Abstract
Frailty in elderly people takes a high toll in personal suffering, disability, mortality, morbidity, and health care costs. Frailty is closely associated with, but is not the same as, comorbidity (multiple coexisting medical conditions), or disability. This article presents overlapping definitions of frailty and summarizes common medical problems in the frail person. All frail people exhibit muscle weakness and many are undernourished. Clinical aspects of frailty are outlined. Frailty can be ameliorated and in some cases reversed by good nutrition, proper medication, attention to vision and hearing, expansion of social networks, and exercise. Exercise recommendations for frail elders and general suggestions for clinicians are presented, with a view toward excellent care.
THE geriatric syndrome of frailty has been the subject of intensive research efforts in the last 10 years, concurrent with the growth of the relatively new field of geriatric medicine and the exponential increase in the numbers of elderly people living in developed nations. By the year 2030, the percentage of persons older than 65 years in the United States will have doubled from 11% to 22%, ultimately representing approximately 55 million individuals. At age 65, life expectancy for women is 19 more years, to age 84, of which 14 can be expected to be active, and 5 years dependent. Men at age 65 can expect 15 more years of life, to age 80, 12 years of which will be fully independent and 3 years dependent. 1 Two-thirds of women and almost half of men older than 85 years either need extensive assistance in their everyday activities to remain at home or are already living in a nursing home. 2 As many as 12 million Americans will need long-term care by the year 2020. 3 As medical science has reduced or eradicated disease processes, frailty has been the price of longevity.
Even though frailty is not universal in old age and represents only a fraction of the population older than 65 years, it assumes an importance greater than its prevalence. There is a high toll in personal suffering, caregiver burden, and costs of health care including medication use. 4,5 Frail individuals are at much higher risk for falls, fractures, infections, disabilities, hospitalization, institutionalization, and death, compared with their age-matched nonfrail counterparts. 6 Frailty leads to dependence and the family with a frail person in its midst faces many challenges: dealing with stress, anticipatory grief, changes in roles and responsibilities, and the physical and emotional demands of caregiving.