Frailty

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Olivia Geen MD, Sharon Marr MD, Justin Lee, MD, MSc, Alex Papaioannou, McMaster Textbook of Internal Medicine, 2022.

INTRODUCTION

Frailty is a dynamic state of decreased physiologic, functional, or cognitive reserve resulting in increased vulnerability to acute health stressors. The relation between frailty and reserve can be conceptualized as a set of scales (Figure 8.1-1). If aging, environmental factors, comorbidities, and genetics outweigh an individual’s cognitive, physical, or physiologic reserve, it may only take a minor illness such as a urinary tract infection or change in medications to cause a large change in functional status.

The prevalence of frailty varies depending on the population. Frailty in the community ranges from 12% to 24% in those aged >65 years. Almost 50% of community-dwelling seniors are prefrail, and rates tend to be higher in women than in men. In long-term care, the prevalence can reach 75%, depending on the assessment tool used.

Frailty occurs through a complex interplay of comorbid diseases, aging, genetics, as well as social and environmental factors (Figure 8.1-2). Although frailty increases with age, it is distinct from chronologic age and is more analogous to the “biologic age” of an individual.