Frailty Syndrome: A Transitional State in a Dynamic Process

Abstract

Frailty has long been considered synonymous with disability and comorbidity, to be highly prevalent in old age and to confer a high risk for falls, hospitalization and mortality. However, it is becoming recognized that frailty may be a distinct clinical syndrome with a biological basis. The frailty process appears to be a transitional state in the dynamic progression from robustness to functional decline. During this process, total physiological reserves decrease and become less likely to be sufficient for the maintenance and repair of the ageing body. Central to the clinical concept of frailty is that no single altered system alone defines it, but that multiple systems are involved. Clinical consensus regarding the phenotype which constitutes frailty, drawing upon the opinions of numerous authors, shows the characteristics to include wasting (loss of both muscle mass and strength and weight loss), loss of endurance, decreased balance and mobility, slowed performance, relative inactivity and, potentially, decreased cognitive function. Frailty is a distinct entity easily recognized by clinicians, with multiple manifestations and with no single symptom being sufficient or essential in its presentation. Manifestations include appearance (consistent or not with age), nutritional status (thin, weight loss), subjective health rating (health perception), performance (cognition, fatigue), sensory/physical impairments (vision, hearing, strength) and current care (medication, hospital). Although the early stages of the frailty process may be clinically silent, when depleted reserves reach an aggregate threshold leading to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral and biological markers. Thus, a better understanding of these clinical changes and their underlying mechanisms, beginning in the pre-frail state, may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible. We therefore provide an update of the physiopathology and clinical and biological characteristics of the frailty process and speculate on possible preventative approaches.

Oxidative stress and frailty: A systematic review and synthesis of the best evidence

“…Frail people have a significant reduction in the function of the innate immune system, T-cell activity, the production of antibodies, and an increase in mitochondrial activity by means of OS products (7,33). In addition, predominantly inflammatory cytokines may influence frailty status either directly by promoting protein degradation, or indirectly by affecting important metabolic pathways (34). Third, frail and pre-frail participants have a higher prevalence of various medical disorders, including cardiovascular diseases, stroke, dementia and diabetes mellitus, all of which are both strongly associated with frailty and could also increase the generation of OS products (5,28).…”

Análise do conceito fragilidade em idosos

“…7 The term elderly was used officially for the first time, in 1970, by members of the Federal Council on Aging (FCA) of the United States of America in order to describe the elderly that lived in unfavorable socioeconomic conditions, had physical weakness, cognitive deficit, advancing age and started to demand greater care. In the eighties, based on the concept of functionality, frailty in the elderly was understood mainly as a synonym of disability, presence of chronic disease or extreme aging.…”

“…2,7,15 Such evidence is accentuated as age advances, and thus, there is an increase of deleterious effects on various organic systems resulting from the aging process. This makes the elderly prone to deleterious effects, including a greater use of the health services, greater risk of immobility, disability, and death.…”

“…11 Several authors 3,7 indicate the existence of hierarchy between different manifestations of frailty. Considering this hierarchy, it is noteworthy that frail elderly present the possibility of developing muscle frailty and march modifications in a proportion of 3.7 and 1.7 more times, respectively, than the risk for developing weight loss.…”

Testes de equilíbrio e mobilidade funcional na predição e prevenção de riscos de quedas em idosos

“…1,43 É possível que variações em relação à forma de mensuração dessas variáveis e ao perfil mais ativo da amostra do presente estudo justifiquem tal divergência. 44,45 Ferreira et al 46 e Lang, Michel & Zekry 47 propõem que a redução da atividade física com o avançar da idade colabora com o declínio da reserva funcional dos sistemas cardiovasculares, respiratórios e musculoesqueléticos. Esses fatores contribuem para a maior percepção de esforço nas atividades de vida diária.…”