Toward an Understanding of Frailty

Abstract

Medical Writings1 June 1999Toward an Understanding of FrailtyDavid Hamerman, MDDavid Hamerman, MDAlbert Einstein College of Medicine; Bronx, NY 10467 (Hamerman)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-11-199906010-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Health care providers who serve an aging population inherently associate the word frailty with patients whom they perceive as frail. Although frailty is not confined to elderly persons, it is more frequently observed in persons older than 85 years of age (the "oldest old") (1). This is because limitations and diseases associated with aging are an inseparable part of frailty (2-5). As a result, frailty remains more a constellation of many conditions than a discrete clinical entity, and it certainly does not have a precise scientific meaning (6). Frailty is often identified by words that express a similar state, such ...References1. Suzman RM, Manton KG, Willis DP. Introducing the oldest old.. In: Suzman RM, Willis DP, Manton KC, eds. The Oldest Old. New York: Oxford Univ Pr; 1992:3-14. Google Scholar2. Fried LP. Frailty. In: Hazzard WR, Bierman EL, Blass JP, Ettinger WH Jr, Halter JB, eds. Principles of Geriatric Medicine and Gerontology. 3d ed. New York: McGraw-Hill; 1994:1149-55. Google Scholar3. Powell C. Frailty: help or hindrance? J R Soc Med. 1997;90 Suppl 23-36. CrossrefMedlineGoogle Scholar4. van Weel C, Michels J. Dying, not old age, to blame for costs of health care. Lancet. 1997;350:1159-60. CrossrefMedlineGoogle Scholar5. Fried LP, Williamson JD, Kaspar J. The epidemiology of frailty: scope of the problem.. In: Perry HM 3d, Morley JE, Coe RM, eds. Aging and Musculoskeletal Disorders: Concepts, Diagnosis, and Treatment. New York: Springer; 1993:3-15. Google Scholar6. Buchner DM, Wagner EH. Preventing frail health. Clin Geriatr Med. 1992;8:1-17. CrossrefMedlineGoogle Scholar7. Brown I, Renwick R, Raphael D. Frailty: constructing a common meaning, definition, and conceptual framework. Int J Rehabil Research. 1995;18:93-102. CrossrefMedlineGoogle Scholar8. Speechley M, Tinetti M. Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc. 1991;339:46-52. CrossrefGoogle Scholar9. Strawbridge WJ, Shema SJ, Balfour JL, Higby HR, Kaplan GA. Antecedents of frailty over three decades in an older cohort. J Gerontol. 1998;53B:S9-16. CrossrefGoogle Scholar10. Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominguez F, Vallone R. Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc. 1991;39:778-84. CrossrefMedlineGoogle Scholar11. Rockwood K. Medical management of frailty: confessions of a gnostic. CMAJ. 1997;157:1081-4. MedlineGoogle Scholar12. Hébert R. Functional decline in old age. CMAJ. 1997;157:1037-45. MedlineGoogle Scholar13. Gealey SG. Quantification of the term frail as applied to the elderly client. J Am Acad Nurse Pract. 1997;9:505-10. CrossrefMedlineGoogle Scholar14. Fretwell MD. Acute hospital care for frail older patients. In: Hazzard WR, Bierman EL, Blass JP, Ettinger WH Jr, Halter JB, eds. Principles of Geriatric Medicine and Gerontology. 3d ed. New York: McGraw-Hill; 1994:241-8. Google Scholar15. Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BL. Frailty in elderly people: an evolving concept. CMAJ. 1994;150:489-95. MedlineGoogle Scholar16. Gill TM, Robison JT, Tinetti ME. Difficulty and dependence: two components of the disability continuum among community-living older persons. Ann Intern Med. 1998;128:96-101. LinkGoogle Scholar17. Egbert AM. "The dwindles." Failure to thrive in older patients. Postgrad Med. 1993;94:199-201, 204-6, 210-2. Google Scholar18. Evans WJ. What is sarcopenia? J Gerontol A Biol Sci Med Sci. 1995; 50 Spec No:5-8. Google Scholar19. Roubenoff R, Harris TB. Failure to thrive, sarcopenia and functional decline in the elderly. Clin Geriatr Med. 1997;13:613-22. CrossrefMedlineGoogle Scholar20. Hildebrand JK, Joos SK, Lee MA. Use of the diagnosis "failure to thrive" in older veterans. J Am Geriatr Soc. 1997;45:1113-7. CrossrefMedlineGoogle Scholar21. Sarkisian CA, Lachs MS. "Failure to thrive" in older adults. Ann Intern Med. 1996;124:1072-8. LinkGoogle Scholar22. Verdery RB. Failure to thrive in old age: follow-up on a workshop. J Gerontol A Biol Sci Med Sci. 1997;52:M333-6. CrossrefMedlineGoogle Scholar23. Verdery RB. Failure to thrive. In: Hazzard WR, Bierman EL, Blass JP, Ettinger WH Jr, Halter JB, eds. Principles of Geriatric Medicine and Gerontology. 3d ed. New York: McGraw-Hill; 1994:1205-11. Google Scholar24. Fox KM, Hawkes WG, Magaziner J, Zimmerman SI, Hebel JR. Markers of failure to thrive among older hip fracture patients. J Am Geriatr Soc. 1996;44:371-6. CrossrefMedlineGoogle Scholar25. Verdery RB. Failure to thrive in older people. J Am Geriatr Soc. 1996;44:465-6. CrossrefMedlineGoogle Scholar26. Fried LP, Guralnik JM. Dis