Fried frailty phenotype assessment components as applied to geriatric inpatients

Abstract

BackgroundManagement of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in elderly patients presenting with relatively good health status.ObjectiveThe aim of this article was to assess the usefulness and limitations of Fried frailty phenotype criteria in geriatric inpatients, characterized by comorbidity and functional impairments, and to estimate the frailty phenotype prevalence in this group.Patients and methods:Five hundred consecutive patients of the university hospital subacute geriatric ward, aged 79.0±8.4 years (67% women and 33% men), participated in this cross-sectional study. Comprehensive geriatric assessment and Fried frailty phenotype component evaluation were performed in all patients.ResultsMultimorbidity (6.0±2.8 diseases) characterized our study group, with a wide range of clinical conditions and functional states (Barthel Index of Activities of Daily Living 72.2±28.2 and Mini-Mental State Examination 23.6±7.1 scores). All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8–69.2) (diagnostic group). One or more components were not feasible to be assessed in 35% of the remaining patients (nondiagnostic group) because of lack of past patient’s body mass control and/or cognitive or physical impairment. Patients from the nondiagnostic group, as compared to patients from the diagnostic group, presented with more advanced age, higher prevalence of dementia, lower prevalence of hypertension, lower systolic and diastolic blood pressure, body mass index, Mini-Mental State Examination and Barthel Index of Activities of Daily Living. Despite diagnostic limitations, we found ≥3 positive criteria (thus, frailty diagnosis) in 54.2% of the study group (95% CI =49.8–58.6), with prevalence from 31.7% in sexagenarians to 67.6% in nonagenarians.ConclusionFried frailty phenotype criteria seem useful for geriatric inpatient assessment, despite diagnostic limitations. High prevalence of frailty among geriatric inpatients suggests that evaluation for frailty should be considered a part of the comprehensive geriatric assessment.

Associations of Frailty Status with Low-Mileage Driving and Driving Cessation in a Cohort of Older Drivers

“…Frailty is a clinical syndrome that develops following a decline in function and resilience across numerous physiological systems [8][9][10][11]. One commonly used measure of frailty is the frailty phenotype created and validated by Fried and colleagues, which provides a standardized measure based on the assessment of five criteria: unintentional weight loss, weakness, exhaustion, slowness, and low physical activity [9].…”

Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial

“…Due to a global rise in life expectancy, maintaining physical function and preventing disability in advanced age are among the major clinical and public health priorities 2,3. Frailty is one of the main factors that suppresses successful aging and leads to adverse health consequences, mainly falls and delirium after minor stressor 4…”

Examining Frailty Phenotype Dimensions in the Oldest Old

“…Fourth, the slight association of sociodemographic variables with the two dimensions suggested that this approach of frailty showed very little association with sociodemographic aspects not corroborating previous studies (Bieniek et al, 2016;Nyunt et al, 2017;Papachristou et al, 2017;Lewis et al, 2018), which should be the subject of further research, considering these two dimensions of the frailty phenotype and across different age groups. This study analyzed only the oldest old people with very low variability in education level and health condition, as referred to in the Limitations section.…”

“…Recent studies that used the frailty phenotype revealed that the proportion of frailty among oldest old individuals is particularly high (Duarte and Paúl, 2015;Bieniek et al, 2016) in comparison with younger old individuals (e.g., frailty prevalence increased with age from 31.7% in the 60-69 age group to 67.6% in the 90+ age group, and from 22.5% in the 50-65 age group to 60.4% in the 75+ age group, respectively). These results seem to indicate that the frail condition is very frequent among oldest old individuals and suggests that the frailty phenotype provides low variability within the oldest old subgroup once a large proportion of oldest old individuals are frail.…”

“…These results seem to indicate that the frail condition is very frequent among oldest old individuals and suggests that the frailty phenotype provides low variability within the oldest old subgroup once a large proportion of oldest old individuals are frail. Other studies have already analyzed the components of the frailty phenotype and showed some results in relation to characteristics such as age (Hoogendijk et al, 2015), gender (Bieniek et al, 2016), disability (Papachristou et al, 2017), and mortality (Papachristou et al, 2017). Nevertheless, these studies did not inform about the weight/contribution of each component for the frailty phenotype, and it would be important to understand if all components contribute equally (or not) to the frailty condition and how they interrelate with each other.…”