Abstract
Abstract
Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate.
Objectives
The purpose of this paper is to present expert’s positions on the main aspects of the frailty syndrome in the older persons.
Participants
Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG).
Results
Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from “very fit” to “severely frail,” but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice.
Conclusion
Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.
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References
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56:M146–M156.
Walston J, Fried LP: Frailty and the older man. Med Clin North Am 1999, 83:1173–1194.
Bergman H, Hogan D, Karunananthan S: Frailty: A clinically relevant concept? Canadian J of Geriatrics 2008, 11:124–128.
Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12:29–37.
Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010;11:344–455.
Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc. 2012;60:1478–1486.
Bergman H, Ferrucci L, Guralnik J, Hogan D, Hummel S, Karunananthan S, Wolfson C. Frailty, an Emerging Research and Clinical Paradigm: Issues and Controversies. J Gerontol: Med Sci. 2007;62A: 731–737
Rodriguez-Manas L, Feart C, Mann G, Vina J, Chatterji S, Chodzko-Zajko W, Gonzalez-Colaco Harmand M, Bergman H, Carcaillon L, Nicholson C, et al: Searching for an Operational Definition of Frailty: A Delphi Method Based Consensus Statement. The Frailty Operative Definition-Consensus Conference Project. J Gerontol A Biol Sci Med Sci 2012.
Studenski S, Hayes RP, Leibowitz RQ, Bode R, Lavery L, Walston J, Duncan P, Perera S: Clinical Global Impression of Change in Physical Frailty: development of a measure based on clinical judgment. J Am Geriatr Soc 2004, 52:1560–1566.
Mitnitski A, Song X, Skoog I, Broe GA, Cox JL, Grunfeld E, Rockwood K: Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc 2005, 53:2184–2189.
Jones DM, Song X, Rockwood K: Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004, 52:1929–1933.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A: A global clinical measure of fitness and frailty in elderly people. CMAJ 2005, 173:489–495.
Song X, Mitnitski A, Rockwood K: Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010, 58:681–687.
Rockwood K, Rockwood MR, Mitnitski A: Physiological redundancy in older adults in relation to the change with age in the slope of a frailty index. J Am Geriatr Soc 2010, 58:318–323.
Rockwood K, Mitnitski A. How might deficit accumulation give rise to frailty? J Frailty Aging 2012;1:8–12
Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, et al: Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 2008, 168:382–389.
Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, et al: Gait speed and survival in older adults. JAMA 2011, 305:50–58.
Andrew MK, Mitnitski AB, Rockwood K: Social vulnerability, frailty and mortality in elderly people. PLoS One 2008, 3:e2232.
Grady D, Berkowitz S. Why is a good clinical prediction rule so hard to find? Arch Inter Med. 2011;171(19):1701–1702.
Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC: Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007, 60:34–42.
de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW: Outcome instruments to measure frailty: a systematic review. Ageing Res Rev 2011, 10:104–114.
Rockwood K, Mitnitski A: Frailty defined by deficit accumulation and geriatricmedicine defined by frailty. Clin Geriatr Med 2011, 27:17–26.
Parks RJ, Fares E, Macdonald JK, Ernst MC, Sinal CJ, Rockwood K, Howlett SE: A procedure for creating a frailty index based on deficit accumulation in aging mice. J Gerontol A Biol Sci Med Sci 2012, 67:217–227.
Carcaillon L, García-García FJ, Tresguerres JA, Gutiérrez Avila G, Kireev R, Rodríguez-Mañas L.. Higher Levels of Endogenous Estradiol are Associated with Frailty in Postmenopausal Women from the Toledo Study for Healthy Aging. J Clin Endocrinol Metabol 2012 Jun 7 (Epub ahead of print)
Ferrucci L, Penninx BW, Volpato S, Harris TB, Bandeen-Roche K, Balfour J, Leveille SG, Fried LP, Md JM: Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. J Am Geriatr Soc 2002, 50:1947–1954.
Cesari M, Penninx BW, Pahor M, Lauretani F, Corsi AM, Rhys Williams G, Guralnik JM, Ferrucci L: Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2004, 59:242–248.
Birnie K, Cooper R, Martin RM, Kuh D, Sayer AA, Alvarado BE, Bayer A, Christensen K, Cho SI, Cooper C, et al: Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis. PLoS One 2011, 6:e15564.
Alvarado BE, Zunzunegui MV, Beland F, Bamvita JM: Life course social and health conditions linked to frailty in Latin American older men and women. J Gerontol A Biol Sci Med Sci 2008, 63:1399–1406.
Yang Y, Lee LC: Dynamics and heterogeneity in the process of human frailty and aging: evidence from the U.S. older adult population. J Gerontol B Psychol Sci Soc Sci 2010, 65B:246–255.
Mocchegiani E, Corsonello A, Lattanzio F: Frailty, ageing and inflammation: reality and perspectives. Biogerontology 2010, 11:523–525.
Morley JE: Sarcopenia in the elderly. Fam Pract 2012, 29 Suppl 1:i44–i48.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, et al: Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010, 39:412–423.
Landi F, Russo A, Danese P, Liperoti R, Barillaro C, Bernabei R, Onder G: Anemia status, hemoglobin concentration, and mortality in nursing home older residents. J Am Med Dir Assoc 2007, 8:322–327.
Landi F, Russo A, Pahor M, Capoluongo E, Liperoti R, Cesari M, Bernabei R, Onder G: Serum high-density lipoprotein cholesterol levels and mortality in frail, community-living elderly. Gerontology 2008, 54:71–78.
Gruenewald TL, Seeman TE, Karlamangla AS, Sarkisian CA: Allostatic load and frailty in older adults. J Am Geriatr Soc 2009, 57:1525–1531.
Retornaz, F*, Monette J, Batist G, Monette M, Sourial N, Small D, Caplan S, Wan-Chow-Wah D, Puts MTE*, Bergman H. Usefulness of frailty markers in the assessment of the health and functional status of older cancer patients referred for chemotherapy: a pilot study. J Gerontol Med Sci. 2008;63A,: 518–522
Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, Lichtman SM, Gajra A, Bhatia S, Katheria V, et al: Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011, 29:3457–3465.
Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP: Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010, 210:901–908.
Puts MT, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H: Does frailty predict hospitalization, emergency department visits, and visits to the general practitioner in older newly-diagnosed cancer patients? Results of a prospective pilot study. Crit Rev Oncol Hematol 2009, 76:142–151.
Tan KY, Kawamura YJ, Tokomitsu A, Tang T: Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg 2011.
Wilhelm-Leen ER, Hall YN, M KT, Chertow GM: Frailty and chronic kidney disease: the Third National Health and Nutrition Evaluation Survey. Am J Med 2009, 122:664–671 e662.
Krumholz HM, Chen J, Chen YT, Wang Y, Radford MJ: Predicting one-year mortality among elderly survivors of hospitalization for an acute myocardial infarction: results from the Cooperative Cardiovascular Project. J Am Coll Cardiol 2001, 38:453–459.
Singh M, Rihal CS, Lennon RJ, Spertus JA, Nair KS, Roger VL: Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes 2011, 4:496–502.
Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, Morin JF, Langlois Y, Ohayon SM, Monette J, et al: Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes 2012, 5:222–228.
Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, Perrault LP, Alexander KP, Langlois Y, Dendukuri N, et al: Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010, 56:1668–1676.
Chen PJ, Lin MH, Peng LN, Liu CL, Chang CW, Lin YT, Chen LK: Predicting Cause-Specific Mortality of Older Men Living in the Veterans Home by Handgrip Strength and Walking Speed: A 3-Year, Prospective Cohort Study in Taiwan. J Am Med Dir Assoc 2012.
Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R, Guralnik JM, Ferrucci L: Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2009, 64:377–384.
Sumukadas D, Witham MD, Struthers AD, McMurdo ME: Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial. CMAJ 2007, 177:867–874.
Beasley JM, LaCroix AZ, Neuhouser ML, Huang Y, Tinker L, Woods N, Michael Y, Curb JD, Prentice RL: Protein intake and incident frailty in the Women’s Health Initiative observational study. J Am Geriatr Soc 2010, 58:1063–1071.
Sundell J: Resistance Training Is an Effective Tool against Metabolic and Frailty Syndromes. Adv Prev Med 2011, 2011:984683.
Pahor M, Blair SN, Espeland M, Fielding R, Gill TM, Guralnik JM, Hadley EC, King AC, Kritchevsky SB, Maraldi C, et al: Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci 2006, 61:1157–1165.
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Berrut, G., Andrieu, S., Araujo De Carvalho, I. et al. Promoting access to innovation for frail old persons. J Nutr Health Aging 17, 688–693 (2013). https://doi.org/10.1007/s12603-013-0039-2
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DOI: https://doi.org/10.1007/s12603-013-0039-2