Approaches to the diagnosis and prevention of frailty

Abstract

An individual who is living with frailty has impairments in homeostasis across several body systems and is more vulnerable to stressors that may ultimately predispose them to negative health-related outcomes, disability and increased healthcare use. Approximately a quarter of individuals aged > 85 years are living with frailty and as such the identification of those who are frail is a public health priority. Given that the syndrome of frailty is defined by progressive and gradual loss of physiological reserves there is much scope to attempt to modify the trajectory of the frailty syndrome via physical activity and nutritional interventions. In this review we give an up to date account on the identification of frailty in clinical practice and offer insights into physical activity and nutritional strategies that may be beneficial to modify or reverse the frailty syndrome.

Keywords: Frailty; Identifying frailty; Nutrition; Physical activity.

Fig. 1

Determinants and development of frailty. The ideal healthy ageing paradigm, free of illness and physiological vulnerability, is represented by the thick line (blue). Frailty, represented by the thin line (red), develops as a continuum from a state of being physiologically robust and independent to being at risk of disability and dependency and, ultimately, to being hospitalised institutionalised or at risk of dying. In younger robust individuals (a) rapid recovery after an injury or illness that leads to reduced functional capacity is more likely. Later in the life course, cumulative physiological decline across multiple body systems leads to episodic functional, psychological or cognitive decompensation. At this stage, recovery after these stressor events takes longer as physiological and cognitive reserves are depleted. Eventually, a transition point in later life is crossed when the individual cannot compensate adequately and the ability to perform daily activity diminishes. This increases the likelihood of disability, healthcare service use or hospitalisation as a consequence of a relatively minor stresses or insults. Ultimately, the accumulation of these homeostatic insults results in further disability, healthcare dependency, recurrent hospitalisation, institutionalisation and risk of dying (b). Adapted from Patel et al.