Frailty syndrome - Wikipedia

Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults. Frailty is a ... Frailtysyndrome FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Weaknessinelderlyperson MedicalconditionFrailtysyndromeAwomansupportingherselfwithawalkingframe.SpecialtyGeriatrics Frailtyisacommongeriatricsyndromethatembodiesanelevatedriskofcatastrophicdeclinesinhealthandfunctionamongolderadults.Frailtyisaconditionassociatedwithageing,andithasbeenrecognizedforcenturies.Itisalsoamarkerofamorewidespreadsyndromeoffrailty,withassociatedweakness,slowing,decreasedenergy,loweractivity,and,whensevere,unintendedweightloss.Frailtyhasbeenidentifiedasariskfactorforthedevelopmentofdementia. Asapopulationages,acentralfocusofgeriatriciansandpublichealthpractitionersistounderstand,andthenbeneficiallyinterveneon,thefactorsandprocessesthatputeldersatsuchrisk,especiallytheincreasedvulnerabilitytostressors(e.g.extremesofheatandcold,infection,injury,orevenchangesinmedication)thatcharacterizesmanyolderadults.[1] Contents 1Geriatricsyndromesrelatedtofrailty 1.1Sarcopenia 1.2Osteoporosis 1.3Muscleweakness 2Biologicalandphysiologicalmechanisms 2.1Theoreticalunderstanding 3Frailtyassessment 3.1Physicalfrailtyphenotype 3.2Frailtyindex/Deficitaccumulation 3.3Fourdomainsoffrailty 3.4SHAREFrailtyIndex 4Prevention 4.1Identificationofriskfactors 4.2Exercise 4.3Nutrition 5Non-surgicalmanagement 5.1Exercise 5.2Occupationaltherapy 5.3Nutritionalsupplementation 5.4Palliativecare 6Surgicaloutcomes 7Epidemiologyandpublichealth 8Ongoingclinicaltrials 9References Geriatricsyndromesrelatedtofrailty[edit] Sarcopenia[edit] Sarcopeniaisthedegenerativelossofskeletalmusclemass,quality,andstrengthassociatedwithaging.[2]Therateofmusclelossisdependentonexerciselevel,co-morbidities,nutritionandotherfactors.Sarcopeniacanleadtoreductioninfunctionalstatusandcausesignificantdisabilityfromincreasedweakness.Themusclelossisrelatedtochangesinmusclesynthesissignallingpathwaysalthoughisincompletelyunderstood.Thecellularmechanismsaredistinctfromothertypesofmuscleatrophysuchascachexia,inwhichmuscleisdegradedthroughcytokine-mediateddegradationalthoughbothconditionsmayco-exist.[3] Osteoporosis[edit] Osteoporosiscausesahunched-overappearanceinsomepeople. Osteoporosisisanage-relateddiseaseofbonethatleadstoanincreasedriskoffracture.Inosteoporosisthebonemineraldensity(BMD)isreduced,bonemicroarchitectureisdisrupted,andtheamountandvarietyofproteinsinboneisaltered.OsteoporosisisdefinedbytheWorldHealthOrganization(WHO)inwomenasabonemineraldensity2.5standarddeviationsbelowpeakbonemass(20-year-oldhealthyfemaleaverage)asmeasuredbyDXA;theterm"establishedosteoporosis"includesthepresenceofafragilityfracture.[4] Osteoporosisismostcommoninwomenaftermenopause,whenitiscalledpostmenopausalosteoporosis,butmayalsodevelopinmen,andmayoccurinanyoneinthepresenceofparticularhormonaldisordersandotherchronicdiseasesorasaresultofmedications,specificallyglucocorticoids,whenthediseaseiscalledsteroid-orglucocorticoid-inducedosteoporosis(SIOPorGIOP).Givenitsinfluenceintheriskoffragilityfracture,osteoporosismaysignificantlyaffectlifeexpectancyandqualityoflife.[citationneeded] Muscleweakness[edit] Muscleweakness,alsoknownasmusclefatigue,(or"lackofstrength")referstotheinabilitytoexertforcewithone'sskeletalmuscles.Weaknessoftenfollowsmuscleatrophyandadecreaseinactivity,suchasafteralongboutofbedrestasaresultofanillness.Thereisalsoagradualonsetofmuscleweaknessasaresultofsarcopenia–theage-relatedlossofskeletalmuscle.[citationneeded] Muscleweaknessmakesitdifficulttoperformeverydayactivities,likegettingintoabathtub. Atestofstrengthisoftenusedduringadiagnosisofamusculardisorderbeforetheetiologycanbeidentified.Suchetiologydependsonthetypeofmuscleweakness,whichcanbetrueorperceivedaswellasvariabletopically.Trueweaknessissubstantial,whileperceivedratherisasensationofhavingtoputmoreefforttodothesametask.[5]Ontheotherhand,varioustopiclocationsformuscleweaknessarecentral,neuralandperipheral.Centralmuscleweaknessisanoverallexhaustionofthewholebody,whileperipheralweaknessisanexhaustionofindividualmuscles.Neuralweaknessissomewherebetween.[citationneeded] Biologicalandphysiologicalmechanisms[edit] Ithasbeensuggestedthatthecausesoffrailtyaremultifactorial,involvingdysregulationacrossmanyphysiologicalsystems.[6]Aproinflammatorystate,[7]sarcopenia,[8]anemia,[9][10]relativedeficienciesinanabolichormones(androgensandgrowthhormone)[11]andexcessexposuretocatabolichormones(cortisol),[12]insulinresistance,[13]glucoselevels,[14]compromisedalteredimmunefunction,[15][16]micronutrientdeficienciesandoxidativestress[17]areeachindividuallyassociatedwithahigherlikelihoodoffrailty.Additionalfindingsshowthattheriskoffrailtyincreaseswithanincreasednumberofabnormalbodilysystems.[6]Thisfindingshowsthatinterventionsthattargetmultiplesystemsmayyieldgreaterresultsinpreventionandtreatmentoffrailtythaninterventionsthattargetonlyonesystem. Associationsbetweenspecificdiseasestatesarealsoassociatedwithandfrailtyhavealsobeenobserved,includingcardiovasculardisease,diabetesmellitus,chronickidneydiseaseandotherdiseasesinwhichinflammationisprominent.Itispossiblethatclinicallymeasurablediseasestatescanmanifestthemselvesorbecapturedpriortotheonsetoffrailty.Nosinglediseasestateisnecessaryandsufficientforthepathogenesisoffrailty,sincemanyindividualswithchronicdiseasesarenotfrail.Therefore,ratherthanbeingdependentonthepresenceofmeasurablediseases,frailtyisanexpressionofacriticalmassofphysiologicimpairments. Frailtyhasbeenidentifiedasariskfactorforthedevelopmentofdementia.[18] Theoreticalunderstanding[edit] Recentworkonfrailtyhassoughttocharacterizeboththeunderlyingchangesinthebodyandthemanifestationsthatmakefrailtyrecognizable.Itiswell-agreeduponthatdeclinesinphysiologicreservesandresilienceistheessenceofbeingfrail.[19]Similarly,scientistsagreethattheriskoffrailtyincreaseswithageandwiththeincidenceofdiseases.Beyondthat,thereisnowstrongevidencetosupportthetheorythatthedevelopmentoffrailtyinvolvesdeclinesinenergyproduction,energyutilizationandrepairsystemsinthebody,resultingindeclinesinthefunctionofmanydifferentphysiologicalsystems.Thisdeclineinmultiplesystemsaffectsthenormalcomplexadaptivebehaviorthatisessentialtohealth[6]andeventuallyresultsinfrailtytypicallymanifestingasasyndromeofaconstellationofweakness,slowness,reducedactivity,lowenergyandunintendedweightloss.[20]Whenmostsevere,i.e.when3ormoreofthesemanifestationsarepresent,theindividualisatahighriskofdeath. Frailtyassessment[edit] Furtherinformation:FrailtyindexandPhysiologicalfunctionalcapacity Thesyndromeofgeriatricfrailtyishypothesizedtoreflectimpairmentsintheregulationofmultiplephysiologicsystems,embodyingalackofresiliencetophysiologicchallengesandthuselevatedriskforarangeofdeleteriousendpoints.Generallyspeaking,theempiricalassessmentofgeriatricfrailtyinindividualsseeksultimatelytocapturethisorrelatedfeatures,thoughdistinctapproachestosuchassessmenthavebeendevelopedintheliterature(seedeVriesetal.,2011foracomprehensivereview).[21] Twomostwidely-usedapproaches,differentintheirnatureandscopes,[22]arediscussedbelow.Otherapproachesfollow. Physicalfrailtyphenotype[edit] Apopularapproachtotheassessmentofgeriatricfrailtyencompassestheassessmentoffivedimensionsthatarehypothesizedtoreflectsystemswhoseimpairedregulationunderliesthesyndrome.Thesefivedimensionsare: unintentionalweightloss, exhaustion, muscleweakness, slownesswhilewalking,and lowlevelsofactivity.[1] Correspondingtothesedimensionsarefivespecificcriteriaindicatingadversefunctioning,whichareimplementedusingacombinationofself-reportedandperformance-basedmeasures.Thosewhomeetatleastthreeofthecriteriaaredefinedas“frail”,whilethosenotmatchinganyofthefivecriteriaaredefinedas“robust”.AdditionalworkontheconstructisdonebyBandeen-Rocheetal.(2006),[20]thoughsomeoftheexactcriteriaandmeasuresdiffer(seeTable1inthepaperforthiscontrast).OtherstudiesintheliteraturehavealsoadoptedthegeneralapproachofLindaP.Friedetal.(2001)[1]though,again,theexactcriteriaandtheirparticularmeasuresmayvary.ThisassessmentapproachwasdevelopedandrefinedbyFriedandcolleaguesattheJohnsHopkinsUniversity'sCenteronAgingandHealth.ThisCenterishometoJohnsHopkinsClaudeD.PepperOlderAmericansIndependenceCenter,whichfocusesonfrailtyresearchandhaslaunchedawebsitededicatedtofrailtyscience:https://frailtyscience.org. Frailtyindex/Deficitaccumulation[edit] Anothernotableapproachtotheassessmentofgeriatricfrailty(ifnotalsotosomedegreeitsconceptualization)isthatofRockwoodandMitnitski(2007)[23]inwhichfrailtyisviewedintermsofthenumberofhealth"deficits"thataremanifestintheindividual,leadingtoacontinuousmeasureoffrailty(seeRockwood,Andrew,andMitnitski(2007)[24]foracontrastofthetwoapproaches).ThisapproachwasdevelopedbyDr.RockwoodandcolleaguesatDalhousieUniversity. Fourdomainsoffrailty[edit] AfourdomainsoffrailtymodelwasproposedinresponsetoanarticleintheBMJ.[25]Thisconceptualisationcouldbeviewedasblendingthephenotypicandindexmodels.Researcherstestedthismodelforsignalinroutinelycollectedhospitaldata,[26]andthenusedthissignalinthedevelopmentofafrailtymodel,findingevenpredictivecapabilityacross3outcomesofcare.[27]Inthecarehomesetting,onestudyindicatedthatnotallfourdomainsoffrailtywereroutinelyassessedinresidents,givingevidencetosuggestthatfrailtymaystillprimarilybeviewedonlyintermsofphysicalhealth.[28] SHAREFrailtyIndex[edit] TheSHARE-FrailtyIndex(SHARE-FI)wasoriginallydevelopedbyRomero-Ortuno(2010)[29]andresearchersaspartoftheSurveyofHealthyAgeingandRetirementinEurope.Itconsistsoffivedomainsofthefrailtyphenotype: •Fatigue •Lossofappetite •Gripstrength •Functionaldifficulties •Physicalactivity TheSHARE-FIcalculatorisfreelyavailabletouseonline. Thecalculatorclassifiesindividualsas1)frail;2)pre-frail;and3)non-frail/robust. TheSHARE-FIhasgoodclinicalutilityasitprovidesrelativelyquickassessmentoffrailtyinoftentime-poorhealthcaresettings. Prevention[edit] Identificationofriskfactors[edit] Whenconsideringpreventionoffrailty,itisimportanttounderstandtheriskfactorsthatcontributetofrailtyandidentifythemearlyon.A2005observationalstudyfoundassociationsbetweenfrailtyandanumberofriskfactorssuchas:lowincome,advancedage,chronicmedicalconditions,lackofeducation,andsmoking.[30] Exercise[edit] Asignificanttargetinthepreventionoffrailtyisphysicalactivity.Aspeopleage,physicalactivitymarkedlydrops,withthesteepestdeclinesseeninadolescenceandcontinuingonthroughoutlife.[31]Thelowerlevelsofphysicalactivityandareassociatedwithandakeycomponentoffrailtysyndrome.Thereforeexerciseregimenshavebeenexaminedinanumberofstudiesasaninterventiontopreventfrailty.[32][33]Arandomizedcontroltrialpublishedin2017foundsignificantlylowerratesoffrailtyinolderadultswhowereassignedanexerciseregimenvsthosewhowereinthecontrolgroup.[32]Inthisstudy,15.3%ofthecontrolgroupbecamefrailinthetimeframeofthestudy,incomparisonto4.9%oftheexercisegroup.Theexercisegroupalsoreceivedanutritionalassessment,whichisanothertargetinfrailtyprevention. Nutrition[edit] Nutritionhasalsobeenamajortargetinthepreventionofphysicalactivity.A2019reviewpaperexaminedavarietyofstudiesandfoundevidenceofnutritionalinterventionasaneffectivewayofpreventingfrailty.[34]Withthemediterraneandietinparticularreducingriskoffrailtyupto60%. Non-surgicalmanagement[edit] Exercise[edit] Individualspartakinginexerciseappeartohavepotentialinpreventingfrailty.In2018,asystemicreviewconcludedthatgroupexercisehadthebenefitofdelayingfrailtyinolderadultsaged65andabove.[35]Elderlyadultsarealsolesslikelytosufferfromfallinjuries.[36] Occupationaltherapy[edit] Activitiesofdailyliving(ADLs)includeactivitiesthatarenecessarytosustainlife.Examplesarebrushingteeth,gettingoutofbed,dressingoneself,bathing,etc.OccupationaltherapyprovidedmodestimprovementsinelderlyadultsmobilitytodoADLs.[37] Nutritionalsupplementation[edit] Frailtycaninvolvechangessuchasweightloss.Interventionsshouldfocusonanydifficultieswithsupplementationanddiet.Forthosewhomaybeundernourishedandnotacquiringadequatecalories,oralnutritionalsupplementsinbetweenmealsmaydecreasenutritionaldeficits.[38] Withagecomesdecreasedbonedensity.Therefore,vitaminDsupplementationmayprovidethebenefitsofimprovingstabilityandmusclestrengthretention.[39] Palliativecare[edit] Palliativecaremaybehelpfulforindividualswhoareexperiencinganadvancedstateoffrailtywithpossibleotherco-morbidities.Improvingqualityoflife byreducingpainandotherharmfulsymptomsisthegoalwithpalliativecare.Onestudyshowedthecostreductionbyfocusingonpalliativecareratherthanexpensivetreatmentsthatmaybeunnecessaryandunhelpful.[40] Surgicaloutcomes[edit] Frailelderlypeopleareatsignificantriskofpost-surgicalcomplicationsandtheneedforextendedcare.Frailtymorethandoublestheriskofmorbidityandmortalityfromsurgeryandcardiovascularconditions.[41]Assessmentofolderpatientsbeforeelectivesurgeriescanaccuratelypredictthepatients'recoverytrajectories.[42] Themost[citationneeded][dubious–discuss]widelyusedfrailtyscaleconsistsoffiveitems:[1] unintentionalweightloss>4.5 kginthepastyear self-reportedexhaustion <20thpopulationpercentileforgripstrength slowedwalkingspeed,definedaslowestpopulationquartileon4-minutewalkingtest lowphysicalactivitysuchthatpersonswouldonlyrarelyundertakeashortwalk Ahealthypersonscores0;averyfrailpersonscores5.Comparedtonon-frailelderlypeople,peoplewithintermediatefrailtyscores(2or3)aretwiceaslikelytohavepost-surgicalcomplications,spend50%moretimeinthehospital,andarethreetimesaslikelytobedischargedtoaskillednursingfacilityinsteadoftotheirownhomes.[42]Frailelderlypatients(scoreof4or5)haveevenworseoutcomes,withtheriskofbeingdischargedtoanursinghomerisingtotwentytimestheratefornon-frailelderlypeople. Epidemiologyandpublichealth[edit] Frailtyisacommongeriatricsyndrome.Estimatesoffrailtyprevalenceinolderpopulationsmayvaryaccordingtoanumberoffactors,includingthesettinginwhichtheprevalenceisbeingestimated–e.g.,nursinghome(higherprevalence)vs.community(lowerprevalence)–andtheoperationaldefinitionusedfordefiningfrailty.UsingthewidelyusedfrailtyphenotypeframeworkproposedbyFriedetal.(2001),[1]prevalenceestimatesof7–16%havebeenreportedinnon-institutionalized,community-dwellingolderadults. Theoccurrenceoffrailtyincreasesincrementallywithadvancingage,ismorecommoninolderwomenthanmen,andamongthoseoflowersocio-economicstatus.Frailolderadultsareathighriskformajoradversehealthoutcomes,includingdisability,falls,institutionalization,hospitalization,andmortality. Epidemiologicresearchtodatehasledtotheidentificationofanumberofriskfactorsforfrailty,including:(a)chronicdiseases,suchascardiovasculardisease,diabetes,chronickidneydisease,depression,andcognitiveimpairment;[43](b)physiologicimpairments,suchasactivationofinflammationandcoagulationsystems,[7]anemia,[9][10]atherosclerosis,[44]autonomicdysfunction,[9][45]hormonalabnormalities,[11]obesity,[46]hypovitaminosisDinmen,[47]andenvironment-relatedfactorssuchaslifespaceandneighborhoodcharacteristics.[48]Advancesaboutpotentiallymodifiableriskfactorsforfrailtynowofferthebasisfortranslationalresearcheffortaimedatpreventionandtreatmentoffrailtyinolderadults.Arecentsystematicreviewfoundthatexerciseinterventionscanincreasemusclestrengthandimprovephysicalfunction;however,resultsareinconsistentinfrailolderadultslivinginthecommunity.[49] Areviewlookedattherelationshipbetweenthefrailtysyndromeandchroniclowerextremityischemiainthosepeoplewithdiabetes.Ontheonehand,chroniclowerlimbischemiamaypredisposetothedevelopmentoffrailty,ontheotherhand,thepresenceofthefrailtymayaffecttheprognosisinpatientswithperipheralarterialdisease.[50] Ongoingclinicaltrials[edit] AsofSeptember2021,ongoingclinicaltrialsonfrailtysyndromeintheUSinclude: theimpactoffrailtyonclinicaloutcomesofpatientstreatedforabdominalaorticaneurysms[51] theuseof“pre-habilitation,”anexerciseregimenusedbeforetransplantsurgery,topreventthefrailtyeffectsofkidneytransplantinrecipients[52] definingtheacutechangesinfrailtyfollowingsepsisintheabdomen[53] theefficacyoftheanti-inflammatorydrug,Fisetin,inreducingfrailtymarkersinelderlyadults[54] Up-to-dateinformationonongoingclinicaltrialsonfrailtysyndromeandotherconditionscanbefoundatclinicaltrials.gov. 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^PhD,JamesL.Kirkland,MD(2021-02-22)."AFFIRM-LITE:APhase2Randomized,Placebo-ControlledStudyofAlleviationbyFisetinofFrailty,Inflammation,andRelatedMeasuresinOlderAdults".MayoClinic.{{citejournal}}:Citejournalrequires|journal=(help) Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Frailty_syndrome&oldid=1056569582" Categories:GeriatricsGerontologyHiddencategories:WebarchivetemplatewaybacklinksCS1errors:deprecatedparametersCS1errors:missingperiodicalArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromFebruary2020ArticleswithunsourcedstatementsfromOctober2020AllaccuracydisputesArticleswithdisputedstatementsfromOctober2020 Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English expanded collapsed Views ReadEditViewhistory More expanded collapsed Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute 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