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Frailty

Author
Jeremy D Walston, MD
Section Editor
Kenneth E Schmader, MD
Deputy Editor
H Nancy Sokol, MD

INTRODUCTION

Frailty is often defined as a state of decline and vulnerability in late life, characterized by weakness and decreased physiologic reserve. Frail older adults are less able to adapt to stressors such as acute illness or trauma. This increased vulnerability contributes to increased risk for multiple adverse outcomes, including procedural complications, falls, institutionalization, disability, and death [1]. Frailty in older patients often becomes apparent after adverse outcomes that are related to other geriatric syndromes, including falls, fractures, delirium, and incontinence.

There is no gold standard for diagnosing frailty. Importantly, old age itself does not define frailty. Some patients remain vigorous, despite advanced age, while others have gradual but unrelenting functional decline in the absence of apparent stress factors or failure to rebound following illness or hospitalization.

Multiple frailty screening tools have been developed and utilized for risk assessment and epidemiologic study. The utility of these screening tools in the clinical setting, however, is limited. The ability to establish a diagnosis of frailty in the clinical setting and the ability to provide effective intervention to prevent progression to disability remain major challenges in managing the geriatric patient [2].

Frail patients often present with an increased burden of symptoms and medical complexity and reduced tolerance for medical interventions. Awareness of frailty and associated risks for adverse outcomes, and an understanding of its biological basis, can improve care for this most vulnerable subset of patients.

This topic will review the definition, pathophysiology, epidemiology, and diagnosis of frailty and present a clinical approach that may attenuate vulnerability and relieve symptoms.

                        

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 07 00:00:00 GMT 2016.
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