This makes them more vulnerable, less able to recover and even apparently minor events (infections, environmental changes) can have drastic impacts on their physical and mental health.
[1][2] Frailty can have various symptoms including muscle weakness (reduced grip strength), slower walking speed, exhaustion, unintentional weight loss, and frequent falls.
The reduced reserve capacity of organ systems, muscle, and bone create a state where the body is not capable of coping with stressors such as illness or falls.
[14] Frailty most commonly refers to physical status and is not a syndrome of mental capacity such as dementia, which is a decline in cognitive function.
[3] Most often frailty is identified by having three out of five of the following symptoms: unintentional weight loss, muscle weakness, self-reported exhaustion, slowness and low physical activity.
[9] Decreases in skeletal muscle mass (sarcopenia) and bone density (osteopenia and osteoporosis) are two major contributors to developing frailty in older adults.
[19] The rate of muscle loss is dependent on exercise level, co-existing health conditions, nutrition and other factors.
[9] Conditions and symptoms related to mental health that can increase the likelihood of frailty include depression and loneliness.
Demographic factors include older age, being female, having lower level of education, and having low income.
[9] Living in poor neighborhood conditions, in a rural area, and having low social support are also potential risk factors for frailty.
Other mechanisms associated with frailty include insulin resistance,[32] increased glucose levels,[33] compromised immune function,[34][35] micronutrient deficiencies, and oxidative stress.
This decline in multiple systems affects the normal complex adaptive behavior that is essential to health and eventually results in frailty.
CGA looks at multiple domains of potential risk factors including physical, psychological, and social health.
[45][8] Older people with moderate or severe frailty who are admitted to a hospital due to an unexpected emergency have an increased risk of a prolonged length of stay, death, and being discharged to a place other than their home.
[48][49] In the United Kingdom, best practice guidelines recommend a medical review based on CGA to establish the management plan for people with frailty.
[62] Other studies note that frailty scales alone may be inaccurate in predicting outcomes for people undergoing surgical procedures, and other factors such as co-morbid medical conditions need to be considered.
[63] For people with frailty undergoing abdominal surgery, prehabilitation programmes that include exercise, improved diet and psychological support can reduce the length of hospital stay and decrease the risk of serious complications.
As people age, physical activity markedly drops, with the steepest declines seen in adolescence and continuing on throughout life.
Therefore, regular exercise such as walking, strength training, and self-directed physical activity is an important way to prevent frailty.
and understanding mechanisms to reduce frailty can help older adults prevent worsening their frail status.
[75] Currently, preventative interventions focus on minimizing muscle loss and improvement of overall well-being in older adults or individuals with chronic illnesses.
For example, progressive resistance strength training for older adults can be used in clinical practice or at-home as a way to regain mobility.
It can improve mobility, social participation, provide empowerment, and help with activities of daily living (brushing teeth, bathing, dressing up, etc.).
[79][80] Specific ways of frailty management largely depends on an individual's classification (i.e. pre-fail, frail) and treatment needs.
[5] Physicians need to work closely with people who have frailty to develop a realistic management plan to ensure their compliance, leading to better health outcomes.
[81][8] Advance care planning can effectively support hospitalised people with frailty to express what kind of healthcare they prefer to receive in the future.
[82][83] Palliative care may be helpful for individuals who are experiencing an advanced state of frailty with possible other co-existing health conditions.
The goal of palliative care in people with frailty is improving quality of life by reducing pain and other harmful symptoms.
Using the widely used frailty phenotype framework,[42] prevalence estimates of 7–16% have been reported in non-institutionalized, community-dwelling older adults.
The presence of frailty with these mental disorders was also associated with a poor prognosis and increased mortality[85] Research comparing case management trials to standard care for people living with frailty in high-income countries found that there was no difference in reducing cost or improving patient outcomes between the two approaches.