Abstract
Frailty is a distinctive health state in which the ability of older people to cope with acute stressors is compromised by an increased vulnerability brought by age-associated declines in physiological reserve and function across multiple organ systems. Although closely associated with age, multimorbidity, and disability, frailty is a discrete syndrome that is associated with poorer outcomes across a range of medical conditions. However, its role in cerebrovascular disease and stroke has received limited attention. The estimated rise in the prevalence of frailty associated with changing demographics over the coming decades makes it an important issue for stroke practitioners, cerebrovascular research, clinical service provision, and stroke survivors alike. This review will consider the concept and models of frailty, how frailty is common in cerebrovascular disease, the impact of frailty on stroke risk factors, acute treatments, and rehabilitation, and considerations for future applications in both cerebrovascular clinical and research settings.
Highlights
Frailty—the state of vulnerability characterized by the cumulative multisystem decline of physiological reserves to maintain homeostasis following a stressor event1—is associated with increased morbidity and mortality across a range of medical conditions,[2] though only recently has attention been paid to its role in cerebrovascular disease
Different clinical contexts: (i) Secondary care: The Hospital Frailty Risk Score (HFRS) considers 109 routinely collected ICD-10 diagnoses to produce a score associated with length of hospitalization and in-patient mortality.[10] (ii) Community: The electronic frailty index using 36 deficits in primary health datasets measures frailty at a population level, and demonstrates associations with hospitalization, nursing home admission, and all-cause one-year mortality.[11]
Different data settings: (i) Bedside assessment using the Clinical Frailty Scale (CFS), which correlates strongly with the frailty index, evaluates how an individual aged over 65 years was, two weeks prior to admission.[12] (ii) Routinely collected health data, e.g. electronic frailty index (eFI), HFRS. (iii) Research study data, e.g. grip strength, gait speed
Summary
Frailty—the state of vulnerability characterized by the cumulative multisystem decline of physiological reserves to maintain homeostasis following a stressor event1—is associated with increased morbidity and mortality across a range of medical conditions,[2] though only recently has attention been paid to its role in cerebrovascular disease. This review will consider the models of frailty and how it is evaluated, prior to considering the effect of frailty along the natural history of stroke This operationalized model of frailty considers that ‘‘the more things individuals have wrong with them, the higher the likelihood that they will be frail.’’7 This model is predicated upon recognition that physiological changes (‘‘deficits’’) may not necessarily achieve disease status, yet their accumulation is associated with higher levels of frailty and adverse outcomes. The measures used may reflect: 1. Different models of frailty: frailty indices (Cumulative Deficit Model), or measures including grip strength and walking speed (Frailty Phenotype Model)
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