailty is of considerable interest in research and in practice, but agreement on factors necessary for defining frailty is elusive (Conroy 2009;Fried et al 2001Fried et al , 2004Rockwood and Mitnitski 2007). The 2 main ways to conceptualize frailty are the phenotype model and the cumulative deficit model (Clegg et al 2013;Fried et al 2001;Morley et al 2013;Rockwood and Mitnitski 2007).…”

Section: What Is Frailty?mentioning

confidence: 99%

“…Although there is agreement regarding the importance of identifying and treating frailty, there is currently no consensus on what elements are necessary for its diagnosis (Conroy 2009;Fried et al 2001Fried et al , 2004Rockwood and Mitnitski 2007). The 2 main models for conceptualizing frailty (phenotype and cumulative deficit) form the basis for many screening and assessment tools created to date (Clegg et al 2013;Fried et al 2001;Morley et al 2013;Rockwood and Mitnitski 2007 (Fried et al 2001), the Clinical Frailty Scale (Rockwood et al 2005), the Gérontopôle Frailty Screening Tool (Subra et al 2012), the interRAI Assessment Urgency Algorithm (Elliott 2016), or simply, walking speed (Mathias et al 1986;Muscedere et al 2016).…”

Section: Frailty Screening/assessment Toolsmentioning

confidence: 99%

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Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition

Laur

McNicholl

Valaitis

et al. 2017

Appl. Physiol. Nutr. Metab.

123

116

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Abstract:There is increasing awareness of the detrimental health impact of frailty on older adults and of the high prevalence of malnutrition in this segment of the population. Experts in these 2 arenas need to be cognizant of the overlap in constructs, diagnosis, and treatment of frailty and malnutrition. There is a lack of consensus regarding the definition of malnutrition and how it should be assessed. While there is consensus on the definition of frailty, there is no agreement on how it should be measured. Separate assessment tools exist for both malnutrition and frailty; however, there is intersection between concepts and measures. This narrative review highlights some of the intersections within these screening/assessment tools, including weight loss/decreased body mass, functional capacity, and weakness (handgrip strength). The potential for identification of a minimal set of objective measures to identify, or at least consider risk for both conditions, is proposed. Frailty and malnutrition have also been shown to result in similar negative health outcomes and consequently common treatment strategies have been studied, including oral nutritional supplements. While many of the outcomes of treatment relate to both concepts of frailty and malnutrition, research questions are typically focused on the frailty concept, leading to possible gaps or missed opportunities in understanding the effect of complementary interventions on malnutrition. A better understanding of how these conditions overlap may improve treatment strategies for frail, malnourished, older adults.Key words: frailty, malnutrition, screening, assessment, diagnosis, handgrip strength, oral nutritional supplements, older adult.Résumé : Les effets néfastes de la fragilité des personnes âgées sur leur santé ainsi que la forte prévalence de malnutrition dans cette strate de la population suscitent une prise de conscience grandissante. Les experts dans ces deux domaines doivent être au fait du chevauchement des construits, du diagnostic et du traitement de la fragilité et de la malnutrition. Il n'y a pas encore de consensus au sujet de la définition de la malnutrition et de son évaluation. Concernant la fragilité, on s'entend sur sa définition, mais pas sur sa mesure. Il existe pourtant des outils distincts de mesure de la malnutrition et de la fragilité et, d'ailleurs, les concepts et mesures présentent une intersection. Cette revue narrative souligne les intersections entre les outils de dépistage et d'évaluation comme la perte de poids/diminution de la masse corporelle, de la capacité fonctionnelle et la faiblesse (force de préhension manuelle). En guise de tentative, on propose un ensemble minimal de mesures objectives pour la détermination ou, à tout le moins, l'identification d'un risque dans les deux conditions. La fragilité et la malnutrition aboutissent, études à l'appui, à des problèmes de santé similaires justifiant des stratégies communes de traitement tels les suppléments nutritionnels oraux. Alors que plusieurs résultats du traitement c...

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Section: What Is Frailty?mentioning

confidence: 99%

Section: Frailty Screening/assessment Toolsmentioning

confidence: 99%

Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition

Laur

McNicholl

Valaitis

et al. 2017

Appl. Physiol. Nutr. Metab.

123

116

View full text Add to dashboard Cite

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“…In view of these consequences, frailty plays a central role in the well-being of older people at the individual and societal levels, and has major public health importance. Moreover, with the projection of rapid growth in number of older people living across the world, frailty presents a rapidly escalating societal challenge on a global scale (Conroy 2009). Given its impact, frailty has been described as the most problematic expression of ageing (Clegg et al 2013).…”

Section: Introductionmentioning

confidence: 99%

Multidimensional predictors of physical frailty in older people: identifying how and for whom they exert their effects

2017

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Physical frailty in older people is an escalating health and social challenge. We investigate its physical, psychological, and social predictors, including how and for whom these conditions exert their effects. For 4638 respondents aged 65–89 years from wave 2 of the English Longitudinal Study of Ageing, we examine prediction of future physical frailty by physical, psychological, and social conditions using latent growth curve analysis with multiple indicators. In addition, we explore their indirect effects through disease and physiologic decline, and repeat these analyses after stratification by gender, age group, and selected conditions which are possible moderators. We find that chronic disease, allostatic load, low physical activity, depressive symptoms, cognitive impairment, and poor social support all predict future physical frailty. Furthermore, chronic disease and allostatic load mediate the effects of low physical activity, depressive symptoms, and cognitive impairment on future physical frailty. Finally, although poor social integration is not a predictor of future physical frailty, this condition moderates the indirect effect of poor social support through chronic disease by rendering it stronger. By virtue of their roles as predictor, mediator, or moderator on pathways to physical frailty, chronic disease, allostatic load, low physical activity, cognitive impairment, depressive symptoms, poor social support, and poor social integration are potentially modifiable target conditions for population-level health and social interventions to reduce future physical frailty in older people.Electronic supplementary materialThe online version of this article (doi:10.1007/s10522-017-9677-9) contains supplementary material, which is available to authorized users.

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“…Using the Cardiovascular Health Study cohort, Linda Fried operationalized five components commonly recognized in frailty (slowness, weakness, shrinking, low levels of activity, and exhaustion) to validate one of the most commonly used indices [55, 57]. The frailty pheno-type is associated with high vulnerability for adverse health outcomes including hospitalization, morbidity, and mortality [33, 58, 59]. The presence of multiple deficits acts synergistically to increase an individual's vulnerability to illness or hospitalization [55, 60].…”

Section: Introductionmentioning

confidence: 99%

“…Other definitions of frailty have been tested with variable uptake in the clinical and research setting and include: the Tilburg Frailty Indicator [63], the Groningen Frailty Indicator [64], the Edmonton Frail Scale [65], the FRAIL scale [66], and the more commonly used Frailty Index introduced by Rockwood, et al [67–70]. Despite over a decade of experience in using the frailty phenotype first described by Fried et al, the best way to assess and measure frailty is still debated among geriatricians [58, 61, 70–73]. …”

Section: Introductionmentioning

confidence: 99%

Functional Impairment, Disability, and Frailty in Adults Aging with HIV-Infection

et al. 2014

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The integration of antiretroviral therapy (i.e., ART) into HIV care has dramatically extended the life expectancy of those living with HIV. However, in comparison to similar HIV-uninfected populations, HIV-infected persons experience an excess of morbidity and mortality with an early onset of aging complications including neurocognitive decline, osteoporosis, impaired physical function, frailty, and falls. Recent consensus guidelines encourage clinicians and researchers to consider functional impairment of HIV-infected adults as a measure to understand the impact of aging across a range of abilities. Despite the importance of assessing function in persons aging with HIV infection, a lack of consistent terminology and standardization of assessment tools has limited the application of functional assessments in clinical or research settings. Herein, we distinguish between different approaches used to assess function, describe what is known about function in the aging HIV population, and consider directions for future research.

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Defining frailty — the holy grail of geriatric medicine

Cited by 40 publications

References 7 publications

Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition

Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition

Multidimensional predictors of physical frailty in older people: identifying how and for whom they exert their effects

Functional Impairment, Disability, and Frailty in Adults Aging with HIV-Infection

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