State Of Frailty Research Articles

Postural instability and the condition of physical frailty in the elderly.

Objective:to analyze the relationship between postural instability and the condition and markers of physical frailty of the elderly people in outpatient geriatric and gerontology care.Method:a cross-sectional study with a sample of 381 elderly subjects. Physical frailty was evaluated by the frailty phenotype and postural instability through the Berg Balance Scale. Univariate analyses consisted in Chi-square tests, and multivariate analyses used the Forward Stepwise method, which resulted in a model of physical frailty associated with postural instability.Results:among the participants, 56 (14.7%) were frail, 217 (57%) pre-frail, and 68 (28.3%) non-frail. Pre-frailty (p < 0.001), frailty (p = 0.000), and the markers hand grip strength (p = 0.0008), unintentional weight loss (p = 0.0094), level of physical activity (p = 0.0001), fatigue/exhaustion (p = 0.0001), and gait speed (p = 0.0001) were associated with postural instability.Conclusion:the presence of postural instability determines a greater chance of the elderly being frail or pre-frail. This result favors the planning of gerontological nursing care and strengthens the treatment plan under a specific approach.

Sarcopenia in the elderly: from clinical aspects to therapeutic options

Sarcopenia is a major contributor to the risk of physical frailty, functional decline, poor health-related quality of life and premature death in older people. Sarcopenia can be considered a geriatric syndrome. The term sarcopenia indicates the loss of muscle mass that accompanies aging. Muscle mass declines with aging process with differences between subjects in relation to the presence of chronic diseases, to lifestyles habits (mainly diet and physical activity), to cognitive status. Sarcopenia in the elderly is associated with poor health outcomes, such as falls, disability, loss of independence, and mortality; however, it is potentially treatable if recognized and intervened early. The prevalence of sarcopenia rates between 5% and 13% in community-dwelling older people aged 65 years and over, and is higher in those 80 years and older (20-25%). The cause of sarcopenia is generally thought to be multifactorial, with environmental causes, disease triggers, inflammatory pathway activation, and a large number of cellular and biochemical abnormalities. Resistance training and amino acid supplementation are a recommended practice for the prevention of sarcopenia. The essential elements for the management of the sarcopenic patient are the recognition of a condition of frailty, an accurate multidimensional geriatric assessment, with attention to cognitive problems, mood, functional problems, living conditions, using standardized instruments. Combining exercise with some pharmacological compounds such as β- Hydroxy-β-methylbutyrate (HMB) and dietary supplements (including proteins, aminoacids and vitamin D) may exert a beneficial effect on older adults thus influencing the progress to sarcopenia. The recommended daily amount of protein is greater for older people. Vitamin D and leucine enrichment seems mandatory in order to improve muscle mass and lowerextremity function among sarcopenic older adults. There are some evidences that collagen peptides in this setting might be even superior to whey protein in promoting muscle growth and increasing the mobility.

Health care are associated with worsening of frailty in community older adults.

ABSTRACTOBJECTIVE To identify the factors associated with the worsening of frailty in older adults resident in the community.METHODS This is a prospective, longitudinal, and analytical study. The data collection in the baseline occurred in the participants’ homes from a random sampling by conglomerates. Demographic and socioeconomic variables, morbidities, and use of health services were analyzed. Frailty was measured by the Edmonton Frail Scale. The second data collection was performed after an average period of 42 months. The adjusted prevalence ratios were obtained by multiple Poisson regression analysis with robust variance.RESULTS A total of 394 older adults participated in both phases of the study, with 21.8% of them presenting worsening of the frailty condition. The variables that remained statistically associated with the transition to a worse state of frailty were: polypharmacy, negative self-perception of health, weight loss, and hospitalization over the past 12 months.CONCLUSIONS The factors associated with worsening of frailty along the studied period among older adults in the community were those related to health care. This result must be considered by health professionals when addressing frail and vulnerable older adults.

Cachexia and advanced dementia.

Cachexia is a complex metabolic process that is associated with several end‐stage organ diseases. It is known to be also associated with advanced dementia, although the pathophysiologic mechanisms are still largely unknown. The present narrative review is aimed at presenting recent insights concerning the pathophysiology of weight loss and wasting syndrome in dementia, the putative mechanisms involved in the dysregulation of energy balance, and the interplay among the chronic clinical conditions of sarcopenia, malnutrition, and frailty in the elderly. We discuss the clinical implications of these new insights, with particular attention to the challenging question of nutritional needs in advanced dementia and the utility of tube feeding in order to optimize the management of end‐stage dementia.

How reliable is the assessment of Porotic Hyperostosis and Cribra Orbitalia in skeletal human remains? A methodological approach for quantitative verification by means of a new evaluation form

Intra vitam porous lesions of the skull (Cribra Orbitalia and Porotic Hyperostosis) are pathological conditions due to genetic or acquired chronic anaemia. They are the most reported skeletal lesions in human skeletal remains and are routinely used to assess health, hygiene and nutritional status of past populations. Despite the existence of a number of proposed classifications, there is no generally accepted classification system used by all, with clear advantages over the others. Here, we propose a new evaluation form (BoPLE-Bone Porous Lesion Evaluation) that takes in consideration all the observable features of bone porous lesions, integrating existing qualitative criteria for the evaluation of severity and healing’s conditions with a new quantitative analysis based on the count of pores per square centimetre. Porotic Hyperostosis and Cribra Orbitalia were investigated using the newly developed evaluation forms on 189 cranial bones from several distinct archaeological sites. Reliability and reproducibility of both existing qualitative scoring criteria and the new quantitative method were statistically tested. We believe that the new proposed classification system, which takes into consideration diverse parameters like surface area of lesion, location of lesion on cranial vault, and number of pits per surface area, represents a progress in the objective evaluation of porous bone lesions. Its use will allow the determination of the severity of the lesion and thus provide data to assess conditions of frailty in past populations.

Determination of frail state and association of frailty with inflammatory markers among cardiac surgery patients in a Central European patient population.

With the aging of the population, the screening of frail patients, especially before high-risk surgery, come to the fore. The background of the frail state is not totally clear, most likely inflammatory processes are involved in the development. Our survey of patients over age of 65 who were on cardiac surgery were performed with Edmonton Frail Scale (EFS). Patients' demographic, perioperative data, incidence of complications and correlations of inflammatory laboratory parameters were studied with the severity of the frail state. On the basis of EFS, 313 patients were divided into non-frail (NF,163,52%), pre-frail (PF,89,28.5%) and frail (F,61,19.5%) groups. Number of complications in the three groups were different (NF:0.67/patient, PF:0.76/patient, F:1.08/patient). We showed significant difference between NF and F in both intensive care and hospital stay, but there was no statistical difference between the groups in hospital deaths (NF:5/163, PF:3/89, F:5/61). We also found a significant difference between NF and F patients in preoperative fibrinogen-, CRP- and white blood cell count levels. We first present the incidence of frailty in patients with heart surgery in a Central-European population. According to our results, inflammatory processes are likely to play a role in the development of the frail state.

Disability relating to instrumental activities of daily living in the elderly with rheumatic diseases

Abstract Objective: to characterize the sociodemographic profile of elderly persons with arthritis/rheumatism in relation to gender, as well as to estimate the prevalence and factors associated with functional disability for the performance of instrumental activities of daily living (IADL). Method: a cross-sectional population-based study with a sample of 1,136 elderly persons (≥65 years old) from seven Brazilian municipal regions was carried out. Functional capacity was assessed by the self-reports of the elderly in terms of the performance of IADL, using the Lawton Scale. Differences between the genders, according to sociodemographic variables, were verified by the chi-squared test (p&lt;0.05). The prevalence of inability to perform IADL was calculated and the independent associations were verified through multiple logistic regression. Results: the mean age was 72.4 years, 79.1% of the sample were women, and 45.9% of the elderly with arthritis/rheumatism were dependent for the performance of IADL. Differences were observed between the genders in relation to age, marital status, income and household arrangements (p&lt;0.05). A higher prevalence of disability was observed among older elderly persons, those with no schooling and lower incomes, who lived in multigenerational households and who were frail. In the evaluation of the performance of specific activities, elderly persons with arthritis/rheumatism had greater difficulty taking medication (OR: 1,90; CI 95%: 1.19 - 3.06), after adjusting for gender and age. Conclusion: associations were found between functional disability and sociodemographic variables and frailty. Independence in daily activities such as those evaluated in this study is one of the primary conditions for the well-being of the elderly, even in conditions of frailty or chronic diseases.

Application of an electronic Frailty Index in Australian primary care: data quality and feasibility assessment.

The primary care setting is the ideal location for identifying the condition of frailty in older adults. The aim of this pragmatic study was twofold: (1) to identify data items to extract the data required for an electronic Frailty Index (eFI) from electronic health records (EHRs); and (2) test the ability of an eFI to accurately and feasibly identify frailty in older adults. In a rural South Australian primary care clinic, we derived an eFI from routinely collected EHRs using methodology described by Clegg et al. We assessed feasibility and accuracy of the eFI, including complexities in data extraction. The reference standard for comparison was Fried's frailty phenotype. The mean (SD) age of participants was 80.2 (4.8) years, with 36 (60.0%) female (n = 60). Frailty prevalence was 21.7% by Fried's frailty phenotype, and 35.0% by eFI (scores > 0.21). When deriving the eFI, 85% of EHRs were perceived as easy or neutral difficulty to extract the required data from. Complexities in data extraction were present in EHRs of patients with multiple health problems and/or where the majority of data items were located other than on the patient's summary problem list. This study demonstrated that it is entirely feasible to extract an eFI from routinely collected Australian primary care data. We have outlined a process for extracting an eFI from EHRs without needing to modify existing infrastructure. Results from this study can inform the development of automated eFIs, including which data items to best access data from.

Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures.

Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries. We hypothesized that this index would predict, and might ultimately prevent, complications in patients older than 50 years with distal radius fractures. We retrospectively reviewed the American College of Surgeons-National Surgery Quality Improvement Program (ACS-NSQIP) database, including patients older than 50 years who underwent open reduction and internal fixation of a distal radius fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates, as well as length of stay (LOS) were recorded. Bivariate and multivariable statistical analysis was then performed. We identified 6,494 patients (mean age, 65 years). Compared with patients with mFI of 0, patients with mFI of 2 or greater were nearly 2.5 times as likely to incur a postoperative complication (1.7% vs 7.4%). Specifically, the rates of Clavien-Dindo IV, wound, cardiac, and renal complications were increased significantly in patients with mFI of 2 or greater. In addition, as mFI increased from 0 to 2 or greater, 30-day reoperation rate increased from 0.8% to 2.4%, 30-day readmission from 0.8% to 4.6%, and LOS from 0.5 days to 1.44 days. Frailty was associated with increased complications as well as rates of readmission and reoperation even when controlling for demographic data, LOS, and operative time. Age alone was not significantly associated with postoperative complications, readmission, reoperation, or LOS. A state of frailty is highly predictive of postoperative complications, readmission, reoperation, and increased LOS following open reduction and internal fixation of distal radius fractures. Our data suggest that a simple frailty evaluation can help inform surgical decision making in patients older than 50 years with distal radius fractures. Prognostic II.

The relationship between serum IGF-1, handgrip strength, physical performance and falls in elderly men and women.

Human aging is accompanied by a decrease in growth hormone secretion and serum insulin-like growth factor (IGF)-1 levels. Also, loss of muscle mass and strength and impairment of physical performance, ending in a state of frailty, are seen in elderly. We aimed to investigate whether handgrip strength, physical performance and recurrent falls are related to serum IGF-1 levels in community-dwelling elderly. Observational cohort study (cross-sectional and prospective). We studied the association between IGF-1 and handgrip strength, physical performance and falls in participants of the Longitudinal Aging Study Amsterdam. A total of 1292 participants were included (633 men, 659 women). Serum IGF-1 levels were divided into quartiles (IGF-1-Q1 to IGF-1-Q4). Data on falls were collected prospectively for a period of 3 years. All analyses were stratified for age and physical activity and adjusted for relevant confounders. Men with a low physical activity score in IGF-1-Q1 and IGF-1-Q2 of the younger age group had a lower handgrip strength compared to IGF-1-Q4. In younger more active males in IGF-1-Q2 physical performance was worse. Recurrent fallers were less prevalent in older, low active males with low IGF-1 levels. In females, recurrent fallers were more prevalent in older, more active females in IGF-1-Q2. IGF-1 quartile may predict changes in handgrip strength and physical performance in men and women. Our results indicate that lower IGF-1 levels are associated with lower handgrip strength and worse physical performance, but less recurrent fallers especially in men. Associations were often more robust in IGF-1-Q2. Future studies on this topic are desirable.

Occupational burnout, a reality for caregivers

Occupational burnout corresponds to a state of thymic frailty linked to the work environment. It concerns all types of occupations but was initially associated with the caring professions (social, medical, etc.). Burnout is particularly prevalent in the geriatric sector where the caregiver's personal investment and confrontation with death are considerable.

Bacterial pneumonia in kidney transplant recipients.

Bacterial pathogens are the most frequent cause of pneumonia after transplantation. Early after transplantation, recipients are at higher risk for nosocomial infections. The most commonly encountered pathogens during this period are gram-negative bacilli (Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa …), but gram-positive coccus such as Staphylococcus aureus or Streptococcus pneumoniae and anaerobic bacteria can also be found. Empirical antibiotic therapy should be guided by previous colonisation of the recipient and bacterial resistance pattern in the hospital. Six months after transplantation, pneumonias are mostly due to community-acquired bacteria (S. pneumonia, H. influenza, Mycoplasma, Chlamydia and others). Opportunistic pathogens take advantage of the state of immunosuppression which is usually highest from one to six months after transplantation. During this period, but also occurring many years later in the setting of a chronically depressed immune system, bacterial pathogens with low intrinsic virulence can cause pneumonia. The diagnosis of pneumonia caused by opportunistic pathogens can be challenging. The delay in diagnosis preventing the early instauration of adequate treatment in kidney transplant recipients with a depressed immune system, frequently coupled with co-morbid conditions and a state of frailty, will affect prognosis and outcome, increasing morbidity and mortality. This review will focus on the most common opportunistic bacterial pathogens causing pneumonia in kidney transplant recipients: Legionella, Nocardia, Mycobacterium tuberculosis/nontuberculous, and Rhodococcus. Recognition of their specificities in the setting of immunosuppression will allow early diagnosis, crucial for initiation of effective therapy and successful outcome. Interactions with immunosuppressive therapy should be considered as well as reducing immunosuppression if necessary.

Peripheral artery disease is associated with frailty in chronic hemodialysis patients.

Objectives The clinical condition of frailty is a common problem in the elderly population. However, the relationship between peripheral artery disease and frailty in hemodialysis patients remains unknown. The aim of this study was to identify the relationships between peripheral artery disease and frailty in Japanese chronic hemodialysis patients. Methods A total of 362 chronic hemodialysis patients who regularly visited six institutions were enrolled. To evaluate frailty, the modified Fried's frailty phenotype adjusted for Japanese were used. Peripheral artery disease was defined as ankle-brachial index <0.9. Results Of 362 patients, 62 patients (17.1%) were categorized as peripheral artery disease group and 300 patients (82.9%) as Non-peripheral artery disease group. The prevalence of frailty in the peripheral artery disease group was significantly higher than in the Non-peripheral artery disease group (34% vs. 18%, P = 0.0103). Non-shunt side grip strength was significantly stronger in the Non-peripheral artery disease group (23.6 kg vs. 17.0 kg, P < 0.0001). Thigh circumferences were also significantly larger in the Non-peripheral artery disease group (41.7 cm vs. 39.7 cm, P = 0.0054). A multivariate logistic regression analysis demonstrated that the factors independently associated with peripheral artery disease were as follows: frailty (odds ratio = 2.06, 95% confidence interval 1.09-3.89) and myocardial infarction (odds ratio = 3.74, 95% confidence interval 2.05-6.83). Conclusions It is concluded that peripheral artery disease is closely associated with frailty in hemodialysis patients.

Cross-sectional study on the association between frailty and violence against community-dwelling elderly people in Brazil.

The physical, emotional and cognitive limitations that may be present in the aging process, coupled with family unpreparedness, may lead to greater dependence among the elderly. This favors development of frailty syndrome and greater levels of violence against the elderly. The objective here was to analyze the association between violence against the elderly and frailty; and the geographic distribution of violence against the elderly according to the presence of frailty syndrome. Cross-sectional study on 705 community-dwelling elderly people in Uberaba (MG), Brazil. The Fried frailty phenotype and conflict tactics scale were used. Data were analyzed using descriptive statistics, the chi-square test and a logistic regression model. The intensity of the events and the relationship between clusters of violence and frailty status were assessed by means of kernel estimation. The adjusted analysis indicated that pre-frailty and frailty were associated with physical and verbal aggression (odds ratio, OR = 1.51; 95% confidence interval, CI: 1.04-2.19; OR = 2.12; 95% CI: 1.29-3.47), frailty was associated with physical aggression (OR = 2.48; 95% CI: 1.25-4.94) and pre-frailty and frailty were associated with verbal aggression (OR = 1.48; 95% CI: 1.03-2.15; OR = 2.15; 95% CI: 1.31-3.52), respectively. Regardless of frailty status and its relationship with violence, clusters of occurrences were larger in similar regions in the southeastern part of the municipality; but superimposition of overlays relating to aggression showed that for frail individuals the clusters were smaller than for non-frail and pre-frail individuals. The condition of frailty was associated with greater chances of violence against the elderly.

The Prevalence of Frailty and its Associated Factors in Japanese Hemodialysis Patients.

The population undergoing dialysis is aging worldwide, particularly in Japan. The clinical condition of frailty is the most problematic expression in the elderly population. Potential pathophysiological factors of frailty present in patients with CKD and are accentuated in patients with ESRD. The aim of this study was to identify the prevalence and predictors of frailty in Japanese HD patients. This study was a multicenter, cross-sectional and observational investigation conducted at 6 institutions. To evaluate frailty, the modified Fried’s frailty phenotype adjusted for Japanese as the self-reported questionnaire was used. Of the 542 patients visiting each institution, 388 were enrolled in this study. In total, 26.0% of participants were categorized as not-frailty, 52.6% as pre-frailty and 21.4% as frailty. The prevalence of frailty increased steadily with age and was more prevalent in females than in males and the subjects with frailty received polypharmacy. A multivariate logistic regression analysis revealed that the factors independently associated with frailty were the following: female gender (odds ratio [OR] = 3.661, 95% confidence interval [CI] 1.398-9.588), age (OR = 1.065, 95% CI 1.014-1.119), age ≥ 75 years old (OR = 4.892, 95% CI 1.715-13.955), body mass index (BMI) < 18.5 (OR = 0.110, 95% CI 0.0293-0.416), number of medications being taken (OR = 1.351, 95% CI 1.163-1.570), diabetes mellitus (DM) (OR = 2.765, 95% CI 1.081-7.071) and MNA-SF ≤ 11 (OR = 7.405, 95% CI 2.732-20.072). Frailty was associated with the accumulation of risk factors. The prevalence of frailty in Japanese patients with HD was relatively lower than that previously reported in Western developed countries; however, it was extremely high compared to the general population regardless of age. Our findings suggest that frailty might be associated with an increase in the prevalence of adverse health outcomes in patients with HD.

Is Delirium the Cognitive Harbinger of Frailty in Older Adults? A Review about the Existing Evidence.

Frailty is a clinical syndrome defined by the age-related depletion of the individual’s homeostatic reserves, determining an increased susceptibility to stressors and disproportionate exposure to negative health changes. The physiological systems that are involved in the determination of frailty are mutually interrelated, so that when decline starts in a given system, implications may also regard the other systems. Indeed, it has been shown that the number of abnormal systems is more predictive of frailty than those of the abnormalities in any particular system. Delirium is a transient neurocognitive disorder, characterized by an acute onset and fluctuating course, inattention, cognitive dysfunction, and behavioral abnormalities, that complicates one out of five hospital admissions. Delirium is independently associated with the same negative outcomes of frailty and, like frailty, its pathogenesis is usually multifactorial, depending on complex inter-relationships between predisposing and precipitating factors. By definition, a somatic cause should be identified, or at least suspected, to diagnose delirium. Delirium and frailty potentially share multiple pathophysiologic mechanisms and pathways, meaning that they could be thought of as the two sides to the same coin. This review aims at summarizing the existing evidence, referring both to human and animal models, to postulate that delirium may represent the cognitive harbinger of a state of frailty in older persons experiencing an acute clinical event.

SY5-5 - Anorexia may be one of the components of frailty state in patients with heart failure: a cross-sectional study

Background: Anorexia is a major symptom of cachexia, an underlying condition of frailty due to secondary sarcopenia in heart failure (HF). Yet, the role of anorexia in progress of HF frailty has not been well investigated. This study, therefore, aimed to examine the relationship between anorexia and frailty in HF patients. Methods: We analyzed 1,129 HF patients enrolled into the multicenter cohort study. Anorexia was defined as Simplified Nutritional Appetite Questionnaire (SNAQ) < 14 points. Frailty was defined as three or more of the followings: body mass index < 20 kg/m2; usual walking speed < 0.8 m/sec; grip strength < 26 kg in male, 17kg in female; Performance Measure of Activity in Daily Living-8 > 20. First, correlations between SNAQ and Controlling Nutritional status, Geriatric Nutritional Risk Index (GNRI), their components and brain natriuretic peptide (BNP) were assessed using Spearman's rank correlation. Then, logistic regression was performed to assess the relationship between anorexia and frailty. Results: SNAQ was significantly but weakly correlated with GNRI (r=0.10), serum albumin (r=0.09) and BNP (r=-0.10). As the result of logistic regression, anorexia was significantly associated with frailty after adjustment for age, gender and BNP. Conclusions: The findings of this study suggest that anorexia measured by SNAQ may be a marker of progressing frailty. Adequate medication and nutritional intervention should be considered before starting exercise program to improve frailty in HF.

Diseases AND or IN frailty, an important conceptual difference

Frailty is a clinical state that increases an individual's vulnerability. It is an outcome marker in several medical scenarios. However, there is a lack of recognition in the medical field. Frailty should not be regarded as a condition superimposed to disease. Contrarily, it should be noticed as a state frequently found either as a component of diseases themselves or as their outcome. The work of a geriatrician is focused on the best possible approximation to the medical and psychosocial issues that an elder has, and must join the treatment team when the person has a considerable number of conditions that makes him/her frail. Traditionally medicine has focused mainly on illnesses, but the state of frailty requires a change of mindset, through a multidimensional person centered approach.

What is the duration of life expectancy in the state of frailty? Estimates in the SIPAF study.

The screening of frailty can trigger interventions aiming to delay disability in older people. Whereas the prevalence, the consequences, and the factors associated with frailty are well described, little is known about the duration of the state of frailty. This study aimed to estimate the time spent in the state of frailty in men and women using the Sullivan method. Data used were the age- and sex-specific prevalence of frailty found in SIPAF study ("Système d'Information sur la Perte d'Autonomie Fonctionnelle de la personne âgée") and statistics of mortality from the Human Mortality Database. The SIPAF study included 2350 individuals aged 70 and over and living in France. Participants were interviewed at home by trained nurses. Frailty was defined as impairment in three domains or more among nutrition, energy, physical activity, strength, and mobility. People requiring assistance in basic activities of daily living were considered in a separate category. Mean age of the study sample was 83.3±7.5years, with 59.4% of women. Overall, the prevalence of pre-frailty, frailty, and dependency was 39.1, 17.0, and 15.4%, respectively. Life expectancy at age 70 was 18.3years for women, of which 7.4years (95% CI 6.9-7.9) were pre-frail, 3.4years (95% CI 3.0-3.8) frail, and 2.4 (95% CI 2.1-2.7) with disability. In contrast, LE for men at 70 was 14.8years, of which pre-frail, frail, and disabled years were 6.0years (95% CI 5.5-6.5), 1.2years (95% CI 1.0-1.5), and 1.2 (95% CI 1.0-1.5), respectively. In conclusion, frailty is a transition state that is relatively limited in time compared to pre-frailty that may represent a larger time window for prevention.

The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty

ObjectiveTo develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. MethodsAn adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RecommendationsStrong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. ConclusionsThe recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.