Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

Abstract

Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multicomponent physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

COVID-19 Spiraling of Frailty in Older Italian Patients

“…A.M. ABBATECOLA 1,2 , R. ANTONELLI-INCALZI 3,4 in the ratio of angiotensin receptor-1 (AT-1) to angiotensin receptor-2 (AT-2) in pulmonary regions with marked fibrosis (12). AT-2s have been shown to hold anti-fibrotic properties, while AT-1s seem to hold a role in COPD-lung induced fibrosis (12).…”

“…Frailty should be considered a constantly evolving syndrome and only reversible if appropriate intervention is quickly recognized and applied. Indeed, there is substantial literature underlining the importance of geriatric medicine toward frailty prevention and clinical criteria to rapidly identify those with frailty or pre-frailty (3)(4)(5). If any negative health conditions break the equilibrium, the irreversible downward spiraling of frailty will begin.…”

COVID-19 and Older Adult

“…Persons with comorbidity are at an increased risk. It is suggested that the FRAIL screen is used to detect persons at increased risk (6,7,8). Persons with hypertension and diabetes mellitus are at increased risk possibly due to alterations in the angiotensin converting enzyme 2 (ACE 2) receptor produced by ACE 1 inhibitors.…”

Physical Fitness in Hospitalized Frail Elderly Patients

“…An increased amount of physical activity, exercise, adequate protein intake and appropriate medication are thought to be the first-line therapies in the management of frailty [105][106][107] and comprehensive and individualized prescribed treatment interventions can improve or slow down the deterioration 108 .…”

“…It is recommended that frailty screening to identify frailty and facilitate risk stratification should be performed with instruments that capture multiple domains of the frailty syndrome 40 . Since frailty is strongly related to progressive disability 32 , additional assessments focusing on components of physical fitness should also be made of patients identified as frail 107 . Greater attention to the physical domains, at an early stage during the hospital stay, would probably facilitate the tailoring of interventions adapted to suit each patient.…”