Frailty and cerebrovascular disease: Concepts and clinical implications for stroke medicine

Abstract

Frailty is a distinctive health state in which the ability of older people to cope with acute stressors is compromised by an increased vulnerability brought by age-associated declines in physiological reserve and function across multiple organ systems. Although closely associated with age, multimorbidity, and disability, frailty is a discrete syndrome that is associated with poorer outcomes across a range of medical conditions. However, its role in cerebrovascular disease and stroke has received limited attention. The estimated rise in the prevalence of frailty associated with changing demographics over the coming decades makes it an important issue for stroke practitioners, cerebrovascular research, clinical service provision, and stroke survivors alike. This review will consider the concept and models of frailty, how frailty is common in cerebrovascular disease, the impact of frailty on stroke risk factors, acute treatments, and rehabilitation, and considerations for future applications in both cerebrovascular clinical and research settings.

Keywords: Frailty; inflammageing; rehabilitation; stroke.

Figure 1.

Differing trajectories in disability following stroke events in non-frail (a) and frail (b) individuals.

Figure 2.

Schema illustrating the relationships between frailty, disability, and multimorbidity.

Figure 3.

Factors influencing propagation of frailty and stroke risk.