Treating frailty-a practical guide
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OPINION
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Treating frailty-a practical guide Nicola Fairhall1,2, Colleen Langron3, Catherine Sherrington2, Stephen R Lord4, Susan E Kurrle3, Keri Lockwood3, Noeline Monaghan1, Christina Aggar5, Liz Gill1 and Ian D Cameron1*
Abstract Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people. Background Identification and treatment of frailty is a challenge for clinicians. Frailty is a common geriatric syndrome, characterized by decreased reserve and increased vulnerability to adverse outcomes, including falls, hospitalization, institutionalization and death [1,2]. The prevalence and the consequences of frailty present a considerable burden to older people, their carers, health care services and the community. Interventions designed to reduce frailty therefore have the potential for profound and widespread benefits. Management of the frail older individual is challenging on multiple levels. Understanding of frailty has increased dramatically over the past decade, thanks to research into the biological basis of frailty and methods to define and predict the syndrome. There is no firm consensus, however, on how to assess and diagnose frailty in the clinical setting [3]. Care of frail individuals is also difficult, due to complex comorbidities, vulnerability to deterioration and increased social needs [1,4], compounded by the need for consistent ongoing management despite frequently fragmented health service delivery. A practical, evidence-based guide for clinicians is therefore needed. There is a paucity of direct evidence guiding interventions to decrease frailty. Research has concentrated on * Correspondence: [email protected] 1 Rehabilitation Studies Unit, Faculty of Medicine, The University of Sydney, Ryde, Sydney 2112, Australia Full list of author information is available at the end of the article
the effect of interventions on functional and nutritional outcomes in frail older people [5-9] and application of geriatric models of care to frail older people in a variety of settings [4,10]. However, clinical improvement from the frail state is possible [11,12] and there is an urgent need for effective interventions to mitigate frailty. As in other fields, clinicians should aim to integrate the highe
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