The knowledge about frailty is rapidly growing, and improved understanding of molecular and physiological mechanisms involved in determining the increased vulnerability of frail older adults has encouraged investigators from many disciplines to contribute to this emerging field of research. Medical practitioners have often used the term ‘‘frailty’’ to characterize the weakest and most vulnerable subset of older adults. Recent research efforts have helped to better define clinical and physiological characteristics of frailty and to highlight the vulnerability of frail older adults to poor health outcomes. The term ‘‘frail’’ has various clinically relevant meanings (e.g., likely to fail or die quickly; unusually susceptible to some diseases or other infirmity; lacking normal strength or force; weak, thin, and slight). Although there is a wide range of common phenotypes in geriatric medicine to which such terms may be related, including muscle weakness, bone fragility, very low body mass index, susceptibility to falling, vulnerability to trauma, vulnerability to infection, high risk for delirium, blood pressure instability, and severely diminished physical capabilities, the word ‘‘frailty’’ in the common notation of clinical geriatric medicine usually describes a condition in which a critical combination of these specific impairments occurs. Nevertheless, researchers have applied different approaches describing these phenomena. As reported by Rockwood (2005), conceptual definitions of frailty have included a variety of domains with a multidisciplinary approach, including physical performance, cognitive function, psychological factors, as well as disability owing to the presence of illness. Other investigators defined frailty as a single syndrome coupled with the presence of clinical traits associated with aging, such as weakness, fatigue, weight loss, decreased balance, low levels of physical activity, slowed motor processing and performance, social withdrawal, mild cognitive changes, and increased vulnerability to stressors (Fried et al. 2009). Whatever is the definition of frailty we could consider, there is a general consensus that frailty is also characterized by specific alterations in physiological variables, including inflammatory biomarkers, altered glucose metabolism, mitochondria function and markers of clotting processes, providing further evidence of multisystemic involvement (Fried et al. 2009). Therefore, the old frail subject has to be considered as the sum of various patho-physiological components E. Mocchegiani (&) Ctr. Nutrition and Ageing, Italian National Research Centre on Aging (INRCA), Via Birarelli 8, 60121 Ancona, Italy e-mail: e.mocchegiani@inrca.it
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