There is a growing amount of evidence showing frailty is a predictor of worse outcomes in many different groups of patients. Although there is no single definition of frailty, it can be thought of as a decline in the physical and cognitive reserves that lead to increased vulnerability, affecting a person’s ability to recover from illness. The three main contributors to frailty are age, disability and multimorbidity. *
Frailty is NOT = ageing. Most people that grow old remain fit and active.
The pathophysiology of frailty is thought to be driven by inflammation and dysregulation of neuroendocrine systems which lead to sarcopenia.
Sarcopenia is a key element of frailty – defined as a loss of muscle mass, strength and function. There is a greater loss of type 2 (fast twitch) muscle fibres than type 1 (slow twitch) fibres. Sarcopenia is thought to be due to ageing, less sex hormones, comorbidities, drug therapy side effects, protein and vitamin D deficiencies, smoking, excess alcohol and inactivity.
Management of frailty is tailored to the individual, establishing individual priorities, weighing risks and benefits of interventions, and making decisions regarding aggressiveness of care. To date, no medications or drugs have proven efficacy.