Special Article
Frailty Consensus: A Call to Action

https://doi.org/10.1016/j.jamda.2013.03.022Get rights and content

Abstract

Frailty is a clinical state in which there is an increase in an individual’s vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty.

  • 1.

    Physical frailty is an important medical syndrome. The group defined physical frailty as “a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death.”

  • 2.

    Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy.

  • 3.

    Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons.

  • 4.

    For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (≥5%) due to chronic disease should be screened for frailty.

Section snippets

Methods

Six major international (International Association of Gerontology and Geriatrics; Society on Sarcopenia, Cachexia, and Wasting Diseases; and the International Academy of Nutrition and Aging), European (European Union Geriatric Medicine Society), and US societies (American Medical Directors Association and American Federation for Aging Research) provided delegates to attend this consensus meeting. In addition, 7 other experts in the area of frailty were invited by the conveners (Bruno Vellas and

Physical Frailty Is an Important Medical Syndrome

The group defined frailty as

“A medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death.”

In addition to the definition, the group made 4 key points:

  • 1.

    Although recognizing that frail individuals could be disabled and that not all disabled persons are frail, the group agreed that the emphasis on case finding should

Acknowledgments

Supported by unrestricted educational grants from Sanofi and Nutricia Advanced Medical Nutrition (group Danone).

References (98)

  • M. Muscaritoli et al.

    Consensus definition of sarcopenia, cachexia and pre-cachexia: Joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting disease” and “nutrition in Geriatrics.”

    Clin Nutr

    (2010)
  • R.E. Hubbard et al.

    Frailty in older women

    Maturitas

    (2011)
  • E. Pijpers et al.

    The frailty dilemma. Review of the predictive accuracy of major frailty scores

    Eur J Intern Med

    (2012)
  • J.E. Morley

    Frailty: Diagnosis and management

    J Nutr Health Aging

    (2011)
  • J.E. Morley et al.

    A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans

    J Nutr Health Aging

    (2012)
  • J. Subra et al.

    The integration of frailty into clinical practice: Preliminary results from the Gérontopôle

    J Nutr Health Aging

    (2012)
  • N.A. Singh et al.

    Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: A randomized controlled trial

    J Am Med Dir Assoc

    (2012)
  • M. Yamada et al.

    Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults

    J Am Med Dir Assoc

    (2012)
  • F. Landi et al.

    The anorexia of aging: Is it a geriatric syndrome?

    J Am Med Dir Assoc

    (2010)
  • J.E. Morley

    Undernutrition: A major problem in nursing homes

    J Am Med Dir Assoc

    (2011)
  • C.R. van Wetering et al.

    Efficacy and costs of nutritional rehabilitation in muscle-wasted patients with chronic obstructive pulmonary disease in a community-based setting: A prespecified subgroup analysis of the INTERCOM trial

    J Am Med Dir Assoc

    (2010)
  • M. Tieland et al.

    Protein supplementation improves physical performance in frail elderly people: A randomized, double-blind, placebo-controlled trial

    J Am Med Dir Assoc

    (2012)
  • D. Paddon-Jones

    Perspective: Exercise and protein supplementation in frail elders

    J Am Med Dir Assoc

    (2013)
  • V. Malafarina et al.

    Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: A systematic review

    J Am Med Dir Assoc

    (2013)
  • M. Tieland et al.

    Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: A randomized, double-blind, placebo-controlled trial

    J Am Med Dir Assoc

    (2012)
  • J.E. Morley

    Do frail older persons need more protein?

    J Am Med Dir Assoc

    (2012)
  • A.L. Cawood et al.

    Systematic review and meta-analysis of the effects of high protein oral nutritional supplements

    Ageing Res Rev

    (2012)
  • D.L. Waters et al.

    Long-term maintenance of weight loss after lifestyle intervention in frail, obese older adults

    J Nutr Health Aging

    (2013)
  • Y. Rolland et al.

    Current and future pharmacologic treatment of sarcopenia

    Clin Geriatr Med

    (2011)
  • D. Gnjidic et al.

    Polypharmacy cutoff and outcomes: Five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes

    J Clin Epidemiol

    (2012)
  • S.E. Bronskill et al.

    Exploring variation in rates of polypharmacy across long term care homes

    J Am Med Dir Assoc

    (2012)
  • Y. Gokce Kutsal et al.

    Polypharmacy in the elderly: A multicenter study

    J Am Med Dir Assoc

    (2009)
  • G. Kojima et al.

    Reducing cost by reducing polypharmacy: The polypharmacy outcomes project

    J Am Med Dir Assoc

    (2012)
  • S.P. Fitzgerald et al.

    An analysis of the interactions between individual comorbidities and their treatments—implications for guidelines and polypharmacy

    J Am Med Dir Assoc

    (2010)
  • B.K. Tamura et al.

    Physician intervention for medication reduction in a nursing home: The polypharmacy outcomes project

    J Am Med Dir Assoc

    (2011)
  • J.E. Morley

    Polypharmacy in the nursing home

    J Am Med Dir Assoc

    (2009)
  • B. Vellas et al.

    Implementing frailty into clinical practice: We cannot wait

    J Nutr Health Aging

    (2012)
  • A. Sinclair et al.

    Diabetes mellitus in older people: Position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes

    J Am Med Dir Assoc

    (2012)
  • J. Walston et al.

    Research agenda for frailty in older adults: Toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults

    J Am Geriatr Soc

    (2006)
  • F. Cerreta et al.

    Drug policy for an aging population—the European Medicines Agency's geriatric medicines strategy

    N Engl J Med

    (2012)
  • Available at: http://ec.europa.eu/economy_finance/publications/european_economy/2012/pdf/ee-2012-2_en.pdf. Accessed...
  • L.P. Fried et al.

    Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care

    J Gerontol A Biol Sci Med Sci

    (2004)
  • N. Sourial et al.

    Contribution of frailty markers in explaining differences among individuals in five samples of older persons

    J Gerontol A Biol Sci Med Sci

    (2012)
  • R.M. Collard et al.

    Prevalence of frailty in community-dwelling older persons: A systematic review

    J Am Geriatr Soc

    (2012)
  • L. Rodríguez-Mañas et al.

    Searching for an operational definition of frailty: A Delphi method based consensus statement. The Frailty Operative Definition-Consensus Conference Project

    J Gerontol A Biol Sci Med Sci

    (2013)
  • K. Rockwood

    What would make a definition of frailty successful?

    Age Ageing

    (2005)
  • L.P. Fried et al.

    Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: Evidence for a phenotype

    J Gerontol A Biol Sci Med Sci

    (2001)
  • K. Bandeen-Roche et al.

    Phenotype of frailty: Characterization in the women's health and aging studies

    J Gerontol A Biol Sci Med Sci

    (2006)
  • K.E. Ensrud et al.

    Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women

    Arch Intern Med

    (2008)
  • Cited by (0)

    The authors declare no conflicts of interest.

    View full text