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


Frail patients often present with an increased burden of symptoms, 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.

Frailty is most often defined as a syndrome of physiological decline in late life, characterized by marked vulnerability to adverse health outcomes. Frail older adults are less able to adapt to stressors such as acute illness or trauma than younger or non-frail older adults. This increased vulnerability contributes to increased risk for multiple adverse outcomes, including procedural complications, falls, institutionalization, disability, and death [1]. Increasingly, frailty in older patients is considered the hallmark geriatric syndrome and a forerunner to many other geriatric syndromes, including falls, fractures, delirium, and incontinence.

Importantly, old age itself does not define frailty. Some patients remain vigorous, despite advanced age, while others have gradual yet unrelenting functional decline in the absence of apparent disease states, or failure to rebound following illness or hospitalization.

Although there is no gold standard for detecting frailty in older adults, multiple frailty screening tools have been developed and utilized for risk assessment and epidemiologic study. These tools have mostly been utilized to identify older adults at high risk of adverse outcomes in a variety of clinical settings. Clinicians from a variety of disciplines are utilizing frailty status to identify patients at highest risk of adverse outcomes related to procedures and interventions, and working towards safer interventions.

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: Mar 2017. | This topic last updated: Mar 01, 2017.
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