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Definitions and markers of frailty: a systematic review of literature

Published online by Cambridge University Press:  15 October 2010

LL Borges  and
RL Menezes
LL Borges*
Affiliation:
Core Physical Therapy and Rehabilitation, Health Department of the Federal District of Brasília
RL Menezes
Affiliation:
Faculty of Ceilândia, University of Brasília, Brazil
*
Address for correspondence: Larissa de Lima Borges, SHIN, Bloco 4, Conjunto L, Edifício Mônica Assunção, apto. 206, Lago Norte. Brasília-DF, Brasil. E-mail: larissalima10@gmail.com
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Summary

Frailty is a central concept in geriatric medicine, but without a clear definition. Many regard it as a syndrome with its own clinical manifestations and pathophysiology, whilst others consider it to be the result of the accumulation of age-related deficits that predict adverse changes in health. We analysed, through a systematic review, the definitions and markers of the frailty syndrome. Twenty-five articles were included and divided, according to design, into observational, intervention, review and qualitative studies. There was a predominance of operational definitions that used only physical markers to identify frailty. The only qualitative study found that health professionals chose a multidimensional definition that took into account factors other than just the physical. We conclude that there is still no standard definition or agreement about markers of the frailty syndrome.

Keywords

reviewfrail older adultsbiological markersdefinition
Type
Intermediate care and rehabilitation
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 1 , February 2011 , pp. 67 - 77
Creative Commons
This is a work of the U.S. Government and is not subject to copyright protection in the United States.
Copyright
Copyright © Cambridge University Press 2010. This is a work of the U.S. Government and is not subject to copyright protection in the United States.

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References

1Lima-Costa, MF, Barreto, SM, Giatti, L. Condições de saúde, capacidade funcional, uso de serviços de saúde e gastos com medicamentos da população idosa brasileira: um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios. Cad Saúde Pública 2003; 19: 1–11.Google Scholar
2Garrido, R, Menezes, PR. O Brasil está envelhecendo: boas e más notícias por uma perspectiva epidemiológica. Rev Bras Psiquiatr 2002; 24: 3–6.CrossRefGoogle Scholar
3Gazzola, JM, Muchale, SM, Perracini, MR, Cordeiro, RC, Ramos, LR. Caracterização funcional do equilíbrio de idosos em serviço de reabilitação gerontológica. Rev Fisioter Univ São Paulo 2004; 11: 1–14.Google Scholar
4Chaimowicz, F. Epidemiologia e o Envelhecimento no Brasil. In Freitas, EV, Py, L, Cançado, FAX, Doll, J, Gorzoni, ML (eds). Tratado de Geriatria e Gerontologia, 2nd edn.Rio de Janeiro: Guanabara; 2006. pp. 106–30.Google Scholar
5Ferrucci, L, Guralnik, JM, Studenski, S, Fried, LP, Cutler, GB Jr, Walston, JD; Interventions on Frailty Working Group. Designing randomized, controlled trials aimed at preventing or delaying funcional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004; 52: 625–34.CrossRefGoogle Scholar
6Ensrud, KE, Ewing, S, Taylor, SK et al. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 2007; 62A: 744–51.CrossRefGoogle Scholar
7Cawthon, PM, Marshall, LM, Michael, Y, Dam, TT, Ensrud, KE, Barrett-Connor, E, Orwoll, ES; Osteoporotic Fractures in Men Research Group. Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc 2007; 55: 1216–23.CrossRefGoogle Scholar
8Fried, LP, Tangen, CM, Walston, J, Newman, AB, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, WJ, Burke, G, McBurnie, MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56A: M146–56.CrossRefGoogle Scholar
9Ottenbacher, KJ, Ostir, GV, Peek, MD, Snith, SA, Raji, MA, Markides, KS. Frailty in Mexican American older adults. J Am Geriatr Soc 2005; 53: 1524–31.CrossRefGoogle Scholar
10Ávila-Funes, JA, Helmer, C, Amieva, H, Barberger-Gateau, P, Le Goff, M, Ritchie, K, Portet, F, Carrière, I, Tavernier, B, Gutiérrez-Robledo, LM, Dartigues, JF. Frailty among community-dwelling elderly people in France: the three-city study. J Gerontol A Biol Sci Med Sci 2008; 63A: 1089–96.CrossRefGoogle Scholar
11Ávila-Funes, JA, Amieva, H, Barberger-Gateau, P, Le Goff, M, Raoux, N, Ritchie, K, Carrière, I, Tavernier, B, Tzourio, C, Gutiérrez-Robledo, LM, Dartigues, JF. Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc 2009; 57: 453–61.CrossRefGoogle ScholarPubMed
12Raphael, D, Cava, M, Brown, I, Renwick, R, Heathcote, K, Weir, N, Wright, K, Kirwan, L. Frailty: a public health perspective. Can J Pub Health 1995; 86: 224–27.Google ScholarPubMed
13Bortz, WM. A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci 2002; 57A: M283–88.CrossRefGoogle Scholar
14Fried, LP, Ferruci, L, Dater, J, Williamson, JD, Anderson, G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59: 255–63.CrossRefGoogle ScholarPubMed
15Crews, DE, Zavotka, S. Aging, disability, and frailty: implications for universal design. J Physiol Anthropol 2006; 25: 113–18.CrossRefGoogle ScholarPubMed
16Teixeira, I, Neri, AL. A fragilidade no envelhecimento: fenômeno multidimensional, multideterminado e evolutivo. In Freitas, EV, Py, L, Cançado, FAX, Doll, J, Gorzoni, ML (eds). Tratado de Geriatria e Gerontologia, 2nd edn.Rio de Janeiro: Guanabara, 2006. pp. 1102–9.Google Scholar
17Slaets, JPJ. Vulnerability in the elderly: Frailty. Med Clin N Am 2006; 90: 593–601.CrossRefGoogle ScholarPubMed
18Bergman, H, Ferrucci, L, Guralnik, J, Hogan, DB, Hummel, S, Karunananthan, S, Wolfson, C. Frailty: an emerging research and clinical paradigm – issues and controversies. J Gerontol A Biol Sci Med Sci 2007; 62A: 731–37.CrossRefGoogle Scholar
19Ahmed, N, Mandel, R, Fain, MJ. Frailty: an emerging geriatric syndrome. Am J Med 2007; 120: 748–53.CrossRefGoogle ScholarPubMed
20Rockwood, K, Mitnitski, A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62A: 722–27.CrossRefGoogle Scholar
21Levers, M, Estabrooks, CA, Kerr, JCR. Factors contributing to frailty: literature review. J Adv Nurs 2006; 56: 282–91.CrossRefGoogle ScholarPubMed
22Fisher, AL. Just what defines frailty? J Am Geriatr Soc 2005; 53: 2229–30.CrossRefGoogle ScholarPubMed
23Kuh, D. A life course approach to healthy aging, frailty, and capability. J Gerontol A Biol Sci Med Sci 2007; 62A: 717–21.CrossRefGoogle Scholar
24Vanltallie, TB. Frailty in the elderly: contributions of sarcopenia and visceral protein depletion. Metabolism 2003; 52: 22–26.CrossRefGoogle Scholar
25Kinney, JM. Nutritional frailty, sarcopenia and falls in the elderly. Curr Opin Clin Nutr Metab Care 2004; 7: 15–20.CrossRefGoogle ScholarPubMed
26Ávila-Funes, JAA, Garcia-Mayo, EJ. Benefícios dela práctica del ejercicio en los ancianos. Gac Méd Méx 2004; 140: 431–36.Google Scholar
27Sampaio, RF, Mancini, MC. Estudos de revisão sistemática: um guia para síntese criteriosa da evidência científica. Rev Bras de Fisioterapia 2007; 11: 83–89.CrossRefGoogle Scholar
28Jones, DM, Song, X, Rockwood, K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004; 52: 1929–33.CrossRefGoogle ScholarPubMed
29Bandeen-Roche, K, Xue, Q, Ferruci, L, Walston, J, Guraldik, JM, Chaves, P, Zeger, SL, Fried, LP. Phenotype of frailty: characterization in the Women's Health and Aging Studies. J Gerontol A Biol Sci Med Sci 2006; 61A: 262–66.CrossRefGoogle Scholar
30Matteini, AM, Waltson, JD, Fallin, MD, Bandeen-Roche, K, Kao, WHL, Semba, RD, Allen, RH et al. Markers of B-vitamin deficiency and frailty in older women. J Nutr Health Aging 2007; 12: 303–8.CrossRefGoogle Scholar
31Xue, Q, Bandeen-Roche, K, Varadhan, R, Zhou, J, Fried, L. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women's Health and Aging Study II. J Gerontol A Biol Sci Med Sci 2008, 63A: 984–90.CrossRefGoogle Scholar
32Kulminski, AM, Ukraintseva, SV, Kulminskaya, IV, Arbeev, KG, Land, K, Yashin, AI. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 2008; 56: 898–903.CrossRefGoogle ScholarPubMed
33Woo, J, Goggins, W, Sham, A, Ho, SC. Social determinants of frailty. Gerontology 2005; 51: 402–8.CrossRefGoogle ScholarPubMed
34Mitniski, A, Song, X, Skoog, I, Broe, GA, Cox, JL, Grunfeld, E, Rockwood, K. Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc 2005; 53: 2184–89.CrossRefGoogle Scholar
35Paw, MJM, Dekker, JM, Feskens, EJM, Schoutern, EG, Kromhout, D. How to select a frail elderly population? A comparison of three working definitions. J Clin Epidemiol 1999; 52: 1015–21.CrossRefGoogle Scholar
36Schuurmans, H, Steverink, N, Lindenberg, S, Frieswijk, N, Slaets, PJ. Old or frail: what tells us more? J Gerontol A Biol Sci Med Sci 2004; 59A: 962–65.CrossRefGoogle Scholar
37Rockwood, K, Song, X, Macknight, C, Bergman, H, Hogan, DB. A global clinical measure of fitness and frailty in elderly people. JAMC 2005; 174: 489–495.Google Scholar
38Binder, EF, Schechtman, KB, Ehsani, AA, Steger-May, K, Brown, M, Sinacore, DR, Yarasheski, KE, Holloszy, JO. Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc 2002; 50: 1921–28.CrossRefGoogle ScholarPubMed
39Binder, EF, Yarasheski, KE, Steger-May, K, Sinacore, DR, Brown, M, Schechtman, KB, Holloszy, JO. Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. J Gerontol A Biol Sci Med Sci 2005; 60A: 1425–31.CrossRefGoogle Scholar
40Fairhall, N, Aggar, C, Kurrle, SE, Sherrington, C, Lord, S, Lockwood, K, Monaghan, N, Cameron, ID. Frailty intervention (FIT). BMC Geriatrics 2008; 8: 1–10.CrossRefGoogle Scholar
41Wells, JL, Seabrook, JA, Stolee, P, Borrie, MJ, Knoefel, F. State of the art in Geriatric Rehabilitation. Part I: Review of frailty and comprehensive Geriatric assessment. Arch Phys Med Rehabil 2003; 84: 890–97.CrossRefGoogle ScholarPubMed
42Phan, HM, Alpert, JS, Fain, M. Frailty, inflammation, and cardiovascular disease: evidence of a connection. Am J Geriatr Cardiol 2008; 17: 101–7.Google ScholarPubMed
43Daniels, R, Rossum, E, Witte, L, Kempen, G, Heuvel, W. Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res 2008; 8: 1–8.CrossRefGoogle ScholarPubMed
44Rolland, Y, Abellan van Kan, G, Bénétos, A, Blain, H, Bonnefoy, M, Chassagne, P, Jeandel, C, Laroche, M, Nourhashémi, F, Orcel, P, Piette, F, Ribot, C, Ritz, P, Roux, C, Taillandier, J, Trémollières, F, Weryha, G, Vellas, B. Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives. J Nutr Health Aging 2008; 12: 319–30.CrossRefGoogle ScholarPubMed
45Teixeira, I. Percepções de profissionais de saúde sobre duas definições de fragilidade no idoso. Ciência e Saúde Coletiva 2008; 13: 1181–88.CrossRefGoogle Scholar