Bringing frailty into all realms of medicine

Abstract

Although the concept of frailty has been recognised for centuries, it wasn't until 2001 that a landmark attempt was made to standardise the definition of frailty, via a description of the condition's core clinical presentations. Characterised by a reduction in functioning across multiple physiological systems, which heightens an individual's vulnerability to stressors, the prevalence of frailty has increased in recent years largely because of population ageing. To recognise this growing burden, this week, The Lancet publishes a two-paper Series focusing on the identification, management, and prevention of frailty. Frailty places a burden not only on affected individuals, their families, and caregivers but also on health and social care systems. Frailty is not an inevitable consequence of ageing and, even at advanced ages, many people do not become frail. Conversely, frailty is not limited to older people: frailty and prefrailty can exist in individuals younger than 65 years, particularly among those with multimorbidity. Frailty is a dynamic condition and individuals can transition in and out of frailty states. Prevention is possible, especially during the early stages, and prompt identification is crucial to maximise opportunities for intervention. Frailty increases the risk of adverse outcomes in patients undergoing medical or surgical treatment. Consideration of frailty status should be integral when assessing patients to support decision making. Frailty might also amplify the effect of traditional risk factors on outcomes. For example, frail patients with Alzheimer's dementia have lower levels of Alzheimer's pathology than do non-frail patients, suggesting that frailty might reduce the threshold needed for Alzheimer's pathology to cause clinical symptoms. In the past two decades, great strides have been made in our understanding of frailty. However, as a comparatively new research discipline, many gaps in knowledge remain: no universal consensus exists on the definition of frailty or its assessment, and more robust, high-quality trials of strategies to prevent and manage frailty are needed. What is clear, however, is that frailty is not solely the realm of geriatricians, and care plans for management of individuals with frailty should involve professionals from a range of relevant medical specialties. Frailty: implications for clinical practice and public healthFrailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. Full-Text PDF Management of frailty: opportunities, challenges, and future directionsFrailty is a complex age-related clinical condition characterised by a decline in physiological capacity across several organ systems, with a resultant increased susceptibility to stressors. Because of the heterogeneity of frailty in clinical presentation, it is important to have effective strategies for the delivery of care that range across the continuum of frailty severity. In clinical practice, we should do what works, starting with frailty screening, case identification, and management of frailty. Full-Text PDF