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Ageing
Published in Henry J. Woodford, Essential Geriatrics, 2022
Frailty tends to progressively become more severe.93 However, there is a dynamic continuum from fit to frail and individual frailty can change over time in either direction.94 It is potentially partially reversible and this may reduce associated disability. Although there is some capacity to become less frail, transitioning from moderate to severe frailty to a non-frail state is rare. It may be possible to reduce vulnerability without, necessarily, improving function. This may be through improved support structures. Comprehensive geriatric assessment is the cornerstone of the approach to people with frailty (see Chapter 2).
More Complex Patients
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Most research that has been done looking at the management of acute pain in older patients has grouped individuals on the basis of age only. However, it maybe that biological “fitness” rather than chronological age is of most importance. While it is known that older age correlates with a higher incidence of poor postoperative outcomes, frailty, which can be measured with validated scales, independently predicts the risks. Frailty is defined as an age-related decrease in physiological reserve that leads to a greater vulnerability to stressors and a higher risk of adverse health outcomes (Schug et al, 2020). After both surgery (Lin et al, 2016; Hewitt et al, 2018) and trauma (Zhao et al, 2020), frailty is associated with higher mortality, complication and readmission rates, and longer stays in hospital.
Ageing Unequally
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
The approaches used to measure frailty are broadly divisable into the frailty phenotype and the deficit accumulation model. The phenotype understands frailty as an observable clinical syndrome with five characteristics: unintentional weight loss, exhaustion, weakness, slow walking speed and low physical activity [19]. The deficit accumulation model, operationalised though the frailty index (FI), conceptualises frailty as the accumulation of physical, psychological and social losses [20]. Both approaches attempt to quantify older individuals’ complex needs and are independently predictive of often costly adverse outcomes such as unplanned hospitalisation, admission to long-term care facilities and death [21].
Association Between Frailty-Related Factors and Depression among Older Adults
Published in Clinical Gerontologist, 2022
In Young Cho, Jiyoung Kang, Hyeonyoung Ko, Eunju Sung, Pil Wook Chung, Cheolhwan Kim
Frailty in the geriatric population results in functional limitations and reduced ability to react to stress, and vulnerability to negative health outcomes, such as hospitalization and mortality (Fried et al., 2001). Frailty is an extreme consequence of the natural aging process and is known to increase among those with comorbidities, sedentary lifestyles, and low socioeconomic status. Since Fried proposed the frailty phenotype, consisting of weakness, slowness, reduced physical activity, weight loss, and exhaustion (Fried et al., 2001), many frailty assessment methods have been developed (Gobbens, van Assen, Luijkx, Wijnen-Sponselee, & Schols, 2010; Mitnitski, Mogilner, & Rockwood, 2001). As a broader concept of frailty, Rockwood and Mitnitski introduced the Frailty Index, defining frailty as the accumulation of deficits, presenting as symptoms, medical disorders, functional impairments, or abnormal lab results (Mitnitski et al., 2001). Frailty is multidimensional, and while there is yet no gold standard for defining frailty, psychological deficits are being considered as an important component of frailty (Gobbens et al., 2010).
Letter to the editor regarding the article ‘Are older patients with non-small cell lung cancer receiving optimal care? A population-based study’
Published in Acta Oncologica, 2022
We read with great interest the recently published article by Willén et al. [1] on the optimal care of non-small cell lung cancer (NSCLC) in elderly patients. The optimal systemic treatment of adjuvant and palliative settings is of keen interest to medical researchers in elderly patients. Some researchers have emphasized that biological age is important along with chronological age in treatment decisions [2,3]. In this situation, geriatric assessment tools to detect frail patients, are very important to evaluate the eligible older patients for treatment. In this study, the authors suggested that overall and cause-specific survival decreased with increasing age in patients with a stage IA-IIIA disease and there was no age difference in survival in patients with stage IIIB-IV NSCLC [1]. We congratulate the authors for this work. Although it is of utmost importance in its concept, we want to provide some inferences regarding this study.
The Complex Relationship between Disability Discrimination and Frailty Scores
Published in The American Journal of Bioethics, 2021
Joel Michael Reynolds, Charles E. Binkley, Andrew Shuman
Next, it is worth considering the distinction between “vulnerability” and “frailty.” While Wilkinson uses the former as a way to explain the latter, we do not see how these concepts are in fact different. This raises a deeper issue. While Wilkinson concludes by arguing that “the concept of frailty is conceptually clear and measurable,” we remain unconvinced. In practice, “frailty” has a predictive function; more specifically, it is thought to predict risks concerning various adverse outcomes and events, including morbidity and mortality. Yet, our current abilities to engage in prediction and risk assessment beyond a few months are notoriously deficient, and the definition of frailty itself relies on multivariate models that integrate heterogeneous and ever-changing covariates. Predictive ability is especially problematic when a progressive model is applied to a person whose physical or cognitive manifestation of disability may wax and wane. As Solomon et al. argued during the heat of debates concerning how to deal with COVID-19-related crisis standards of care, “the ability to predict long-term survival is poor and therefore susceptible to bias. Furthermore, many disadvantaged populations have reduced life expectancy, and triage protocols should not exacerbate health inequities. [Only n]ear-term survivability [1–12 months]…can be assessed independently from disability” (Solomon, Wynia, and Gostin 2020, e27[2]).