Introduction to Frailty

What is Frailty?

• Frailty is a state of increased vulnerability to stressors due to age and disease related deficits that accumulate across multiple systems.

• Dynamic and evolving state of health, which involves gradual loss of physiological reserves resulting in losses in one or more domains of human function

• Increases vulnerability of older adults to adverse health related outcomes

  Can be prevented, reversed or delayed

Pathophysiology

• The underlying pathophysiology is complex and arises from dysregulation of various physiological systems from a combination of genetic and environmental fators resulting in cumulative

Prevalence: 3.5-27% in community dwelling adults in Asia Pacific region.

• Higher prevalence in females, increased age, lower education, low socioeconomic position.

Significance

• Important predictor for adverse outcomes- eg. Falls, delirium, disability and death.

• Increased risk of hospital admissions

• Increased length of stay

• Increased cost of care

• Higher risk of functional decline after illness

• Increased functional dependency and poor quality of life

• Premature death

Poorer outcomes of Frail Patients Following Surgery

• Increased length of stay

• Higher risk of new disability

• Increased healthcare utilisation

• Higher risk of institutionalisation

• Serious complications, even death

Diagnosis

• No gold standard measure for detecting frailty

• Multiple frailty screening tools have been developed and utilized for risk assessment and epidemiological study.

Frameworks:

Fried Frailty Phenotype:

• Developed by Fried et al., this model identifies frailty based on five specific criteria: unintentional weight loss, weakness (grip strength), self-reported exhaustion, slow walking speed, and low physical activity. An individual is classified as frail if they meet three or more of these criteria.

• This phenotype is grounded in a theoretical construct hypothesized to have an underlying biological basis, focusing on physical manifestations of frailty.

• It is relatively straightforward to implement in clinical settings and provides a clear, operational definition of frailty.

Frailty Index:

• Proposed by Rockwood and colleagues, the Frailty Index is based on the accumulation of deficits across multiple domains, including symptoms, signs, diseases, disabilities, and laboratory abnormalities. It is calculated as the ratio of the number of deficits present to the total number of deficits considered.

• This index describes frailty as a nonspecific age-associated vulnerability, reflecting a broader range of health deficits