Frailty syndrome
Frailty syndrome | |
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A woman supporting herself with a walking frame. | |
Specialty | Geriatrics |
Frailty is a common and clinically significant grouping of symptoms that occurs in aging and older adults. These symptoms can include decreased physical abilities such as walking, excessive fatigue, and weight and muscle loss leading to declined physical status. In addition, frailty encompasses a decline in both overall physical function and physiologic reserve of organ systems resulting in worse health outcomes for this population.[1][2] This syndrome is associated with increased risk of heart disease, falls, hospitalization, and death.[3][4] In addition, it has been shown that adults living with frailty face more anxiety and depression symptoms than those who do not.[5] The presence of frailty varies based on the assessment technique, however it is estimated that 4-16% of the population over 65 years old is living with frailty.[6]
Frailty can have impacts on public health due to the factors that comprise the syndrome affecting physical and mental health outcomes. There are several ways to identify, prevent, and mitigate the prevalence of frailty and the evaluation of frailty can be done through clinical assessments created to combine recognized signs and symptoms of frailty.
Definitions
Frailty refers to an age-related functional decline and heightened state of vulnerability. It is a worsening of functional status compared to the normal physiological process of aging. It can refer to the combination of a decline of physical and physiological aspects of a human body. 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. Frailty can lead to increased risk of adverse side effects, complications, and mortality.[7]
Older age by itself is not what defines frailty, it is however a syndrome found in older adults. Many adults over 65 are not living with frailty.[8] Frailty is not one specific disease, however is a combination of many factors. Frailty does not have a specific universal criteria on which it is diagnosed; there are a combination of signs and symptoms that can lead to a diagnosis of frailty. Evaluations can be done on physical staus, weight fluctuations, or subjective symptoms.[9] 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. Although, frailty can be a risk factor for the development of dementia.[10]
Geriatric syndromes related to frailty
Major Contributors to Frailty
Decreases in skeletal muscle mass and/or bone density are two major contributors to developing frailty in older adults. In early to middle age, bone density and muscle mass are closely related. As adults progress in age, one or both of these factors may begin to decline. This decline in either skeletal muscle mass or bone mineral density can lead to frailty and have both been identified as contributors to disability and frailty.[11] The development of Sarcopenia or Osteoporosis alone do not establish frailty automatically in patients, as there are many factors that are taken into account during the assessment of frailty. Studies suggest that frailty is a result of multiple body systems experiencing dysregulation, and the more body systems that begin to develop dysregulation, the higher the risk is for developing frailty. [1]
Sarcopenia
Sarcopenia is the degenerative loss of skeletal muscle mass, quality, and strength associated with aging.[12] The rate of muscle loss is dependent on exercise level, co-morbidities, nutrition and other factors. Sarcopenia can lead to reduction in functional status and cause significant disability from increased weakness. The muscle loss is related to changes in muscle synthesis signalling pathways although is incompletely understood. The cellular mechanisms are distinct from other types of muscle atrophy such as cachexia, in which muscle is degraded through cytokine-mediated degradation although both conditions may co-exist.[13]
Osteoporosis
![](http://upload.wikimedia.org/wikipedia/commons/thumb/f/fe/OsteoCutout.png/170px-OsteoCutout.png)
Osteoporosis is an age-related disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture.[14]
Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis. It may also develop in men. Osteoporosis may also occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP). Given its influence in the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life.[citation needed]
Muscle weakness
Muscle weakness (or lack of strength), also known as muscle fatigue, refers to the inability to exert force with one's skeletal muscles. Weakness often follows muscle atrophy and a decrease in activity, such as after a long bout of bedrest as a result of an illness. There is also a gradual onset of muscle weakness as a result of sarcopenia — the age-related loss of skeletal muscle.[citation needed]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/2c/Bathtub_balance_seat.jpg/220px-Bathtub_balance_seat.jpg)
A test of strength is often used during a diagnosis of a muscular disorder before the etiology can be identified. Such etiology depends on the type of muscle weakness, which can be true or perceived as well as variable topically. True weakness is substantial, while perceived rather is a sensation of having to put more effort to do the same task.[citation needed] On the other hand, various topic locations for muscle weakness are central, neural and peripheral. Central muscle weakness is an overall exhaustion of the whole body, while peripheral weakness is an exhaustion of individual muscles. Neural weakness is somewhere between.[citation needed]
Heart Failure
Frailty is also common in people who have experienced Heart Failure before. Both frailty and heart failure share similar methods of progressive health decline and often lead to worsened health conditions when combined. Frailty is a common condition in older people with heart failure. [15]
Depression, Bipolar Disorder, & Anxiety Disorders
People who had mental disorders were found to have frailty more often than people who did not have those disorders. Under the age of 60, these patterns are the most noticeable, and above the age of 60 years old these differences narrow down, although there is still some noticeable difference between the two. The proposed reason is that frailty is a condition that involves a decrease in reserve capacity, and having certain disorders can decrease this reserve over time and eventually lead to frailty. [16]
Biological and physiological mechanisms
It has been suggested that the causes of frailty are multifactorial involving dysregulation across many physiological systems.[17] An example of dysregulation across a physiological system may include a proinflammatory state. A common interleukin elevated in this state is IL-6. A pro-inflammatory cytokine, IL-6 was found to be common in older adults with frailty.[18] IL-6 is typically up-regulated by inflammatory mediators, such as C-reactive protein, released in the presence of chronic disease. Increased levels of inflammatory mediators is often associated with chronic disease; however, previous studies have shown levels to be elevated even in the absence of chronic disease.[19] Sarcopenia,[20] anemia,[21][22] anabolic hormone deficiencies,[23] and excess exposure to catabolic hormones such as stress (cortisol)[24] have been associated with an increased likelihood of frailty. Some other mechanisms associated with frailty include insulin resistance,[25] increased glucose levels,[26] compromised immune function,[27][28] micronutrient deficiencies, and oxidative stress.[29]
Researchers found that individual abnormal body functions may not be the best predictor of risk of frailty. However, they did conclude that once the number of conditions reaches a certain threshold, the risk of frailty increases.[17] This finding suggests that treatment of frailty syndrome should not be focused on a single condition, but a multitude in order to increase the likelihood of better treatment results.
Theoretical understanding
Recent work on frailty has sought to characterize both the underlying changes in the body and the manifestations that make frailty recognizable. It is well-agreed upon that declines in physiologic reserves and resilience is the essence of being frail.[30] Similarly, scientists agree that the risk of frailty increases with age and with the incidence of diseases. Beyond that, there is now strong evidence to support the theory that the development of frailty involves declines in energy production, energy utilization and repair systems in the body, resulting in declines in the function of many different physiological systems. This decline in multiple systems affects the normal complex adaptive behavior that is essential to health [17] and eventually results in frailty typically manifesting as a syndrome of a constellation of weakness, slowness, reduced activity, low energy and unintended weight loss.[31] When most severe, i.e. when 3 or more of these manifestations are present, the individual is at a high risk of death.
A comparison of peripheral blood mononuclear cells from frail older individuals to such cells from healthy younger individuals showed evidence in the frail older individuals of increased oxidative stress, increased apurinic/pyrimidinic sites in DNA, increased accumulation of endogenous DNA damage and reduced ability to repair DNA double-strand breaks.[32]
Frailty assessment
The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. Generally speaking, the empirical assessment of geriatric frailty in individuals seeks ultimately to capture this or related features, though distinct approaches to such assessment have been developed in the literature (see de Vries et al., 2011 for a comprehensive review).[33]
Two most widely used approaches, different in their nature and scopes,[34] are discussed below. Other approaches follow.
Physical frailty phenotype
A popular approach to the assessment of geriatric frailty encompasses the assessment of five dimensions that are hypothesized to reflect systems whose impaired regulation underlies the syndrome. These five dimensions are:
- unintentional weight loss,
- exhaustion,
- muscle weakness,
- slowness while walking, and
- low levels of activity.[35]
These five dimensions form specific criteria indicating adverse functioning, which are implemented using a combination of self-reported and performance-based measures. Those who meet at least three of the criteria are defined as "frail", while those not matching any of the five criteria are defined as "robust". Additional work on the construct is done by Bandeen-Roche et al. (2006),[31] though some of the exact criteria and measures differ (see Table 1 in the paper for this contrast). Other studies in the literature have also adopted the general approach of Linda P. Fried et al. (2001)[35]
Frailty index/deficit accumulation
Another notable approach to the assessment of geriatric frailty (if not also to some degree its conceptualization) is that of Rockwood and Mitnitski (2007)[36] in which frailty is viewed in terms of the number of health "deficits" that are manifest in the individual, leading to a continuous measure of frailty (see Rockwood, Andrew, and Mitnitski, 2007,[37] for a contrast of the two approaches). This approach was developed by Dr. Rockwood and colleagues at Dalhousie University. This index scores people on measurements of frailty by giving them a zero out of one score if they do not possess that physical deficit, a one out of one if they do possess the deficit, or a fraction of a score if they possess the deficit to some degree. [36]
Four domains of frailty
A model consisting of four domains of frailty was proposed in response to an article in the BMJ.[38] This conceptualisation could be viewed as blending the phenotypic and index models. Researchers tested this model for signal in routinely collected hospital data,[39] and then used this signal in the development of a frailty model, finding even predictive capability across 3 outcomes of care.[40] In the care home setting, one study indicated that not all four domains of frailty were routinely assessed in residents, giving evidence to suggest that frailty may still primarily be viewed only in terms of physical health.[41]
SHARE Frailty Index
The SHARE-Frailty Index (SHARE-FI) was originally developed by Romero-Ortuno (2010)[42] and researchers as part of the Survey of Healthy Ageing and Retirement in Europe. It consists of five domains of the frailty phenotype:
- Fatigue
- Loss of appetite
- Grip strength
- Functional difficulties
- Physical activity
The SHARE-FI calculator is freely available to use online. The calculator classifies individuals as:
- frail
- pre-frail
- non-frail / robust
The SHARE-FI has good clinical utility as it provides relatively quick assessment of frailty in often time-poor healthcare settings.
Clinical Frailty Scale
The Clinical Frailty Scale (CFS) is a scale used to assess frailty which was evolved from the Canadian Study of Health and Aging. It is a 9-point scale used to assess a persons frailty level, where a score of 1 point would mean a person is very fit and robust, to a score of 9 points meaning the person is severely frail and terminally ill. This scale is an efficient way to measure a persons frailty level and can be used in clinics relatively quickly. The nine-point system breaks down into the following categories: 1-point: Very fit; this person is very fit for their age. 2-points: Well; This person has no serious health problems and is slightly less fit than category 1, with moderate or seasonal physical activity. 3-points: Managing Well; This person has health problems which are under control, but is not very physically active. 4-points: Living with Very Mild Frailty; This person is limited by their health conditions but does not need help carrying out daily activities. 5-points: Living with Mild Frailty; This person moves more slowly than category 4 and requires some help with difficult daily living activities. 6-points: Living with Moderate Frailty; This person needs help with all activities outside of the home. 7-points; Living with Severe Frailty; This person is completely dependent for help in mental and physical regions of care. This person is stable and not likely to fall terminally ill in the next 6 months. 8-points: Living with Very Severe Frailty; This person is completely dependent and is nearing the end of life, recovery from minor illnesses would be difficult for this person. 9-points: Terminally Ill; This person is at the end of life with a life expectancy of less than six months, this category falls under all who are terminally ill, this person may be someone able to exercise regularly who may or may not be frail. [9]
Edmonton Frail Scale
The Edmonton Frail Scale (EFS) is another method used to screen frailty. This scale is given scores of up to 17 points.[43] It has been assessed to screen all domains of frailty, and is said to be easy to perform by clinicians. Specific tests used in this scaling system are walking tests and clock drawing. [44]
Electronic Frail Scale (eFI)
The electronic Frail Scale (eFI) is a scale weighted out of 36 deficit points where the higher the number in the score will represent the more frail, or more prone to experience frailty the person is. This scale works similar to other scales mentioned before, where each frailty-related deficit the person has is given a point and the more deficits the person is experiencing the more likely they are frail or will experience frailty in the future. To calculate the score, you take the total number of deficits counted, and divide that number by thirty-six. Then, a frailty category is assigned to four groups with the cutoffs going as follows: A person with a score of 0.00–0.12 is in the "Fit" category. A person with a score of 0.13–0.24 is in the "Mild" category. A person with a score of 0.25–0.36 is in the "Moderate" category. Finally, a person with the score of 0.36 and above is considered to be in the "Severe" category. [45]
Prevention
As frailty arises as a result of reduced reserve capacity in a biological system and causes an individual to have heightened vulnerability to stress, avoiding known stressors (ie. surgeries, infections, etc.) and understanding mechanisms to reduce frailty can help older adults prevent worsening their frail status.[46] Some signs of frailty include: unwanted weight loss, muscle weakness, low energy, and low grip strength.[47] Currently, preventative interventions focus on minimizing muscle loss and improvement of overall well-being in older adults or individuals with chronic illnesses.
Identification of risk factors
When considering prevention of frailty, it is important to understand the risk factors that contribute to frailty and identify them early on. Early identification of risk factors allows for preventative interventions, reducing risks of future complications.
A 2005 observational study found associations between frailty and a number of risk factors such as: low income, advanced age, chronic medical conditions, lack of education, and smoking.[48]
Exercise
A significant target in the prevention of frailty is physical activity. As people age, physical activity markedly drops, with the steepest declines seen in adolescence and continuing on throughout life.[49] The lower levels of physical activity and are associated with and a key component of frailty syndrome. Therefore, exercise regimens consisting of walking, strength training, and self-directed physical activity, have been examined in a number of studies as an intervention to prevent frailty.[50][51][52] A randomized control trial published in 2017 found significantly lower rates of frailty in older adults who were assigned an exercise regimen vs those who were in the control group.[50] In this study, 15.3% of the control group became frail in the time frame of the study, in comparison to 4.9% of the exercise group. The exercise group also received a nutritional assessment, which is another target in frailty prevention.
Nutrition
Nutrition has also been a major target in the prevention of frailty. A healthy dietary pattern consisting of high consumption of healthy fats, fruits, vegetables, low-fat dairy products, and whole grains can contribute to maintaining a healthy weight and postpone frailty. A 2019 review paper examined a variety of studies and found evidence of nutritional intervention as an effective way of preventing frailty.[53] Specifically, multiple studies showed adherence to the Mediterranean diet is associated with a decreased risk of incident frailty in the US.[54]
Non-surgical management
Frailty management largely depends on an individual's classification (i.e. non-frail, pre-fail, and frail) and treatment needs.[3] Currently, there is a lack of strong evidence-based treatment and management plans for frailty. Physicians must work closely with patients to develop a realistic management plan to ensure patient compliance, leading to better health outcomes. In clinical practice, guidelines developed by International Conference on Frailty and Sarcopenia Research (ICFSR) can be used to identify and manage frailty based on classification.[3] The recommendations are also labeled based on low, medium, or high certainty of evidence-based literature.
In addition, there is currently no FDA-approved pharmacological intervention for frailty as there is insufficient evidence demonstrating the effectiveness of a medication on improving frailty. Moreover, frailty does not qualify as an acceptable condition for pharmacological intervention by the Food and Drug Administration (FDA).[55]
Exercise
As discussed previously, exercise is one of the major targets to prevent and manage frailty in older adults to improve and maintain mobility. Individuals partaking in exercise appear to have potential in preventing frailty. In 2018, a systemic review concluded that group exercise had the benefit of delaying frailty in older adults aged 65 and above.[56]
Individualized physical therapy programs developed by physicians can help improve frail status. For example, progressive resistance strength training for older adults can be used in clinical practice or at-home as a way to regain mobility. A systematic review conducted in 2022 across multiple countries using data from twelve randomized clinical trials found evidence that mobility training can increase mobility level and functioning in older adults living in community-dwellings, such as a nursing home.[57] However, the review also concluded little to no difference in the risk of falls.
Occupational therapy
Activities of daily living (ADLs) include activities that are necessary to sustain life. Examples are brushing teeth, getting out of bed, dressing oneself, bathing, etc. Occupational therapy provided modest improvements in elderly adults mobility to do ADLs.[58]
Nutritional supplementation
Frailty can involve changes such as weight loss. Interventions should focus on any difficulties with supplementation and diet. For those who may be undernourished and not acquiring adequate calories, oral nutritional supplements in between meals may decrease nutritional deficits.[59]
With age comes decreased bone density. Therefore, vitamin D supplementation may provide the benefits of improving stability and muscle strength retention.[60]
Palliative care
Palliative care may be helpful for individuals who are experiencing an advanced state of frailty with possible other co-morbidities. Improving quality of life by reducing pain and other harmful symptoms is the goal with palliative care. One study showed the cost reduction by focusing on palliative care rather than expensive treatments that may be unnecessary and unhelpful.[61]
Surgical outcomes
Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Frailty more than doubles the risk of morbidity and mortality from surgery and cardiovascular conditions.[62] Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.[63] One frailty scale consists of five items:[35]
- unintentional weight loss >4.5 kg in the past year
- self-reported exhaustion
- <20th population percentile for grip strength
- slowed walking speed, defined as lowest population quartile on 4-minute walking test
- low physical activity such that persons would only rarely undertake a short walk
A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes.[63] Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
Another tool that has been used to predict frailty outcome post-surgery is the Modifies Frailty Index, or mFI-5. This scale consists of 5 key co-morbidities:[64]
- Congestive heart failure within 1 month of surgery
- Diabetes mellitus
- Chronic Obstruction Pulmonary Disease or pneumonia in the past
- Individuals needing additional assistance to perform everyday activities of living
- High blood pressure that is controlled with medication
An individual without one of these conditions would be given a score of 0 for the condition absent. An individual who does have one of the conditions would be given a score of 1 for each of the conditions present. In an initial study using the mFI-5 scale, individuals with a sum mFI-5 score of 2 or greater were predicted to experience post-surgery complications due to frailty, which was supported by the results of the study.[64]
As noted, these frailty scales can be used to predict the risk of frailty in patients before and after surgery. One study examines frailty risk in patients post-kidney transplant. Researchers found there is an association between patients with frailty and kidney transplant recipients.[65] This finding suggested that frailty scales can be used in preoperative assessments for patient at risk of the syndrome. However, other studies make note that the various different frailty scales can create complications predicting accurate outcomes for individuals undergoing surgical procedures. Neither of the scales listed previously consider both co-morbid conditions as well as signs of frailty, such as weight loss, at the same time.[66] Both of these situations are relevant in determining the presence of frailty in an individual. This suggests that predicting the frailty outcomes of individuals undergoing surgery should not be fully based on frailty scales with limitations, but a multitude of factors needs to be considered.
Epidemiology and public health
Frailty is a common geriatric syndrome. Due to the nature of not having international criteria to diagnose frailty, the prevalence estimates may not be accurate. Estimates of frailty prevalence in older populations may vary according to a number of factors, including the setting in which the prevalence is being estimated — e.g., nursing home (higher prevalence) vs. community (lower prevalence) — and the operational definition used for defining frailty. Using the widely used frailty phenotype framework proposed by Fried et al. (2001),[35] prevalence estimates of 7–16% have been reported in non-institutionalized, community-dwelling older adults. In a systemic review exploring the prevalence of frailty based on geographical location it was found that on the basis of physical frailty, Africa and America had the largest prevalence at 22% and 17% respectively. On the other end, Europe had the lowest prevalence at 8%.[67] This data was taken from individuals over the age of 50 years old.
Awareness of the causes and prevalence of frailty can aid in the path of treatment. Epidemiologic data can have a potential impact of future incidence rates of frailty among older adults as the treatment landscape adapts.
The development of frailty occurs most often in individuals with low socio-economic status, those living with obesity, female sex, a history of smoking, limited activity levels, and older age.[68]
Advances about potentially modifiable risk factors for frailty now offer the basis for translational research effort aimed at prevention and treatment of frailty in older adults. Epidemiologic research to date has led to the identification of a number of risk factors for frailty, including: (a) chronic diseases, such as cardiovascular disease, diabetes, chronic kidney disease, depression, and cognitive impairment;[69][70][71] (b) physiologic impairments, such as activation of inflammation and coagulation systems,[72] anemia,[21][22] atherosclerosis,[73] autonomic dysfunction,[21][74] hormonal abnormalities,[23] obesity,[75] hypovitaminosis D in men,[76] and environment-related factors such as life space and neighborhood characteristics.[77]
A recent systematic review found that exercise interventions can increase muscle strength and improve physical function; however, results are inconsistent in frail older adults living in the community.[78]
A review looked at the relationship between the frailty syndrome and chronic lower extremity ischemia in those people with diabetes. On the one hand, chronic lower limb ischemia may predispose to the development of frailty, on the other hand, the presence of the frailty may affect the prognosis in patients with peripheral arterial disease.[79] In addition, there is a correlation between a history of congestive heart failure and the development if frailty.[80]
In regards to mental health, there has been shown to be an association between severe mental health conditions and the development of frailty. There is an understanding that mental health can have an impact on the development of multiple comorbidities and increased mortality. This intersection between frailty and mental health can have a combined impact on the life expectancy of individuals living with both. Mental health treatment has the potential to improve population health with its link to frailty.[81]
Based on the clinical frailty scale, those living with mild frailty to very severe frailty require partial to complete dependence on aid for daily tasks and personal care.[9] A study done, 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.[82]
Overall, understanding what factors lead to frailty can help individuals, health care professionals, and public health officials identify preventative measures to combat that causes. Due to the impacts on the health and well-being of individuals living with frailty, steps taken to prevent and control the syndrome can affect future indicence rates.
Sex differences in frailty
Meta-analyses have shown that the prevalence of frailty is higher in female older adults, compared to male older adults.[83][84] This sex difference was consistently found in pre-clinical research models as well,[85] indicating a conserved sexual dimorphism in the onset of frailty across species, and perhaps also in the underlying pathophysiology. Studies have found that incidence of frailty was related to comorbidities. One study found incidences of frailty was higher in female older adults who also happened to have higher incidences of comorbidities.[86] In recent research where muscle-biopsies were taken from fit and weak older adults of both sexes, it was shown that there were sex-specific alterations in muscle content in association with frailty-related physical weakness.[87] In other words, studied found differences in frailty between male and female older adults through examinations of muscles. Incidence of symptoms also differed between sexes with sarcopenia being more common in male older adults while osteoporosis more common in female older adults.[86] These findings indicate the male-female health-survival paradox, since the lifespan of females is longer compared to males, yet the prevalence of frailty is higher in females compared to males. Future research has yet to reveal where the origin of the higher prevalence of frailty in females can be found.
Frailty syndrome has shown differences in incidence outside of just sex. One study on racial and ethnic variations in frailty found that non-Hispanic Black-Americans and Hispanic-Americans have a higher incidence of frailty compared to non-Hispanic White-Americans.[88] More research is needed in analyzing the differences in incidence of frailty syndrome in other social aspects of society. Such studies have importance in highlighting the disparities in health and the changes needed to solve these issues.
Ongoing clinical trials
As of September 2021[update], ongoing clinical trials on frailty syndrome in the US include:
- the impact of frailty on clinical outcomes of patients treated for abdominal aortic aneurysms[89]
- the use of "pre-habilitation," an exercise regimen used before transplant surgery, to prevent the frailty effects of kidney transplant in recipients[90]
- defining the acute changes in frailty following sepsis in the abdomen[91]
- the efficacy of the anti-inflammatory drug, Fisetin, in reducing frailty markers in elderly adults[92]
- Physical Performance Testing and Frailty in Prediction of Early Postoperative Course After Cardiac Surgery (Cardiostep)[93]
See also
Aging — the normal process of growing older.
Osteoporosis — weakening of bones.
Sarcopenia — decline of muscle mass.
References
- ^ a b "Guidelines on Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care". WHO Clinical Consortium on Healthy Ageing: Topic focus: frailty and intrinsic capacity: Report of consortium meeting 1–2 December 2016 in Geneva, Switzerland (PDF) (Report). World Health Organization. 2017. hdl:10665/272437/WHO-FWC-ALC-17.2-eng. WHO/FWC/ALC/17.2.
- ^ Whitson HE, Cohen HJ, Schmader KE, Morey MC, Kuchel G, Colon-Emeric CS (August 2018). "Physical Resilience: Not Simply the Opposite of Frailty". Journal of the American Geriatrics Society. 66 (8): 1459–61. doi:10.1111/jgs.15233. PMC 6157007. PMID 29577234.
- ^ a b c Allison R, Assadzandi S, Adelman M (February 2021). "Frailty: Evaluation and Management". American Family Physician. 103 (4): 219–226. PMID 33587574.
- ^ "How to avoid frailty and stay strong as you age". www.heart.org. Retrieved 2024-07-25.
- ^ Ní Mhaoláin AM, Fan CW, Romero-Ortuno R, Cogan L, Cunningham C, Kenny RA, et al. (August 2012). "Frailty, depression, and anxiety in later life". International Psychogeriatrics. 24 (8): 1265–74. doi:10.1017/S1041610211002110. hdl:2262/67243. PMID 22333477.
- ^ Waltson JD (June 12, 2023). "Frailty". UpToDate. Retrieved July 26, 2024.
- ^ Xue QL, Tian J, Walston JD, Chaves PH, Newman AB, Bandeen-Roche K (January 2020). "Discrepancy in Frailty Identification: Move Beyond Predictive Validity". J Gerontol A Biol Sci Med Sci. 75 (2): 387–393. doi:10.1093/gerona/glz052. PMC 7176056. PMID 30789645.
- ^ "Age". National Institutes of Health (NIH). 2022-08-11. Retrieved 2024-07-26.
- ^ a b c Mendiratta P, Schoo C, Latif R (2024). "Clinical Frailty Scale". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32644435. NBK559009.
- ^ Ward DD, Ranson JM, Wallace LM, Llewellyn DJ, Rockwood K (April 2022). "Frailty, lifestyle, genetics and dementia risk". Journal of Neurology, Neurosurgery, and Psychiatry. 93 (4): 343–350. doi:10.1136/jnnp-2021-327396. PMC 8921595. PMID 34933996.
- ^ Greco EA, Pietschmann P, Migliaccio S (2019-04-24). "Osteoporosis and Sarcopenia Increase Frailty Syndrome in the Elderly". Frontiers in Endocrinology. 10: 255. doi:10.3389/fendo.2019.00255. PMC 6491670. PMID 31068903.
- ^ Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. (July 2010). "Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People". Age and Ageing. 39 (4): 412–423. doi:10.1093/ageing/afq034. PMC 2886201. PMID 20392703.
- ^ Peterson SJ, Mozer M (February 2017). "Differentiating Sarcopenia and Cachexia Among Patients With Cancer". Nutrition in Clinical Practice. 32 (1): 30–39. doi:10.1177/0884533616680354. PMID 28124947. S2CID 206555460.
- ^ "Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group". World Health Organization Technical Report Series. 843: 1–129. 1994. PMID 7941614.
- ^ Pandey A, Kitzman D, Reeves G (December 2019). "Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management". JACC. Heart Failure. 7 (12): 1001–1011. doi:10.1016/j.jchf.2019.10.005. PMC 7098068. PMID 31779921.
- ^ Mutz J, Choudhury U, Zhao J, Dregan A (August 2022). "Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality". BMC Medicine. 20 (1): 274. doi:10.1186/s12916-022-02474-2. PMC 9425946. PMID 36038880.
- ^ a b c Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, et al. (October 2009). "Nonlinear multisystem physiological dysregulation associated with frailty in older women: implications for etiology and treatment". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 64 (10): 1049–57. doi:10.1093/gerona/glp076. PMC 2737590. PMID 19567825.
- ^ Chen X, Mao G, Leng SX (2014-03-19). "Frailty syndrome: an overview". Clinical Interventions in Aging. 9: 433–441. doi:10.2147/CIA.S45300. PMC 3964027. PMID 24672230.
- ^ Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. (November 2002). "Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study". Archives of Internal Medicine. 162 (20): 2333–41. doi:10.1001/archinte.162.20.2333. PMID 12418947.
- ^ Ferrucci L, Penninx BW, Volpato S, Harris TB, Bandeen-Roche K, Balfour J, et al. (December 2002). "Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels". Journal of the American Geriatrics Society. 50 (12): 1947–54. doi:10.1046/j.1532-5415.2002.50605.x. PMID 12473005. S2CID 30586299.
- ^ a b c Chaves PH, Semba RD, Leng SX, Woodman RC, Ferrucci L, Guralnik JM, et al. (June 2005). "Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women's Health and Aging Studies I and II". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 60 (6): 729–735. doi:10.1093/gerona/60.6.729. PMID 15983175.
- ^ a b Roy CN (February 2011). "Anemia in frailty". Clinics in Geriatric Medicine. 27 (1): 67–78. doi:10.1016/j.cger.2010.08.005. PMC 2998908. PMID 21093723.
- ^ a b Cappola AR, Xue QL, Fried LP (February 2009). "Multiple hormonal deficiencies in anabolic hormones are found in frail older women: the Women's Health and Aging studies". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 64 (2): 243–8. doi:10.1093/gerona/gln026. PMC 2655016. PMID 19182229.
- ^ Varadhan R, Walston J, Cappola AR, Carlson MC, Wand GS, Fried LP (February 2008). "Higher levels and blunted diurnal variation of cortisol in frail older women". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 63 (2): 190–5. doi:10.1093/gerona/63.2.190. PMID 18314456.
- ^ Barzilay JI, Blaum C, Moore T, Xue QL, Hirsch CH, Walston JD, et al. (April 2007). "Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study". Archives of Internal Medicine. 167 (7): 635–641. doi:10.1001/archinte.167.7.635. PMID 17420420.
- ^ Zaslavsky O, Walker RL, Crane PK, Gray SL, Larson EB (September 2016). "Glucose Levels and Risk of Frailty". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 71 (9): 1223–9. doi:10.1093/gerona/glw024. PMC 4978362. PMID 26933160.
- ^ Wang GC, Talor MV, Rose NR, Cappola AR, Chiou RB, Weiss C, et al. (March 2010). "Thyroid autoantibodies are associated with a reduced prevalence of frailty in community-dwelling older women". The Journal of Clinical Endocrinology and Metabolism. 95 (3): 1161–8. doi:10.1210/jc.2009-1991. PMC 2841533. PMID 20061418.
- ^ Yao X, Li H, Leng SX (February 2011). "Inflammation and immune system alterations in frailty". Clinics in Geriatric Medicine. 27 (1): 79–87. doi:10.1016/j.cger.2010.08.002. PMC 3011971. PMID 21093724.
- ^ Semba RD, Ferrucci L, Sun K, Walston J, Varadhan R, Guralnik JM, et al. (December 2007). "Oxidative stress and severe walking disability among older women". The American Journal of Medicine. 120 (12): 1084–9. doi:10.1016/j.amjmed.2007.07.028. PMC 2423489. PMID 18060930.
- ^ Varadhan R, Seplaki CL, Xue QL, Bandeen-Roche K, Fried LP (November 2008). "Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty". Mechanisms of Ageing and Development. 129 (11): 666–670. doi:10.1016/j.mad.2008.09.013. PMC 2650618. PMID 18938195.
- ^ a b Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, et al. (March 2006). "Phenotype of frailty: characterization in the women's health and aging studies". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 61 (3): 262–6. doi:10.1093/gerona/61.3.262. PMID 16567375.
- ^ Kravvariti E, Ntouros PA, Vlachogiannis NI, Pappa M, Souliotis VL, Sfikakis PP (March 2023). "Geriatric Frailty Is Associated With Oxidative Stress, Accumulation, and Defective Repair of DNA Double-Strand Breaks Independently of Age and Comorbidities". J Gerontol A Biol Sci Med Sci. 78 (4): 603–610. doi:10.1093/gerona/glac214. PMID 36209410.
- ^ de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW (January 2011). "Outcome instruments to measure frailty: a systematic review". Ageing Research Reviews. 10 (1): 104–114. doi:10.1016/j.arr.2010.09.001. PMID 20850567. S2CID 28785385.
- ^ Cesari M, Gambassi G, van Kan GA, Vellas B (January 2014). "The frailty phenotype and the frailty index: different instruments for different purposes". Age and Ageing. 43 (1): 10–12. doi:10.1093/ageing/aft160. PMID 24132852.
- ^ a b c d Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. (March 2001). "Frailty in older adults: evidence for a phenotype". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 56 (3): M146–M156. doi:10.1093/gerona/56.3.m146. PMID 11253156.
- ^ a b Rockwood K, Mitnitski A (July 2007). "Frailty in relation to the accumulation of deficits". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 62 (7): 722–7. doi:10.1093/gerona/62.7.722. PMID 17634318.
- ^ Rockwood K, Andrew M, Mitnitski A (July 2007). "A comparison of two approaches to measuring frailty in elderly people". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 62 (7): 738–743. doi:10.1093/gerona/62.7.738. PMID 17634321.
- ^ Soong JT (2011). "Re: Functional assessment in older people". BMJ. 343: d4681. doi:10.1136/bmj.d4681. PMID 21859792. Retrieved 9 March 2024.
- ^ Soong J, Poots AJ, Scott S, Donald K, Woodcock T, Lovett D, et al. (October 2015). "Quantifying the prevalence of frailty in English hospitals". BMJ Open. 5 (10): e008456. doi:10.1136/bmjopen-2015-008456. PMC 4621378. PMID 26490097.
- ^ Soong J, Poots AJ, Scott S, Donald K, Bell D (October 2015). "Developing and validating a risk prediction model for acute care based on frailty syndromes". BMJ Open. 5 (10): e008457. doi:10.1136/bmjopen-2015-008457. PMC 4621379. PMID 26490098.
- ^ Sunkersing D, Martin FC, Reed J, Woringer M, Bell D (March 2019). "What do care home managers believe constitutes an 'assessment for frailty' of care home residents in North-West London? A survey". BMC Geriatrics. 19 (1): 62. doi:10.1186/s12877-019-1083-5. PMC 6397475. PMID 30823874.
- ^ Romero-Ortuno R, Walsh CD, Lawlor BA, Kenny RA (August 2010). "A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)". BMC Geriatrics. 10 (1): 57. doi:10.1186/1471-2318-10-57. PMC 2939541. PMID 20731877.
- ^ "Tools for Clinical History-Taking". British Geriatrics Society. Retrieved 2024-07-31.
- ^ Cappe M, Laterre PF, Dechamps M (February 2023). "Preoperative frailty screening, assessment and management". Current Opinion in Anesthesiology. 36 (1): 83–88. doi:10.1097/ACO.0000000000001221. PMC 9794163. PMID 36476726.
- ^ Walsh B, Fogg C, Harris S, Roderick P, de Lusignan S, England T, et al. (May 2023). "Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017". Age and Ageing. 52 (5): afad058. doi:10.1093/ageing/afad058. PMC 10158172. PMID 37140052.
- ^ Whitson HE, Cohen HJ, Schmader KE, Morey MC, Kuchel G, Colon-Emeric CS (August 2018). "Physical Resilience: Not Simply the Opposite of Frailty". Journal of the American Geriatrics Society. 66 (8): 1459–61. doi:10.1111/jgs.15233. PMC 6157007. PMID 29577234.
- ^ Xue QL (February 2011). "The frailty syndrome: definition and natural history". Clinics in Geriatric Medicine. 27 (1): 1–15. doi:10.1016/j.cger.2010.08.009. PMC 3028599. PMID 21093718.
- ^ Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. (August 2005). "Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study". Journal of the American Geriatrics Society. 53 (8): 1321–30. doi:10.1111/j.1532-5415.2005.53405.x. PMID 16078957. S2CID 2191077.
- ^ Sallis JF (September 2000). "Age-related decline in physical activity: a synthesis of human and animal studies". Medicine and Science in Sports and Exercise. 32 (9): 1598–1600. doi:10.1097/00005768-200009000-00012. PMID 10994911.
- ^ a b Nascimento CM, Ingles M, Salvador-Pascual A, Cominetti MR, Gomez-Cabrera MC, Viña J (February 2019). "Sarcopenia, frailty and their prevention by exercise". Free Radical Biology & Medicine. 132: 42–49. doi:10.1016/j.freeradbiomed.2018.08.035. PMID 30176345. S2CID 52147328.
- ^ Serra-Prat M, Sist X, Domenich R, Jurado L, Saiz A, Roces A, et al. (May 2017). "Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial". Age and Ageing. 46 (3): 401–7. doi:10.1093/ageing/afw242. PMID 28064172.
- ^ Cadore EL, Sáez de Asteasu ML, Izquierdo M (July 2019). "Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization". Experimental Gerontology. 122: 10–14. doi:10.1016/j.exger.2019.04.007. PMID 30995516.
- ^ Feart C (December 2019). "Nutrition and frailty: Current knowledge". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 95: 109703. doi:10.1016/j.pnpbp.2019.109703. PMID 31325470. S2CID 197464368.
- ^ Ni Lochlainn M, Cox NJ, Wilson T, Hayhoe RP, Ramsay SE, Granic A, et al. (July 2021). "Nutrition and Frailty: Opportunities for Prevention and Treatment". Nutrients. 13 (7): 2349. doi:10.3390/nu13072349. PMC 8308545. PMID 34371858.
- ^ Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al. (2019-11-01). "Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management". The Journal of Nutrition, Health & Aging. 23 (9): 771–787. doi:10.1007/s12603-019-1273-z. PMC 6800406. PMID 31641726.
- ^ Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, et al. (January 2018). "Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review". JBI Database of Systematic Reviews and Implementation Reports. 16 (1): 140–232. doi:10.11124/JBISRIR-2017-003382. PMC 5771690. PMID 29324562.
- ^ Treacy D, Hassett L, Schurr K, Fairhall NJ, Cameron ID, Sherrington C, et al. (Cochrane Musculoskeletal Group) (June 2022). "Mobility training for increasing mobility and functioning in older people with frailty". The Cochrane Database of Systematic Reviews. 2022 (6): CD010494. doi:10.1002/14651858.CD010494.pub2. PMC 9245897. PMID 35771806.
- ^ De Coninck L, Bekkering GE, Bouckaert L, Declercq A, Graff MJ, Aertgeerts B (August 2017). "Home- and Community-Based Occupational Therapy Improves Functioning in Frail Older People: A Systematic Review". Journal of the American Geriatrics Society. 65 (8): 1863–9. doi:10.1111/jgs.14889. PMID 28369719. S2CID 25247416.
- ^ Milne AC, Potter J, Vivanti A, Avenell A (April 2009). "Protein and energy supplementation in elderly people at risk from malnutrition". The Cochrane Database of Systematic Reviews. 2009 (2): CD003288. doi:10.1002/14651858.CD003288.pub3. PMC 7144819. PMID 19370584.
- ^ Montero-Odasso M, Duque G (June 2005). "Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone". Molecular Aspects of Medicine. 26 (3): 203–219. doi:10.1016/j.mam.2005.01.005. PMID 15811435.
- ^ Manfredi PL, Morrison RS, Morris J, Goldhirsch SL, Carter JM, Meier DE (September 2000). "Palliative care consultations: how do they impact the care of hospitalized patients?". Journal of Pain and Symptom Management. 20 (3): 166–173. doi:10.1016/s0885-3924(00)00163-9. PMID 11018334.
- ^ Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. (March 2014). "Frailty assessment in the cardiovascular care of older adults". Journal of the American College of Cardiology. 63 (8): 747–762. doi:10.1016/j.jacc.2013.09.070. PMC 4571179. PMID 24291279.
- ^ a b Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. (June 2010). "Frailty as a predictor of surgical outcomes in older patients". Journal of the American College of Surgeons. 210 (6): 901–8. doi:10.1016/j.jamcollsurg.2010.01.028. PMID 20510798.
- Lay summary in: Span P (December 28, 2010). "Who Thrives After Surgery?". The New York Times.
- ^ a b Weaver DJ, Malik AT, Jain N, Yu E, Kim J, Khan SN (April 2019). "The Modified 5-Item Frailty Index: A Concise and Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity Following Elective Posterior Lumbar Fusions". World Neurosurgery. 124: e626–e632. doi:10.1016/j.wneu.2018.12.168. PMID 30639495.
- ^ Garonzik-Wang JM, Govindan P, Grinnan JW, Liu M, Ali HM, Chakraborty A, et al. (February 2012). "Frailty and delayed graft function in kidney transplant recipients". Archives of Surgery. 147 (2): 190–3. doi:10.1001/archsurg.2011.1229. PMID 22351919.
- ^ Lee AC, Lee SM, Ferguson MK (November 2022). "Frailty Is Associated With Adverse Postoperative Outcomes After Lung Cancer Resection". JTO Clinical and Research Reports. 3 (11): 100414. doi:10.1016/j.jtocrr.2022.100414. PMC 9634029. PMID 36340797.
- ^ O'Caoimh R, Sezgin D, O'Donovan MR, Molloy DW, Clegg A, Rockwood K, et al. (January 2021). "Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies". Age and Ageing. 50 (1): 96–104. doi:10.1093/ageing/afaa219. hdl:10468/11159. PMID 33068107.
- ^ Niederstrasser NG, Rogers NT, Bandelow S (2019-10-30). "Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing". PLOS ONE. 14 (10): e0223799. Bibcode:2019PLoSO..1423799N. doi:10.1371/journal.pone.0223799. PMC 6821067. PMID 31665163.
- ^ Garcia-Garcia FJ, Gutierrez Avila G, Alfaro-Acha A, Amor Andres MS, De Los Angeles De La Torre Lanza M, Escribano Aparicio MV, et al. (December 2011). "The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging". The Journal of Nutrition, Health & Aging. 15 (10): 852–6. doi:10.1007/s12603-011-0075-8. PMID 22159772.
- ^ Casas-Herrero A, Cadore EL, Zambom-Ferraresi F, Idoate F, Millor N, Martínez-Ramirez A, et al. (October 2013). "Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalized frail oldest old". Rejuvenation Research. 16 (5): 396–403. doi:10.1089/rej.2013.1438. PMC 3804230. PMID 23822577.
- ^ Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (March 2004). "Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 59 (3): 255–263. doi:10.1093/gerona/59.3.m255. PMID 15031310.
- ^ Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. (Cardiovascular Health Study) (November 2002). "Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study". Archives of Internal Medicine. 162 (20): 2333–41. doi:10.1001/archinte.162.20.2333. PMID 12418947.
- ^ Chaves PH, Varadhan R, Lipsitz LA, Stein PK, Windham BG, Tian J, et al. (September 2008). "Physiological complexity underlying heart rate dynamics and frailty status in community-dwelling older women". Journal of the American Geriatrics Society. 56 (9): 1698–1703. doi:10.1111/j.1532-5415.2008.01858.x. PMC 2848445. PMID 19166446.
- ^ Varadhan R, Chaves PH, Lipsitz LA, Stein PK, Tian J, Windham BG, et al. (June 2009). "Frailty and impaired cardiac autonomic control: new insights from principal components aggregation of traditional heart rate variability indices". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 64 (6): 682–7. doi:10.1093/gerona/glp013. PMC 2679422. PMID 19223607.
- ^ Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP (June 2005). "The association between obesity and the frailty syndrome in older women: the Women's Health and Aging Studies". Journal of the American Geriatrics Society. 53 (6): 927–934. doi:10.1111/j.1532-5415.2005.53300.x. hdl:2027.42/65446. PMID 15935013. S2CID 231645.
- ^ Shardell M, Hicks GE, Miller RR, Kritchevsky S, Andersen D, Bandinelli S, et al. (January 2009). "Association of low vitamin D levels with the frailty syndrome in men and women". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 64 (1): 69–75. doi:10.1093/gerona/gln007. PMC 2691187. PMID 19164273.
- ^ Xue QL, Fried LP, Glass TA, Laffan A, Chaves PH (January 2008). "Life-space constriction, development of frailty, and the competing risk of mortality: the Women's Health And Aging Study I". American Journal of Epidemiology. 167 (2): 240–8. doi:10.1093/aje/kwm270. PMID 17906296.
- ^ Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, et al. (November 2014). "Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS)". Age and Ageing. 43 (6): 748–759. doi:10.1093/ageing/afu115. PMC 4204661. PMID 25241753.
- ^ Jakubiak GK, Pawlas N, Cieślar G, Stanek A (December 2020). "Chronic Lower Extremity Ischemia and Its Association with the Frailty Syndrome in Patients with Diabetes". International Journal of Environmental Research and Public Health. 17 (24): 9339. doi:10.3390/ijerph17249339. PMC 7764849. PMID 33327401.
- ^ Newman AB, Gottdiener JS, Mcburnie MA, Hirsch CH, Kop WJ, Tracy R, et al. (March 2001). "Associations of subclinical cardiovascular disease with frailty". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 56 (3): M158–M166. doi:10.1093/gerona/56.3.M158. PMID 11253157.
- ^ Mutz J, Choudhury U, Zhao J, Dregan A (August 2022). "Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality". BMC Medicine. 20 (1): 274. doi:10.1186/s12916-022-02474-2. PMC 9425946. PMID 36038880.
- ^ Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, et al. (May 2023). "Case management for integrated care of older people with frailty in community settings". The Cochrane Database of Systematic Reviews. 2023 (5): CD013088. doi:10.1002/14651858.CD013088.pub2. PMC 10204122. PMID 37218645.
- ^ Gordon EH, Peel NM, Samanta M, Theou O, Howlett SE, Hubbard RE (March 2017). "Sex differences in frailty: A systematic review and meta-analysis". Experimental Gerontology. 89: 30–40. doi:10.1016/j.exger.2016.12.021. PMID 28043934. S2CID 4652963.
- ^ O'Caoimh R, Sezgin D, O'Donovan MR, Molloy DW, Clegg A, Rockwood K, et al. (January 2021). "Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies". Age and Ageing. 50 (1): 96–104. doi:10.1093/ageing/afaa219. hdl:10468/11159. PMID 33068107.
- ^ Kane AE, Howlett SE (September 2021). "Sex differences in frailty: Comparisons between humans and preclinical models". Mechanisms of Ageing and Development. 198: 111546. doi:10.1016/j.mad.2021.111546. PMID 34324923.
- ^ a b Zeidan RS, McElroy T, Rathor L, Martenson MS, Lin Y, Mankowski RT (December 2023). "Sex differences in frailty among older adults". Experimental Gerontology. 184: 112333. doi:10.1016/j.exger.2023.112333. PMID 37993077.
- ^ de Jong JC, Verschuren L, Caspers MP, van der Hoek MD, van der Leij FR, Kleemann R, et al. (July 2023). "Evidence for sex-specific intramuscular changes associated to physical weakness in adults older than 75 years". Biology of Sex Differences. 14 (1): 45. doi:10.1186/s13293-023-00531-w. PMC 10332038. PMID 37430322.
- ^ Usher T, Buta B, Thorpe RJ, Huang J, Samuel LJ, Kasper JD, et al. (January 2021). "Dissecting the Racial/Ethnic Disparity in Frailty in a Nationally Representative Cohort Study with Respect to Health, Income, and Measurement". The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 76 (1): 69–76. doi:10.1093/gerona/glaa061. PMC 7756712. PMID 32147727.
- ^ Clinical trial number NCT04524247 for "Frailty and Physician Modified Fenestrated Endograft for Thoracoabdominal Aortic Pathologies" at ClinicalTrials.gov
- ^ Clinical trial number NCT04954690 for "Structured Program of Exercise for Recipients of Kidney Transplantation (SPaRKT)" at ClinicalTrials.gov
- ^ Clinical trial number NCT02711709 for "Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS): A New Horizon for Surgical Critical Care and Induced Frailty" at ClinicalTrials.gov
- ^ Clinical trial number NCT03675724 for "Alleviation by Fisetin of Frailty, Inflammation, and Related Measures in Older Adults (AFFIRM-LITE)" at ClinicalTrials.gov
- ^ Clinical trial number NCT05166863 for "Physical Performance Testing and Frailty in Prediction of Early Postoperative Course After Cardiac Surgery (Cardiostep)" at ClinicalTrials.gov
External links
- Frailty