Approaches to the diagnosis and prevention of frailty
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REVIEW
Approaches to the diagnosis and prevention of frailty S. J. Woolford1,2 · O. Sohan1 · E. M. Dennison2 · C. Cooper2 · H. P. Patel1,2,3,4 Received: 30 March 2020 / Accepted: 6 April 2020 © The Author(s) 2020
Abstract An individual who is living with frailty has impairments in homeostasis across several body systems and is more vulnerable to stressors that may ultimately predispose them to negative health-related outcomes, disability and increased healthcare use. Approximately a quarter of individuals aged > 85 years are living with frailty and as such the identification of those who are frail is a public health priority. Given that the syndrome of frailty is defined by progressive and gradual loss of physiological reserves there is much scope to attempt to modify the trajectory of the frailty syndrome via physical activity and nutritional interventions. In this review we give an up to date account on the identification of frailty in clinical practice and offer insights into physical activity and nutritional strategies that may be beneficial to modify or reverse the frailty syndrome. Keywords Frailty · Identifying frailty · Physical activity · Nutrition
Background The syndrome of frailty is most associated with, but not an inevitable consequence of ageing and is characterised by a vulnerability to stressor events that can be both internal (e.g. infections and changes to medication) as well as external (e.g. changes in a person’s immediate environment or a breakdown in social care) [1, 2]. Frailty represents a considerable global healthcare burden, with an analysis of 21 cohorts of 61,500 community dwelling older adults, across mainly developed countries, estimating global frailty prevalence in those aged 80–84 years to be 15.7%, increasing to 26% in those aged > 85 years [3]. In the UK, NHS England estimate that 1.8 million people in the UK aged > 60 years
* H. P. Patel [email protected] 1
Medicine for Older People, University Hospital Southampton, Mailpoint 63, G Level, West Wing, Tremona Road, Southampton SO16 6YD, UK
2
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
3
Academic Geriatric Medicine, University of Southampton, Southampton, UK
4
NIHR Biomedical Research Centre, Southampton University of Southampton and University Hospital Southampton, Southampton, UK
are living with frailty, with diagnoses concentrated in those aged > 85. Biological risk factors for the development of the frailty syndrome include age-related inflammatory processes, as well as common chronic diseases and their interactions with the environment. These factors lead to a physiological decline across multiple body systems, including skeletal muscle and bone, the cardiorespiratory system and the immune and endocrine systems. Other important contributors for developing frailty span non-physical domains. For example, cognitive frailty refers to cognitive decline in absence of dementia, social frailty refers to loneliness and the lack of robust social networks and psychological frailty
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