Frailty in Acute Care: Not Just Your Grandparents' Medical Condition

Abstract

Background and Purpose: Frailty is defined as a clinically recognizable state of increased vulnerability resulting from aging-associated declines in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. Frailty assessment is commonly reserved for the geriatric population and the outpatient setting. The purpose of this review is to discuss the concept of frailty in the acute care setting and its relevance to those in the adult, nongeriatric population. Description: This review describes the characteristics of frailty in the acute care setting, the populations most likely to have non-age-related frailty, how current frailty outcome measures can be used in acute care, and the limitations of these assessments of frailty in the acute care setting. Outcomes: Frailty is associated with patients of all ages and is closely correlated with patients who have dysfunction of the heart, kidneys, liver, and lungs. Frailty is also associated with oncology-related diagnoses, critical care, multimorbidity, and obesity. Multiple assessments in the literature are aimed at assessing frailty but many are subjective and only valid with specific populations and criteria. Discussion: Frailty is a multidimentional clinical diagnosis that is not reserved solely to those older than 65 years. Many diagnoses have been closely linked to frailty. Clinicians across the spectrum need to recognize and assess for frailty, especially in acute care, as discharge planning is a key component in reducing readmissions. Creating and adapting a treatment plan that meets all the necessary domains of fitness, combined with the appropriate intensity and duration, will provide the greatest chance of reversing patients along the continuum from frail to prefrail to nonfrail.