Ageing is associated with a gradual decline in physical functioning. However, the rate of decrease varies, and hence ageing is not always coupled with frailty. Frailty is defined as an ageing-related physiological decline syndrome characterized by significant vulnerability to adverse health outcomes. Multiple protective and risk factors influence frailty during the life course, and these factors have complex interactions among one another. Older frail people experience a dramatic decline in physical and mental functions and have poorer outcomes after apparently minor stressors such as mild physical disorders and anxiety.
Frail adults are at increased
risk of adverse health outcomes, including falls, fractures, disability,
dementia, low quality of life, increased cost of care, hospitalization and
premature death. Several studies have shown that the health care costs of frail
individuals are several-fold higher than non-frail adults. The prevalence of
frailty among 65 years and older adults ranged from 4% to 59% in different
communities. Advanced age is a significant risk factor for frailty, with one-fourth
of those aged 80 and above being frail. The prevalence is even higher in those
with renal disease, heart failure, Alzheimer's disease, cancer etc.
How to identify a frail
individual
Various tools are available, but there
is no one gold standard method. Fried criteria define frailty as the presence
of three out of five phenotypic criteria: low grip strength, low energy, slowed
walking speed, low physical activity and/or unintentional weight loss. A pre-frail
stage, in which one or two criteria are present, identifies people at high risk
of progressing to frailty.
A risk index by counting the
number of deficits accumulated over time termed as Frailty index (FI), developed
by Rockwood and Mitnitski, is available. FI is a more sensitive predictor of
adverse health outcomes. Other scales include frailty/vigor assessment,
clinical frailty scale, brief frailty instrument, vulnerable elders survey (VES-13)
etc. These tools have their advantages and disadvantages. Few are easy to use, not
time-consuming, sensitive, and can be used in an OPD setting or community,
whereas others require special tools, are complicated and time-consuming.
Why identify Frail individuals
It is understood that the treatment
outcomes depend not on the chronological age but the biological age of the individual.
By identifying frail individuals, the treatment goals can be set accordingly,
including treatment (medical, surgical etc.), the intention of therapy
(curative, palliative etc.). Also, by understanding the impact of frailty on
treatment outcomes, the patient and their family members can make a better,
informed decision.
