Frailty

Frailty - Frailty is defined as the loss of an individual’s ability to withstand minor stresses because the reserves in function of several organ systems are so severely reduced that even a trivial illness or adverse drug reaction may result in organ failure and death. The same stresses would cause little upset in a fit person of the same age.

older people is a Frailty

It is important to understand the difference between ‘disability’ and ‘frailty’. Disability indicates established loss of function (e.g. mobility; see Box 7.15, p. 175), while frailty indicates increased vulnerability to loss of function. Disability may arise from a single pathological event (such as a stroke) in an otherwise healthy individual. After recovery, function is largely stable, and the patient may otherwise be in good health. When frailty and disability coexist, function deteriorates markedly even with minor illness, to the extent that the patient can no longer manage independently.

Unfortunately, the term ‘frail’ is often used rather vaguely, sometimes to justify a lack of adequate investigation and intervention in older people. However, it can be specifically identified by assessing function in a number of domains (Box 7.2). These are all commonly impaired by disease, illness and indeed age, but can often be improved by specific intervention. In clinical practice, ‘frailty’ per se is rarely measured formally, but a comprehensive assessment (see below) includes an evaluation of each domain.

Frail older people particularly benefit from a clinical approach that addresses both the precipitating acute illness and their underlying loss of reserves. It may be possible to prevent further loss of function through early intervention; for example, a frail woman with cardiac failure will benefit from specific cardiac investigation and drug treatment, but will benefit even further from an exercise programme to improve musculoskeletal function, balance and aerobic capacity, with nutritional support to restore lost weight. Establishing a patient’s level of frailty also helps inform decisions regarding further investigation and management, and the need for rehabilitation.