INTRODUCTION

As the population ages, recognition of frailty in older adults becomes increasingly important. The potential to tailor medical care for the older patient to prevent frailty, to intervene to improve outcomes, and to recognize when palliation is appropriate are important components of geriatric care.

Frailty is often conceptualized by health care providers as a state of late life decline and vulnerability characterized by weakness and decreased physiologic reserve. Frail older adults are less able to adapt to stressors such as acute illness or trauma. Their increased vulnerability leads to adverse outcomes including falls, institutionalization, disability, and death [1].

Most medical practitioners who care for older adults have noted a subset of patients who are clearly in a state of rapid decline, seemingly unrelated to a specific disease state. Other patients who are frail have more subtle signs and symptoms that can be easily overlooked.

Old age itself does not define frailty. Some patients, despite advanced age, may experience temporary disability related to illness or trauma, but rebound after recovery and return to their baseline. Others may appear robust but tolerate medical stress poorly, and never regain full function following illness or hospitalization. Still others are noted to have gradual but unrelenting functional decline in the absence of apparent stress factors.

Frail older adults present a challenge to clinicians because they usually present with an increased burden of symptoms, are often medically complex, and are less able to tolerate interventions of any kind. Clinician awareness of the frailty syndrome, its biologic basis, and the increased risk for adverse outcomes can improve care for this most vulnerable subset of patients.