Age-Related Frailty: A Clinical Model for Geroscience?
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AGE-RELATED FRAILTY: A CLINICAL MODEL FOR GEROSCIENCE? C. TAKEDA1, D. ANGIONI1, E. SETPHAN3, T. MACARON1, P. DE SOUTO BARRETO2, S. SOURDET1, F. SIERRA2, B. VELLAS2 1. Gérontopôle, Department of Geriatrics, CHU Toulouse, Toulouse, France; 2. Inserm UMR 1027, Toulouse, France; University of Toulouse III, Toulouse, France; Gérontopôle, Department of Geriatrics, CHU Toulouse, Toulouse, France; 3. Saint George’s Hospital, Beyrouth, Lebanon. . Corresponding author: Dr Catherine Takeda, MD, Gérontopôle, CHU Toulouse, Cité de la Santé, Hôpital La Grave, Place Lange, 31059 Toulouse cedex 9, France, Tel : +33.(0)5.17.77.70.28, Fax +33.(0)5.61.77.70.71, E-mail : [email protected]
Abstract: In their everyday practice, geriatricians are confronted with the fact that older age and multimorbidity are associated to frailty. Indeed, if we take the example of a very old person with no diseases that progressively becomes frail with no other explanation, there is a natural temptation to link frailty to aging. On the other hand, when an old person with a medical history of diabetes, arthritis and congestive heart failure becomes frail there appears an obvious relationship between frailty and comorbidity. The unsolved question is: Considering that frailty is multifactorial and in the majority of cases comorbidity and aging are acting synergistically, can we disentangle the main contributor to the origin of frailty: disease or aging? We believe that it is important to be able to differentiate age-related frailty from frailty related to comorbidity. In fact, with the emergence of geroscience, the physiopathology, diagnosis, prognosis and treatment will probably have to be different in the future. Key words: Frailty causes, aging, age-related frailty, frailty related to diseases, geroscience.
Introduction
Fedarko hypothesized that the biology of frailty differed from normal age-related changes and other age-related diseases (22), underlying the importance of distinguishing different clinical Models. Further investigation is needed to validate the origins of frailty from a biological point of view. Geroscience, a new interdisciplinary field that aims to understand the relationship between the biology of aging and the biology of age-related diseases (23), thus has a critical role to play in identifying biomarkers of frailty (24) in order to define the origins of frailty. The objective of this viewpoint is to underline the importance of distinguishing frailty related to age (25) from frailty related to comorbidity (26).
Over the past decades, frailty has commonly been accepted by the scientific and clinical communities (1, 2). Frailty is a clinical condition characterized by an excessive vulnerability of the individual to endogenous and exogenous stressors (3). In 2001, Fried et al. (4) established the Frailty phenotype as a clinical syndrome based on the presence of three out of five criteria: unintentional weight loss (4.5 kg in the past year), selfreported exhaustion, weakness (grip strength), slow walking speed and low physical
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