A multidimensional approach to frailty in older people

Abstract

Frailty is an important factor determining a higher risk of adverse health outcomes in older adults. Although scientific community in the last two decades put a lot of effort for its definition, to date no consensus was reached on its assessment. The mainstream thinking describes frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of frailty has emerged based on the loss of harmonic interaction between multiple domains (also referred as dimensions) including genetic, biological, functional, cognitive, psychological and socio-economic domain that ultimately lead to homeostatic instability. Therefore, the multidimensional aspects of frailty condition could be captured by the comprehensive geriatric assessment (CGA) and its derived Multidimensional Prognostic Index (MPI). This instrument has been applied in different clinical settings and in several cohorts of older adults with specific acute and chronic diseases, showing always excellent accuracy in stratifying population according the mortality risk and other negative health outcomes, i.e. hospitalization, institutionalization or admission to homecare services. This MPI "plasticity" provides a single numerical prognostic index which could be helpful in clinical decision making for the management of frail older adults.

Keywords: Comprehensive geriatric assessment; Frailty; Multidimensional prognostic index.

Fig. 1.

The underlying mechanisms of frailty.

Fig. 2.

Domains of the multidimensional model of frailty. Abbreviations: ADL: Activities of Daily Living; IADL: Instrumental Activities of Daily Living; CIRS: Cumulative Illness Rating Scale; GDS: Geriatric Depression Scale; MEDAS: Mediterranean Diet Adherence Screener; MMSE: Mini Mental State Examination; MNA: Mini Nutritional Assessment; SPMSQ: Short Portable Mental State Questionnaire; SPPB: Short Physical Performance Battery.