frailty

Frailty is a clinical syndrome characterized by diminished strength, endurance, and physiologic function that increases an individual’s vulnerability to stressors such as illness, injury, or surgery. It reflects multisystem decline and reduced reserve rather than a single disease. Frailty commonly occurs in older adults but can be identified earlier. It is distinct from comorbidity (multiple diseases) and disability (difficulty with activities).

Two widely used models organize frailty conceptually. The phenotype model, described by Fried and colleagues, defines frailty as the presence of three or more of five criteria: unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity. The deficit-accumulation model, developed by Rockwood and colleagues, scores frailty based on the proportion of a range of health-related deficits (symptoms, signs, diseases, and functional impairments).

Prevalence increases with age and is influenced by sex, socioeconomic status, and comorbidity. Frailty is associated with higher risks of falls, hospitalization, postoperative complications, institutionalization, disability, prolonged recovery, and mortality. Importantly, frailty can be dynamic and may be reversible or modifiable, particularly in its earlier stages, with appropriate interventions.

Assessment and screening tools include the Clinical Frailty Scale, the FRAIL questionnaire, Tilburg Frailty Indicator, and comprehensive geriatric assessment to guide management and planning. Management is multidisciplinary and person-centered, aiming to optimize function and quality of life. Key components include tailored exercise programs (aerobic and resistance training), nutritional optimization, careful polypharmacy review, management of comorbidities, falls prevention, social support, vaccination, and aligned goals of care.