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Jaffe Daniel  | Clinical Definition and Pathophysiology of Frailty: A Brief Review 

Editorial

With the medical field making constant and dramatic improvements in treatment and prevention of disease progression, life expectancies in the United States are increasing dramatically, with the elderly population demonstrating the greatest expansion. This substantial increase in the elderly population creates new and unfounded challenges in treating and caring for this sect of the population. In 1990, the American Medical association stated that “. . . one of the most important tasks that the medical community faces today is to prepare for the problems in caring for the elderly in the 1990’s and the 21^st century” [1]. This particular study emphasized the need to develop and sustain means of special care for the growing population of the frail and vulnerable elderly. Frailty is often used as an umbrella term to identify a syndrome containing a litany of different symptoms such as a loss of reserves, leading to vulnerability, injury, and death [2,3]. Often times frailty, disability, and comorbidity are used interchangeably, however these terms do not necessarily mean the same thing. Disability has been defined as a difficulty or dependency on others to carry out essential activities for independent living, including: tasks essential to self-care, living independently in a home, and performance of desired activities important to quality of life [3,4]. As of 1996, the prevalence of disability in community-dwelling adults in excess of 70 years of age is approximately 20-30% [5].

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Comorbitity is defined as the concurrent presence of two or more medically diagnosed diseases in the same individual [6,7]. Estimates state that approximately 35% of the population over 65 years of age is comorbid, while greater than 80% of the population over 80 years of age possesses two or more diseases [5]. Much contemporary research is aimed at investigating the physiological impact comorbidity presents in the development of frailty, including the interactions between strength and balance, vision and hearing, and physiological biomarkers, including interleukin-6 and IGF-1 [8,9]. According to a survey completed by 62 geriatricians, Fried and Watson [10] were able to report a list, in order of frequency, of characteristics that represent frailty. These characteristics include: malnourishment, functional dependence, prolonged bed rest, pressure sores, gait disorders, general muscle weakness, in excess of 90 years of age, weight loss, anorexia, fear of falling, dementia, hip fractures, delirium, confusion, going outdoors infrequently, and polypharmacy [10]. In essence, frailty is a dynamic process of increasing vulnerability seen across a broad spectrum of domains, including physical, nutritive, cognitive, and sensory, that lead to functional decline and ultimately death [11-13]. Clinically, Frailty is viewed as a transitional state in the functional process from robustness to functional decline [14].

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