Frailty as an integrative marker of physiological vulnerability in the era of COVID-19
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COMMENTARY
Open Access
Frailty as an integrative marker of physiological vulnerability in the era of COVID-19 Qian-Li Xue1,2
Keywords: Aging, Geriatric syndrome, Reserve, Resilience
Background As researchers across the globe race to develop vaccines and treatments for COVID-19, evidence is mounting that disease severity, prognosis, and outcomes among persons infected with SARS-CoV-2 are vastly heterogeneous. Based on early studies, age and preexisting disease burden are increasingly being used as risk stratifiers in clinical decision-making when treating COVID-19 patients. However, a question worth asking is whether rushed, few-sizes-fit-all decision-making in a crisis as life-altering as the COVID-19 pandemic will cause unintended harms with respect to access to and delivery of care. In this regard, the observational study conducted by Ma et al. in a sample of older patients with confirmed COVID-19 pneumonia in Wuhan China provided initial evidence that frailty, a clinical syndrome of systemic vulnerability, may be a powerful predictor of disease prognosis and outcomes [1]. It is the finding that the predictive relationship was independent of comorbidity and chronological age that makes the study most interesting. This suggests that the concept of frailty captures important information regarding underlying vulnerability that age and comorbidity together do not fully explain.
This comment refers to the article available at https://doi.org/10.1186/ s12916-020-01761-0. Correspondence: [email protected] 1 Department of Medicine Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA 2 Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
Main text In theory, frailty is conceptualized as a state of decreased ability for multiple physiologic systems to interact harmoniously in order to maintain physiologic equilibrium [2]. This compromised state of health affects the normal complex adaptive behavior that is essential to resilient stress response. The FRAIL scale used by Ma et al. was modeled after the physical frailty phenotype composed of mutually exacerbating clinical manifestations (a.k.a., the “cycle of frailty” [2]) that includes skeletal muscle decline, lower levels of energy production, and altered nutritional intake and processing. Even though disability, comorbidity, and/or frailty often coexist in older adults, there is increasing consensus that frailty is a unique clinical entity different from disability and comorbidity. Independent of Ma et al.’s finding, evidence in support of this theory is mounting that disability, comorbidity, and age separately or in combination do not fully explain substantial differences in health outcomes across patient populations (e.g., geriatric vs. disease-specific populations) and clinical settings (e.g., primary care vs. elective surgery) [3]. Therefore, the concept of frailty provides a new window into latent vulnerability that is both integrative and systemic rather than system- or organs
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