Frailty in elderly populations

Frailty is a common condition that affects elderly populations and is associated with increased vulnerability to adverse health outcomes. It is characterized by a decline in physiological reserves and diminished resilience, resulting in decreased functions, increased dependency, and a higher risk of disability, falls, hospitalization, and mortality 

Frailty is not simply a result of aging but rather a distinct clinical syndrome. It is often defined as a state of increased vulnerability to stressors due to age-related declines across multiple physiological systems, leading to functional decline and increased risk of adverse health outcomes 

Frailty is influenced by various factors, including age-related physiological changes, chronic diseases, physical inactivity, poor nutrition, cognitive decline, social isolation, and psychological factors. Genetic predisposition and inflammation also play a role 

In the elderly populations the dynamic homeostasis is lost and this loss is associated with decreased physiologic reserve after the dysregulation of multi-systems. Chronic inflammation is an established contributing factor for frailty with elevated circulating level of proinflammatory cytokines (e.g. interleukin-6 [IL-6]) and inflammatory markers (e.g. C-reactive protein [CRP], tumour necrosis factor-α [TNF-α]) 

The chronic systemic inflammatory state may be directly or indirectly associated with frailty through intermediate pathophysiologic processes including atherosclerosis, cachexia, sarcopenia, osteoporosis and anemia
Other factors that may also exacerbate the development of frailty include socio demographic status (e.g. poverty, living alone, low education level), psychological factors (e.g. depression), nutritional status (e.g. Low protein intake, malnutrition, poor oral health), polypharmacy, comorbidities (e.g. cancer, endocrine disorders, anaemia, dementia, arthritis) and lifestyle factors (e.g. Physical inactivity, smoking)

Frailty is characterized by specific signs and symptoms, including unintended weight loss, exhaustion or fatigue, weakness, slow walking speed, and low levels of physical activity. Other common manifestations may include reduced grip strength, impaired balance, and declines in cognitive function 

Frailty screening is rarely performed in routine perioperative care due to many causes as  Insufficient awareness by clinicians, absence of uniform consensus on the diagnostic criteria and lack of consensus on the best screening or assessment tools for frailty may also be the possible underlying reasons. Alterations in muscle mass and density are closely related to degeneration
Skeletal muscle mass assessment may potentially serve as an objective frailty marker. Clinical Frailty Scale (CFS) is a simple, quick and highly predictive screening tool for frailty. It ranged from 1 (very fit) to 9 (terminally ill). The frailty level was categorized as ‘Non-frail’, ‘Pre-frail’ and ‘Frail’ with CFS≤3, CFS=4 and CFS≥5 respectively 

Several tools and scales are available to assess frailty, such as the Fried Frailty Phenotype, the Clinical Frailty Scale, and the Rockwood Frailty Index. These tools evaluate various domains, including physical function, mobility, strength, cognition, and comorbidities 

Frailty is associated with a higher risk of adverse outcomes, such as disability, falls, fractures, hospitalization, institutionalization, and mortality. Frail individuals are more susceptible to complications from acute illness or surgery and have a reduced ability to recover from stressors 

Frailty in elderly patients can predict  complications, such as deep vein thrombosis, sepsis, depression, cognitive impairment, and physical disability 

The expected consequence of frailty is prolonged postoperative recovery. These frailer elderly patients are also more likely to present with multiple comorbidities, which further complicate their cases resulting in longer hospital stay, higher rates of  complications and in-hospital and mid-to-long term mortality

Managing frailty involves a multidimensional approach, including physical exercise programs to improve strength and balance, optimizing nutrition, managing chronic conditions, reducing polypharmacy (excessive medication use), promoting social engagement, and addressing cognitive impairment. Comprehensive geriatric assessment and care coordination are also important 

Frailty may not be entirely preventable, certain lifestyle choices and interventions can reduce its severity and delay its onset. These include regular physical activity, balanced nutrition, maintaining social connections, managing chronic diseases, and addressing age-related changes promptly 

Frailty in elderly populations is a complex and multifaceted condition that requires a comprehensive approach involving healthcare professionals, caregivers, and the individual themselves. Early recognition, appropriate management, and targeted interventions can help improve the quality of life and outcomes for frail older adults