Frailty

Key Features

• Characterized by loss of physiologic reserve and dysregulation across multiple systems, ultimately resulting in greater risk of poor health outcomes

• Estimates of its prevalence in community-dwelling older adults range from 5% to 17%

• Persons with frailty are at increased risk for

  • Falls

  • Hospitalization

  • Functional decline

  • Poorer outcomes associated with medical interventions (eg, surgery, dialysis, chemotherapy)

  • Death

Clinical Findings

• Weakness (grip strength)

• Slow gait speed

• Decreased physical activity

• Weight loss

• Exhaustion or low energy

Diagnosis

• Diagnosis is made when three or more of the above clinical features are present

• However, there is not one universally agreed upon definition or assessment tool for frailty

Treatment

• Exercise, particularly strength and resistance training, can increase walking speed and improve function

• Optimal nutrition, particularly higher levels of protein intake, may be associated with reduced incidence of frailty

• Treatment is largely supportive, multifactorial, and individualized based on patient goals, life expectancy, and chronic conditions once frailty is established

• When irreversible complications from frailty develop, comfort-focused or hospice care is appropriate