Integrating Frailty Research into the Medical Specialties—Report from a U13 Conference

Abstract

Although the field of frailty research has expanded rapidly, it is still a nascent concept within the clinical specialties. Frailty, conceptualized as increased vulnerability to stressors because of significant depletion of physiological reserves, predicts poorer outcomes in several medical specialties, including cardiology, HIV care, nephrology, and in the behavioral and social sciences. Incorporation of frailty assessment and frailty research into the specialties is hindered by a lack of a consensus definition, by the proliferation of measurement tools, inadequate understanding of the biology of frailty, and lack of validated clinical algorithms for patients who have frailty. In 2015, the American Geriatrics Society, the National Institute on Aging (NIA) and the Alliance for Academic Internal Medicine held a conference for awardees of the NIA sponsored ‘Grants for Early Medical/Surgical Specialists Transition into Aging Research (GEMSSTAR)’1 program to review the current state of the knowledge regarding frailty in the sub-specialties, as well as to highlight key examples of integrating frailty research into the medical specialties. Key research questions to advance frailty research into specialty medicine are proposed.

Leadership Lessons: Developing Mentoring Infrastructure for GEMSSTAR Scholars

“…This article provides observations and lessons learned from leading three U13 theme‐based transdisciplinary research conferences with a focus on the mentoring and leadership skills development aspects of those conferences . In particular, the attention to leadership skills was a novel approach for a U13 conference series that both AGS and NIA believed was vital to advancing the following shared goals: (1) accelerate innovation across geriatrics and gerontology by uniting leaders across fields and linking NIA programmatic goals with GEMSSTAR meetings; and (2) expand the pool of physician scientists in aging research by developing and filling key gaps in faculty development training.…”

“…The first U13 conference, focused on integrating frailty into aging research across surgical and medical specialties, occurred March 2 to 3, 2015, with 73 attendees (including 31 GEMSSTAR and 3 Jahnigen/Williams scholars). This topic was chosen because frailty is a concept without universally accepted measures and there are at least 75 frailty assessment instruments across specialties with scant consensus on how to incorporate the competing philosophies into transdisciplinary research . Given the scientific uncertainty around frailty and the need for GEMSSTAR scholars to understand this concept, senior researchers provided attendees with guidance on using appropriate tools that would fulfill research goals and provide them with an understanding of the frailty research landscape.…”

Frailty in Hematologic Malignancy

“…The integration of frailty measurements and clinical algorithms in subspecialty practice is evolving. (23) There are two major conceptual operationalization of frailty with proposed clinical measurement tools: frailty phenotype also known as Fried’s frailty or Cardiovascular Health Study definition (11) and the Frailty Index. (24) Fried and colleagues used data from the Cardiovascular Health Study, to define frailty as a distinct clinical syndrome characterized by unexplained weight loss, low physical activity, weak grip, slow gait and self-reported exhaustion.…”

The Use of Figurative Language to Describe Frailty in Older Adults

“…Even when defined, confusion persists as to whether frailty should be assessed as a unified, biologically-driven phenomena (i.e., frailty phenotype) versus a cumulative effect of aging-related signs and symptoms (i.e., deficit accumulation index) [6]. Frailty holds significant potential for risk prediction and clinical-decision making [7], though more guidance is needed on how to best incorporate it, and which measure(s) to use, in clinical settings [8]. …”