II. Definitions

  1. Frailty
    1. Physiologic decline with advancing age, with associated increased risk of adverse health outcomes
    2. Findings include slow gait, Unintentional Weight Loss, sedentary
  2. Sarcopenia
    1. Catabolic age-related loss of muscle mass and strength
    2. Findings include reduced grip strength, gait speed and muscle mass

III. Pathophysiology

  1. Frailty is a constellation of progressive physiologic decline inadequately compensated by physiologic reserve

IV. Risk Factors

  1. Older age
  2. Female gender (although frail men have higher mortality)
  3. Lower socioeconomic status and less well educated
  4. Tobacco Abuse and other unhealthy behaviors
  5. Social isolation
  6. Comorbidities
    1. Diabetes Mellitus
    2. Respiratory disease (e.g. COPD)
    3. Cerebrovascular Accident
    4. Dementia
    5. Multiple Sclerosis
    6. Connective Tissue Disease
    7. Osteoarthritis
    8. Chronic Fatigue Syndrome

V. Symptoms

  1. Early
    1. Generalized weakness
    2. Fatigue or exhaustion
  2. Later
    1. Slow gait
    2. Decreased balance
    3. Decreased Physical Activity
    4. Decreased Motor Strength
    5. Cognitive Impairment
  3. Late
    1. Weight loss

VI. Diagnosis: Frailty (Three or more of the following criteria)

  1. Unintentional Weight Loss of at least 10 lb (4.5 kg) in the last year
  2. Self-reported exhaustion
  3. Weakness (decreased grip strength)
  4. Slow walking speed
  5. Low Physical Activity

VIII. Grading: CSHA Clinical Frailty Scale

  1. Category 1: Very Fit
    1. Energetic, active and well motivated
    2. Exercises regularly and most fit for age
  2. Category 2: Well
    1. Less fit than category 1, but no active disease
  3. Category 3: Well with Treated Comorbidity
    1. Well controlled comorbidity
  4. Category 4: Apparently Vulnerable
    1. Disease limits patient by self report
    2. Not dependent on others
  5. Category 5: Mildly Frail
    1. Limited dependence on others for Instrumental Activities of Daily Living
  6. Category 6: Moderately Frail
    1. Assistance needed for Activities of Daily Living (including Instrumental Activities of Daily Living)
  7. Category 7: Severe Frailty
    1. Complete dependence on others for Activities of Daily Living
  8. Category 8: Very Severe Frailty
    1. Approaching end of life
    2. Even minor illness might be difficult to survive
  9. Category 9: Terminally Ill (end of life)
    1. Life Expectancy <6 months
  10. References
    1. Rockwood (2005) CMAJ 173(5): 489-95 [PubMed]
    2. Dalhousie University
      1. https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html

IX. Evaluation

  1. Comprehensive Geriatric Assessment
    1. See Geriatric Assessment
    2. Multidimensional older adult evaluation (e.g. Polypharmacy, ADL Scale, fall risk, hearing, vision, mood, cognition)
  2. Frailty Assessment Tools
    1. Fried Frailty Phenotype Criteria
    2. Rockwood Frailty Index

X. Management

  1. Exercise program
    1. See Exercise in the Elderly
    2. See Geriatric Balance Training
    3. See Geriatric Strength Training
    4. Offer multicomponent Physical Activity program (referral)
      1. Should include Progressive Resistance Training component
  2. Other measures
    1. Additional interventions based on Comprehensive Geriatric Assessment
    2. May consider social support services
    3. Consider geriatrician Consultation
    4. Consider Nutritional Supplementation (e.g. Protein Supplementation) esp. in Unintentional Weight Loss

XI. Complications

  1. Fall Risk
  2. Overall Disability requiring assistance for ADLs
  3. Polypharmacy
  4. Increased hospitalization rates
  5. Longterm Care admission (e.g. Nursing Home)
  6. Increased mortality

XII. Prognosis

  1. Frailty is dynamic and can be improved with interventions
  2. Positive prognostic factors (more likely to reduce Frailty)
    1. Women
    2. Better socioeconomic conditions

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Related Studies

Ontology: Frailty (C0424594)

Concepts Finding (T033)
ICD10 R54
SnomedCT 248279007
Dutch geringe belastbaarheid
French Fragilité
German Gebrechlichkeit
Italian Fragilità
Portuguese Fragilidade
Spanish Estado debilitado, debilidad (hallazgo), debilidad
Japanese 虚弱, キョジャク
Czech Křehkost, slabost
English frailty (diagnosis), frailty, Frailty (finding), Frailty
Hungarian Törékenység

Ontology: Sarcopenia (C0872084)

Definition (MSH) Progressive decline in muscle mass due to aging which results in decreased functional capacity of muscles.
Definition (CSP) loss of skeletal muscle mass, quality and strength; may be associated with aging.
Concepts Finding (T033)
MSH D055948
Japanese 筋肉減少症, キンニクゲンショウショウ
Czech Sarkopenie, sarkopenie
English Sarcopenia, Sarcopenias, Sarcopenia [Disease/Finding], sarcopenia
French Sarcopénie, Sarcoporose
German Muskelschwund, Sarkopenie
Italian Sarcopenia
Portuguese Sarcopenia
Spanish Sarcopenia
Russian SARKOPENIIA, САРКОПЕНИЯ
Swedish Sarkopeni
Polish Sarkopenia
Hungarian Sarcopenia
Norwegian Sarkopeni
Dutch sarcopenie