Understanding frailty

Postgraduate Medical Journal - Tập 83 Số 975 - Trang 16-20 - 2007
Frank Lally1, Peter Crome1
1Keele University Medical School, City General Hospital , Stoke-on-Trent, Staffordshire, UK

Tóm tắt

Abstract

The term “frailty” is used loosely to describe a range of conditions in older people, including general debility and cognitive impairment. There is no clear consensus on the definition of frailty; however, it is proposed that frailty comprises a collection of biomedical factors which influences an individual's physiological state in a way that reduces his or her capacity to withstand environmental stresses. Only a subset of older people are at risk of becoming frail; these are vulnerable, prone to dependency and have reduced life expectancy. These health outcomes contribute to an increased demand for medical and social care, and are associated with increased economic costs. As demographic trends indicate a rise in the older population, this healthcare burden will increase. This review aims to encapsulate the current debate surrounding the concept of frailty, with emphasis on proposed definitions of frailty which may be relevant to its identification in the clinical setting.

Từ khóa


Tài liệu tham khảo

Fried, 2001, Frailty in older adults: evidence for a phenotype, J Gerontol A Biol Sci Med Sci, 56, M146, 10.1093/gerona/56.3.M146

Boyd, 2005, Frailty, hospitalization, and progression of disability in a cohort of disabled older women, Am J Med, 118, 1225, 10.1016/j.amjmed.2005.01.062

Fried, 2004, Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care, J Gerontol A Biol Sci Med Sci, 59, M255, 10.1093/gerona/59.3.M255

Fugate, 2005, Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study, J Am Geriatr Soc, 53, 1321, 10.1111/j.1532-5415.2005.53405.x

World Health Organization, 2006, International classification of functioning, disability and health

Hogan, 2003, Models, definitions, and criteria of frailty, Aging Clin Exp Res, 15, 1

Brody, 1997, Evaluation of a self-report screening instrument to predict frailty outcomes in aging populations, Gerontologist, 37, 182, 10.1093/geront/37.2.182

Mitnitski, 2005, Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality, J Am Geriatr Soc, 53, 1069, 10.1111/j.1532-5415.2005.00506.x

Gill, 2006, Transitions between frailty states among community-living older persons, Arch Intern Med, 166, 418, 10.1001/archinte.166.4.418

Puts, 2005, Sex differences in the risk of frailty for mortality independent of disability and chronic diseases, J Am Geriatr Soc, 53, 40, 10.1111/j.1532-5415.2005.53008.x

Paw, 1999, How to select a frail elderly population? A comparison of three working definitions, J Clin Epidemiol, 52, 1015, 10.1016/S0895-4356(99)00077-3

Mitnitski, 2002, Frailty, fitness and late-life mortality in relation to chronological and biological age, BMC Geriatr, 2, 1, 10.1186/1471-2318-2-1

Woo, 2006, Public health significance of the frailty index, Disabil Rehabil, 28, 515, 10.1080/09638280500215867

Fried, 1991, The Cardiovascular Health Study: design and rationale, Ann Epidemiol, 1, 263, 10.1016/1047-2797(91)90005-W

Woo, 2005, Social determinants of frailty, Gerontology, 51, 402, 10.1159/000088705

Markle-Reid, 2003, Conceptualizations of frailty in relation to older adults, J Adv Nurs, 44, 58, 10.1046/j.1365-2648.2003.02767.x

Studenski, 2004, Clinical global impression of change in physical frailty: development of a measure based on clinical judgment, J Am Geriatr Soc, 52, 1560, 10.1111/j.1532-5415.2004.52423.x

Rockwood, 2005, A global clinical measure of fitness and frailty in elderly people, CMAJ, 173, 489, 10.1503/cmaj.050051

Fisher, 2000, Just what defines frailty?, J Am Geriatr Soc, 53, 2229, 10.1111/j.1532-5415.2005.00510.x

Rockwood, 1999, A brief clinical instrument to classify frailty in elderly people, Lancet, 353, 205, 10.1016/S0140-6736(98)04402-X

Rockwood, 2005, Frailty and its definition: a worthy challenge, J Am Geriatr Soc, 53, 1069, 10.1111/j.1532-5415.2005.53312.x

Saliba, 2000, Identifying a short functional disability screen for older persons, J Gerontol A Biol Sci Med Sci, 55, M750, 10.1093/gerona/55.12.M750

Puts, 2005, Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning, J Clin Epidemiol, 58, 1188, 10.1016/j.jclinepi.2005.03.008

Rockwood, 2004, Changes with age in the distribution of a frailty index, Mech Ageing Dev, 125, 517, 10.1016/j.mad.2004.05.003

Cohen, 2000, In search of the underlying mechanisms of frailty [editorial], J Gerontol A Biol Sci Med Sci, 55, M706, 10.1093/gerona/55.12.M706

Pawelec, 2005, Immunosenescence and vaccination, Immun Ageing, 2, 16, 10.1186/1742-4933-2-16

Hamerman, 1999, Toward an understanding of frailty, Ann Intern Med, 130, 945, 10.7326/0003-4819-130-11-199906010-00022

Ferguson, 1995, Immune parameters in a longitudinal study of a very old population of Swedish people: a comparison between survivors and nonsurvivors, J Gerontol A Biol Sci Med Sci, 50, B378, 10.1093/gerona/50A.6.B378

Walston, 2002, Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study, Arch Intern Med, 162, 2333, 10.1001/archinte.162.20.2333

Puts, 2005, Endocrine and inflammatory markers as predictors of frailty, Clin Endocrinol, 63, 403, 10.1111/j.1365-2265.2005.02355.x

Leng, 2002, Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study, J Am Geriatr Soc, 50, 1268, 10.1046/j.1532-5415.2002.50315.x

Stookey, 2004, Plasma hypertonicity: another marker of frailty?, J Am Geriatr Soc, 52, 1313, 10.1111/j.1532-5415.2004.52361.x

Taaffe, 2000, Cross-sectional and prospective relationships of interleukin-6 and C reactive protein with physical performance in elderly persons: MacArthur studies of successful aging, J Gerontol A Biol Sci Med Sci, 55, M709, 10.1093/gerona/55.12.M709

Gill, 2002, A program to prevent functional decline in physically frail, elderly persons who live at home, N Engl J Med, 347, 1068, 10.1056/NEJMoa020423

Singh, 2006, Cross-sectional relationship between physical fitness components and functional performance in older persons living in long-term care facilities, BMC Geriatr, 6, 4, 10.1186/1471-2318-6-4

Greiwe, 2001, Resistance exercise decreases skeletal muscle tumor necrosis factor (alpha) in frail elderly humans, FASEB J, 15, 475, 10.1096/fj.00-0274com

Ostir, 2004, Onset of frailty in older adults and the protective role of positive affect, Psychol Aging, 19, 402, 10.1037/0882-7974.19.3.402

Stuck, 1993, Comprehensive geriatric assessment: a meta-analysis of controlled trials, Lancet, 342, 1032, 10.1016/0140-6736(93)92884-V

Polder, 2004, Cost of illness in The Netherlands

Wilson, 2004, Frailty—and its dangerous effects—might be preventable, Ann Intern Med, 141, 489, 10.7326/0003-4819-141-6-200409210-00035