Frailty syndrome - Knowledge

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person is severely frail and terminally ill. This scale is an efficient way to measure a persons frailty level and can be used in clinics relatively quickly. The nine-point system breaks down into the following categories: 1-point: Very fit; this person is very fit for their age. 2-points: Well; This person has no serious health problems and is slightly less fit than category 1, with moderate or seasonal physical activity. 3-points: Managing Well; This person has health problems which are under control, but is not very physically active. 4-points: Living with Very Mild Frailty; This person is limited by their health conditions but does not need help carrying out daily activities. 5-points: Living with Mild Frailty; This person moves more slowly than category 4 and requires some help with difficult daily living activities. 6-points: Living with Moderate Frailty; This person needs help with all activities outside of the home. 7-points; Living with Severe Frailty; This person is completely dependent for help in mental and physical regions of care. This person is stable and not likely to fall terminally ill in the next 6 months. 8-points: Living with Very Severe Frailty; This person is completely dependent and is nearing the end of life, recovery from minor illnesses would be difficult for this person. 9-points: Terminally Ill; This person is at the end of life with a life expectancy of less than six months, this category falls under all who are terminally ill, this person may be someone able to exercise regularly who may or may not be frail.

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also in the underlying pathophysiology. Studies have found that incidence of frailty was related to comorbidities. One study found incidences of frailty was higher in female older adults who also happened to have higher incidences of comorbidities. In recent research where muscle-biopsies were taken from fit and weak older adults of both sexes, it was shown that there were sex-specific alterations in muscle content in association with frailty-related physical weakness. In other words, studied found differences in frailty between male and female older adults through examinations of muscles. Incidence of symptoms also differed between sexes with sarcopenia being more common in male older adults while osteoporosis more common in female older adults. These findings indicate the male-female health-survival paradox, since the lifespan of females is longer compared to males, yet the prevalence of frailty is higher in females compared to males. Future research has yet to reveal where the origin of the higher prevalence of frailty in females can be found.

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cytokine, IL-6 was found to be common in older adults with frailty. IL-6 is typically up-regulated by inflammatory mediators, such as C-reactive protein, released in the presence of chronic disease. Increased levels of inflammatory mediators is often associated with chronic disease; however, previous studies have shown levels to be elevated even in the absence of chronic disease. Sarcopenia, anemia, anabolic hormone deficiencies, and excess exposure to catabolic hormones such as stress (cortisol) have been associated with an increased likelihood of frailty. Some other mechanisms associated with frailty include insulin resistance, increased glucose levels, compromised immune function, micronutrient deficiencies, and oxidative stress.

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frailty increases with age and with the incidence of diseases. Beyond that, there is now strong evidence to support the theory that the development of frailty involves declines in energy production, energy utilization and repair systems in the body, resulting in declines in the function of many different physiological systems. This decline in multiple systems affects the normal complex adaptive behavior that is essential to health and eventually results in frailty typically manifesting as a syndrome of a constellation of weakness, slowness, reduced activity, low energy and unintended weight loss. When most severe, i.e. when 3 or more of these manifestations are present, the individual is at a high risk of death.

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suggested that frailty scales can be used in preoperative assessments for patient at risk of the syndrome. However, other studies make note that the various different frailty scales can create complications predicting accurate outcomes for individuals undergoing surgical procedures. Neither of the scales listed previously consider both co-morbid conditions as well as signs of frailty, such as weight loss, at the same time. Both of these situations are relevant in determining the presence of frailty in an individual. This suggests that predicting the frailty outcomes of individuals undergoing surgery should not be fully based on frailty scales with limitations, but a multitude of factors needs to be considered.

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person has is given a point and the more deficits the person is experiencing the more likely they are frail or will experience frailty in the future. To calculate the score, you take the total number of deficits counted, and divide that number by thirty-six. Then, a frailty category is assigned to four groups with the cutoffs going as follows: A person with a score of 0.00–0.12 is in the "Fit" category. A person with a score of 0.13–0.24 is in the "Mild" category. A person with a score of 0.25–0.36 is in the "Moderate" category. Finally, a person with the score of 0.36 and above is considered to be in the "Severe" category.

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syndrome. Therefore, exercise regimens consisting of walking, strength training, and self-directed physical activity, have been examined in a number of studies as an intervention to prevent frailty. A randomized control trial published in 2017 found significantly lower rates of frailty in older adults who were assigned an exercise regimen vs those who were in the control group. In this study, 15.3% of the control group became frail in the time frame of the study, in comparison to 4.9% of the exercise group. The exercise group also received a nutritional assessment, which is another target in frailty prevention.

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skeletal muscle mass or bone mineral density can lead to frailty and have both been identified as contributors to disability and frailty. The development of Sarcopenia or Osteoporosis alone do not establish frailty automatically in patients, as there are many factors that are taken into account during the assessment of frailty. Studies suggest that frailty is a result of multiple body systems experiencing dysregulation, and the more body systems that begin to develop dysregulation, the higher the risk is for developing frailty.

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phenotype framework proposed by Fried et al. (2001), prevalence estimates of 7–16% have been reported in non-institutionalized, community-dwelling older adults. In a systemic review exploring the prevalence of frailty based on geographical location it was found that on the basis of physical frailty, Africa and America had the largest prevalence at 22% and 17% respectively. On the other end, Europe had the lowest prevalence at 8%. This data was taken from individuals over the age of 50 years old.

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frailty (see Rockwood, Andrew, and Mitnitski, 2007, for a contrast of the two approaches). This approach was developed by Dr. Rockwood and colleagues at Dalhousie University. This index scores people on measurements of frailty by giving them a zero out of one score if they do not possess that physical deficit, a one out of one if they do possess the deficit, or a fraction of a score if they possess the deficit to some degree.

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diagnosed; there are a combination of signs and symptoms that can lead to a diagnosis of frailty. Evaluations can be done on physical staus, weight fluctuations, or subjective symptoms. Frailty most commonly refers to physical status and is not a syndrome of mental capacity such as dementia, which is a decline in cognitive function. Although, frailty can be a risk factor for the development of

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plan to ensure patient compliance, leading to better health outcomes. In clinical practice, guidelines developed by International Conference on Frailty and Sarcopenia Research (ICFSR) can be used to identify and manage frailty based on classification. The recommendations are also labeled based on low, medium, or high certainty of evidence-based literature.

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development of a frailty model, finding even predictive capability across 3 outcomes of care. In the care home setting, one study indicated that not all four domains of frailty were routinely assessed in residents, giving evidence to suggest that frailty may still primarily be viewed only in terms of physical health.

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Overall, understanding what factors lead to frailty can help individuals, health care professionals, and public health officials identify preventative measures to combat that causes. Due to the impacts on the health and well-being of individuals living with frailty, steps taken to prevent and control

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Nutrition has also been a major target in the prevention of frailty. A healthy dietary pattern consisting of high consumption of healthy fats, fruits, vegetables, low-fat dairy products, and whole grains can contribute to maintaining a healthy weight and postpone frailty. A 2019 review paper examined

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As frailty arises as a result of reduced reserve capacity in a biological system and causes an individual to have heightened vulnerability to stress, avoiding known stressors (ie. surgeries, infections, etc.) and understanding mechanisms to reduce frailty can help older adults prevent worsening their

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Frailty management largely depends on an individual's classification (i.e. non-frail, pre-fail, and frail) and treatment needs. Currently, there is a lack of strong evidence-based treatment and management plans for frailty. Physicians must work closely with patients to develop a realistic management

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These five dimensions form specific criteria indicating adverse functioning, which are implemented using a combination of self-reported and performance-based measures. Those who meet at least three of the criteria are defined as "frail", while those not matching any of the five criteria are defined

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Researchers found that individual abnormal body functions may not be the best predictor of risk of frailty. However, they did conclude that once the number of conditions reaches a certain threshold, the risk of frailty increases. This finding suggests that treatment of frailty syndrome should not be

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People who had mental disorders were found to have frailty more often than people who did not have those disorders. Under the age of 60, these patterns are the most noticeable, and above the age of 60 years old these differences narrow down, although there is still some noticeable difference between

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Frailty can have impacts on public health due to the factors that comprise the syndrome affecting physical and mental health outcomes. There are several ways to identify, prevent, and mitigate the prevalence of frailty and the evaluation of frailty can be done through clinical assessments created to

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is a common and clinically significant grouping of symptoms that occurs in aging and older adults. These symptoms can include decreased physical abilities such as walking, excessive fatigue, and weight and muscle loss leading to declined physical status. In addition, frailty encompasses a decline in

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An individual without one of these conditions would be given a score of 0 for the condition absent. An individual who does have one of the conditions would be given a score of 1 for each of the conditions present. In an initial study using the mFI-5 scale, individuals with a sum mFI-5 score of 2 or

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may be helpful for individuals who are experiencing an advanced state of frailty with possible other co-morbidities. Improving quality of life by reducing pain and other harmful symptoms is the goal with palliative care. One study showed the cost reduction by focusing on palliative care rather

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As discussed previously, exercise is one of the major targets to prevent and manage frailty in older adults to improve and maintain mobility. Individuals partaking in exercise appear to have potential in preventing frailty. In 2018, a systemic review concluded that group exercise had the benefit of

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In addition, there is currently no FDA-approved pharmacological intervention for frailty as there is insufficient evidence demonstrating the effectiveness of a medication on improving frailty. Moreover, frailty does not qualify as an acceptable condition for pharmacological intervention by the Food

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The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. Generally speaking, the empirical assessment of geriatric

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can be identified. Such etiology depends on the type of muscle weakness, which can be true or perceived as well as variable topically. True weakness is substantial, while perceived rather is a sensation of having to put more effort to do the same task. On the other hand, various topic locations for

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Based on the clinical frailty scale, those living with mild frailty to very severe frailty require partial to complete dependence on aid for daily tasks and personal care. A study done, comparing case management trials to standard care for people living with frailty in high-income countries, found

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As noted, these frailty scales can be used to predict the risk of frailty in patients before and after surgery. One study examines frailty risk in patients post-kidney transplant. Researchers found there is an association between patients with frailty and kidney transplant recipients. This finding

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The electronic Frail Scale (eFI) is a scale weighted out of 36 deficit points where the higher the number in the score will represent the more frail, or more prone to experience frailty the person is. This scale works similar to other scales mentioned before, where each frailty-related deficit the

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Another notable approach to the assessment of geriatric frailty (if not also to some degree its conceptualization) is that of Rockwood and Mitnitski (2007) in which frailty is viewed in terms of the number of health "deficits" that are manifest in the individual, leading to a continuous measure of

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Recent work on frailty has sought to characterize both the underlying changes in the body and the manifestations that make frailty recognizable. It is well-agreed upon that declines in physiologic reserves and resilience is the essence of being frail. Similarly, scientists agree that the risk of

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Meta-analyses have shown that the prevalence of frailty is higher in female older adults, compared to male older adults. This sex difference was consistently found in pre-clinical research models as well, indicating a conserved sexual dimorphism in the onset of frailty across species, and perhaps

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A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled

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in those people with diabetes. On the one hand, chronic lower limb ischemia may predispose to the development of frailty, on the other hand, the presence of the frailty may affect the prognosis in patients with peripheral arterial disease. In addition, there is a correlation between a history of

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Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Frailty more than doubles the risk of morbidity and mortality from surgery and cardiovascular conditions. Assessment of older patients before elective surgeries can accurately predict the

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Frailty refers to an age-related functional decline and heightened state of vulnerability. It is a worsening of functional status compared to the normal physiological process of aging. It can refer to the combination of a decline of physical and physiological aspects of a human body. The reduced

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Advances about potentially modifiable risk factors for frailty now offer the basis for translational research effort aimed at prevention and treatment of frailty in older adults. Epidemiologic research to date has led to the identification of a number of risk factors for frailty, including: (a)

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A significant target in the prevention of frailty is physical activity. As people age, physical activity markedly drops, with the steepest declines seen in adolescence and continuing on throughout life. The lower levels of physical activity and are associated with and a key component of frailty

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The Clinical Frailty Scale (CFS) is a scale used to assess frailty which was evolved from the Canadian Study of Health and Aging. It is a 9-point scale used to assess a persons frailty level, where a score of 1 point would mean a person is very fit and robust, to a score of 9 points meaning the

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In regards to mental health, there has been shown to be an association between severe mental health conditions and the development of frailty. There is an understanding that mental health can have an impact on the development of multiple comorbidities and increased mortality. This intersection

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The Edmonton Frail Scale (EFS) is another method used to screen frailty. This scale is given scores of up to 17 points. It has been assessed to screen all domains of frailty, and is said to be easy to perform by clinicians. Specific tests used in this scaling system are walking tests and clock

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Decreases in skeletal muscle mass and/or bone density are two major contributors to developing frailty in older adults. In early to middle age, bone density and muscle mass are closely related. As adults progress in age, one or both of these factors may begin to decline. This decline in either

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is associated with increased risk of heart disease, falls, hospitalization, and death. In addition, it has been shown that adults living with frailty face more anxiety and depression symptoms than those who do not. The presence of frailty varies based on the assessment technique, however it is

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countries using data from twelve randomized clinical trials found evidence that mobility training can increase mobility level and functioning in older adults living in community-dwellings, such as a nursing home. However, the review also concluded little to no difference in the risk of falls.

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Individualized physical therapy programs developed by physicians can help improve frail status. For example, progressive resistance strength training for older adults can be used in clinical practice or at-home as a way to regain mobility. A systematic review conducted in 2022 across multiple

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A model consisting of four domains of frailty was proposed in response to an article in the BMJ. This conceptualisation could be viewed as blending the phenotypic and index models. Researchers tested this model for signal in routinely collected hospital data, and then used this signal in the

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It has been suggested that the causes of frailty are multifactorial involving dysregulation across many physiological systems. An example of dysregulation across a physiological system may include a proinflammatory state. A common interleukin elevated in this state is IL-6. A pro-inflammatory

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Frailty syndrome has shown differences in incidence outside of just sex. One study on racial and ethnic variations in frailty found that non-Hispanic Black-Americans and Hispanic-Americans have a higher incidence of frailty compared to non-Hispanic White-Americans. More research is needed in

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in older populations may vary according to a number of factors, including the setting in which the prevalence is being estimated — e.g., nursing home (higher prevalence) vs. community (lower prevalence) — and the operational definition used for defining frailty. Using the widely used frailty

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Older age by itself is not what defines frailty, it is however a syndrome found in older adults. Many adults over 65 are not living with frailty. Frailty is not one specific disease, however is a combination of many factors. Frailty does not have a specific universal criteria on which it is

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Frailty is also common in people who have experienced Heart Failure before. Both frailty and heart failure share similar methods of progressive health decline and often lead to worsened health conditions when combined. Frailty is a common condition in older people with heart failure.

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frail status. Some signs of frailty include: unwanted weight loss, muscle weakness, low energy, and low grip strength. Currently, preventative interventions focus on minimizing muscle loss and improvement of overall well-being in older adults or individuals with chronic illnesses.

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Frailty can involve changes such as weight loss. Interventions should focus on any difficulties with supplementation and diet. For those who may be undernourished and not acquiring adequate calories, oral nutritional supplements in between meals may decrease nutritional deficits.

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When considering prevention of frailty, it is important to understand the risk factors that contribute to frailty and identify them early on. Early identification of risk factors allows for preventative interventions, reducing risks of future complications.

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Kravvariti E, Ntouros PA, Vlachogiannis NI, Pappa M, Souliotis VL, Sfikakis PP (March 2023). "Geriatric Frailty Is Associated With Oxidative Stress, Accumulation, and Defective Repair of DNA Double-Strand Breaks Independently of Age and Comorbidities".

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Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. (November 2002). "Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study".

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reserve capacity of organ systems, muscle, and bone create a state where the body is not capable of coping with stressors such as illness or falls. Frailty can lead to increased risk of adverse side effects, complications, and mortality.

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Weaver DJ, Malik AT, Jain N, Yu E, Kim J, Khan SN (April 2019). "The Modified 5-Item Frailty Index: A Concise and Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity Following Elective Posterior Lumbar Fusions".

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Ferrucci L, Penninx BW, Volpato S, Harris TB, Bandeen-Roche K, Balfour J, et al. (December 2002). "Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels".

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nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.

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mass, quality, and strength associated with aging. The rate of muscle loss is dependent on exercise level, co-morbidities, nutrition and other factors. Sarcopenia can lead to reduction in functional status and cause significant

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A popular approach to the assessment of geriatric frailty encompasses the assessment of five dimensions that are hypothesized to reflect systems whose impaired regulation underlies the syndrome. These five dimensions are:

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muscle weakness are central, neural and peripheral. Central muscle weakness is an overall exhaustion of the whole body, while peripheral weakness is an exhaustion of individual muscles. Neural weakness is somewhere between.

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Awareness of the causes and prevalence of frailty can aid in the path of treatment. Epidemiologic data can have a potential impact of future incidence rates of frailty among older adults as the treatment landscape adapts.

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O'Caoimh R, Sezgin D, O'Donovan MR, Molloy DW, Clegg A, Rockwood K, et al. (January 2021). "Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies".

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The SHARE-Frailty Index (SHARE-FI) was originally developed by Romero-Ortuno (2010) and researchers as part of the Survey of Healthy Ageing and Retirement in Europe. It consists of five domains of the frailty phenotype:

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from increased weakness. The muscle loss is related to changes in muscle synthesis signalling pathways although is incompletely understood. The cellular mechanisms are distinct from other types of muscle atrophy such as

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frailty in individuals seeks ultimately to capture this or related features, though distinct approaches to such assessment have been developed in the literature (see de Vries et al., 2011 for a comprehensive review).

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between frailty and mental health can have a combined impact on the life expectancy of individuals living with both. Mental health treatment has the potential to improve population health with its link to frailty.

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analyzing the differences in incidence of frailty syndrome in other social aspects of society. Such studies have importance in highlighting the disparities in health and the changes needed to solve these issues.

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and a decrease in activity, such as after a long bout of bedrest as a result of an illness. There is also a gradual onset of muscle weakness as a result of sarcopenia — the age-related loss of skeletal muscle.

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De Coninck L, Bekkering GE, Bouckaert L, Declercq A, Graff MJ, Aertgeerts B (August 2017). "Home- and Community-Based Occupational Therapy Improves Functioning in Frail Older People: A Systematic Review".

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the two. The proposed reason is that frailty is a condition that involves a decrease in reserve capacity, and having certain disorders can decrease this reserve over time and eventually lead to frailty.

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A recent systematic review found that exercise interventions can increase muscle strength and improve physical function; however, results are inconsistent in frail older adults living in the community.

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The development of frailty occurs most often in individuals with low socio-economic status, those living with obesity, female sex, a history of smoking, limited activity levels, and older age.

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et al. (2006), though some of the exact criteria and measures differ (see Table 1 in the paper for this contrast). Other studies in the literature have also adopted the general approach of

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A 2005 observational study found associations between frailty and a number of risk factors such as: low income, advanced age, chronic medical conditions, lack of education, and smoking.

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Cadore EL, Sáez de Asteasu ML, Izquierdo M (July 2019). "Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization".

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de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW (January 2011). "Outcome instruments to measure frailty: a systematic review".

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Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP (June 2005). "The association between obesity and the frailty syndrome in older women: the Women's Health and Aging Studies".

2816:"Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017" 3729:

Garonzik-Wang JM, Govindan P, Grinnan JW, Liu M, Ali HM, Chakraborty A, et al. (February 2012). "Frailty and delayed graft function in kidney transplant recipients".

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a variety of studies and found evidence of nutritional intervention as an effective way of preventing frailty. Specifically, multiple studies showed adherence to the

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Newman AB, Gottdiener JS, Mcburnie MA, Hirsch CH, Kop WJ, Tracy R, et al. (March 2001). "Associations of subclinical cardiovascular disease with frailty".

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Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. (June 2010). "Frailty as a predictor of surgical outcomes in older patients".

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Another tool that has been used to predict frailty outcome post-surgery is the Modifies Frailty Index, or mFI-5. This scale consists of 5 key co-morbidities:

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Nascimento CM, Ingles M, Salvador-Pascual A, Cominetti MR, Gomez-Cabrera MC, Viña J (February 2019). "Sarcopenia, frailty and their prevention by exercise".

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WHO Clinical Consortium on Healthy Ageing: Topic focus: frailty and intrinsic capacity: Report of consortium meeting 1–2 December 2016 in Geneva, Switzerland

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Garcia-Garcia FJ, Gutierrez Avila G, Alfaro-Acha A, Amor Andres MS, De Los Angeles De La Torre Lanza M, Escribano Aparicio MV, et al. (December 2011).

3097:"Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial" 4333:"Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS)" 4051:"Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study" 757:

syndrome. Due to the nature of not having international criteria to diagnose frailty, the prevalence estimates may not be accurate. Estimates of frailty

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Ní Mhaoláin AM, Fan CW, Romero-Ortuno R, Cogan L, Cunningham C, Kenny RA, et al. (August 2012). "Frailty, depression, and anxiety in later life".

3861:"Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing" 841:

the use of "pre-habilitation," an exercise regimen used before transplant surgery, to prevent the frailty effects of kidney transplant in recipients

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Gordon EH, Peel NM, Samanta M, Theou O, Howlett SE, Hubbard RE (March 2017). "Sex differences in frailty: A systematic review and meta-analysis".

4141:"Frailty and impaired cardiac autonomic control: new insights from principal components aggregation of traditional heart rate variability indices" 4881:

for "Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS): A New Horizon for Surgical Critical Care and Induced Frailty" at

167:(BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the 1721:"Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women's Health and Aging Studies I and II" 4793:"Dissecting the Racial/Ethnic Disparity in Frailty in a Nationally Representative Cohort Study with Respect to Health, Income, and Measurement" 647:(ADLs) include activities that are necessary to sustain life. Examples are brushing teeth, getting out of bed, dressing oneself, bathing, etc. 403:

from frail older individuals to such cells from healthy younger individuals showed evidence in the frail older individuals of increased

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The SHARE-FI has good clinical utility as it provides relatively quick assessment of frailty in often time-poor healthcare settings.

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both overall physical function and physiologic reserve of organ systems resulting in worse health outcomes for this population. This

1536:"Nonlinear multisystem physiological dysregulation associated with frailty in older women: implications for etiology and treatment" 3511:

Montero-Odasso M, Duque G (June 2005). "Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone".

2641:"What do care home managers believe constitutes an 'assessment for frailty' of care home residents in North-West London? A survey" 4917:

for "Physical Performance Testing and Frailty in Prediction of Early Postoperative Course After Cardiac Surgery (Cardiostep)" at

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Treacy D, Hassett L, Schurr K, Fairhall NJ, Cameron ID, Sherrington C, et al. (Cochrane Musculoskeletal Group) (June 2022).

777:, depression, and cognitive impairment; (b) physiologic impairments, such as activation of inflammation and coagulation systems, 741:

greater were predicted to experience post-surgery complications due to frailty, which was supported by the results of the study.

1312:"Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People" 902:"Guidelines on Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care". 292: 4468:"Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality" 1480:"Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality" 1402:"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group". 264: 194:

It may also develop in men. Osteoporosis may also occur in anyone in the presence of particular hormonal disorders and other

4292:"Life-space constriction, development of frailty, and the competing risk of mortality: the Women's Health And Aging Study I" 3961:"Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalized frail oldest old" 1013: 4049:

Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. (Cardiovascular Health Study) (November 2002).

1817:"Multiple hormonal deficiencies in anabolic hormones are found in frail older women: the Women's Health and Aging studies" 203: 2148:"Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty" 271: 858:

Physical Performance Testing and Frailty in Prediction of Early Postoperative Course After Cardiac Surgery (Cardiostep)

2963:"Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study" 441:

Two most widely used approaches, different in their nature and scopes, are discussed below. Other approaches follow.

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Casas-Herrero A, Cadore EL, Zambom-Ferraresi F, Idoate F, Millor N, Martínez-Ramirez A, et al. (October 2013).

3322:"Effectiveness of interventions to prevent pre-frailty and frailty progression in older adults: a systematic review" 2692:"A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)" 412: 176: 278: 387:

focused on a single condition, but a multitude in order to increase the likelihood of better treatment results.

327:(or lack of strength), also known as muscle fatigue, refers to the inability to exert force with one's skeletal 4742:"Evidence for sex-specific intramuscular changes associated to physical weakness in adults older than 75 years" 4010:"Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care" 3670: 249: 4092:"Physiological complexity underlying heart rate dynamics and frailty status in community-dwelling older women" 1997:"Thyroid autoantibodies are associated with a reduced prevalence of frailty in community-dwelling older women" 903: 4899:

for "Alleviation by Fisetin of Frailty, Inflammation, and Related Measures in Older Adults (AFFIRM-LITE)" at

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de Jong JC, Verschuren L, Caspers MP, van der Hoek MD, van der Leij FR, Kleemann R, et al. (July 2023).

260: 206:(SIOP or GIOP). Given its influence in the risk of fragility fracture, osteoporosis may significantly affect 1359:

Peterson SJ, Mozer M (February 2017). "Differentiating Sarcopenia and Cachexia Among Patients With Cancer".

4382:"Chronic Lower Extremity Ischemia and Its Association with the Frailty Syndrome in Patients with Diabetes" 3920:"The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging" 1431:"Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management" 809:

that there was no difference in reducing cost or improving patient outcomes between the two approaches.

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Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al. (2019-11-01).

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for "Frailty and Physician Modified Fenestrated Endograft for Thoracoabdominal Aortic Pathologies" at

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Shardell M, Hicks GE, Miller RR, Kritchevsky S, Andersen D, Bandinelli S, et al. (January 2009).

3273:"Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management" 526:

The SHARE-FI calculator is freely available to use online. The calculator classifies individuals as:

2741: 168: 3320:

Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, et al. (January 2018).

33: 4331:

Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, et al. (November 2014).

238: 1310:

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. (July 2010).

4090:

Chaves PH, Varadhan R, Lipsitz LA, Stein PK, Windham BG, Tian J, et al. (September 2008).

1907:"Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study" 914: 774: 671:

supplementation may provide the benefits of improving stability and muscle strength retention.

343:

Muscle weakness makes it difficult to perform everyday activities, like getting into a bathtub.

2961:

Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. (August 2005).

2093:

Semba RD, Ferrucci L, Sun K, Walston J, Varadhan R, Guralnik JM, et al. (December 2007).

789:

in men, and environment-related factors such as life space and neighborhood characteristics.

285: 2592:"Developing and validating a risk prediction model for acute care based on frailty syndromes" 2369:

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. (March 2001).

838:

the impact of frailty on clinical outcomes of patients treated for abdominal aortic aneurysms

796:

A review looked at the relationship between the frailty syndrome and chronic lower extremity

4517:

Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, et al. (May 2023).

1719:

Chaves PH, Semba RD, Leng SX, Woodman RC, Ferrucci L, Guralnik JM, et al. (June 2005).

1534:

Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, et al. (October 2009).

4953: 3872: 3220:

Ni Lochlainn M, Cox NJ, Wilson T, Hayhoe RP, Ramsay SE, Granic A, et al. (July 2021).

2323:"The frailty phenotype and the frailty index: different instruments for different purposes" 983: 786: 648: 164: 4863:

for "Structured Program of Exercise for Recipients of Kidney Transplantation (SPaRKT)" at

4139:

Varadhan R, Chaves PH, Lipsitz LA, Stein PK, Tian J, Windham BG, et al. (June 2009).

3587:

Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. (March 2014).

8: 4948: 3546:

Manfredi PL, Morrison RS, Morris J, Goldhirsch SL, Carter JM, Meier DE (September 2000).

2814:

Walsh B, Fogg C, Harris S, Roderick P, de Lusignan S, England T, et al. (May 2023).

2198: 2143: 472: 4768: 4741: 4543: 4519:"Case management for integrated care of older people with frailty in community settings" 4518: 3876: 3371:"Mobility training for increasing mobility and functioning in older people with frailty" 3065: 2840: 2815: 2541:

Soong J, Poots AJ, Scott S, Donald K, Woodcock T, Lovett D, et al. (October 2015).

1905:

Barzilay JI, Blaum C, Moore T, Xue QL, Hirsch CH, Walston JD, et al. (April 2007).

4918: 4900: 4882: 4864: 4846: 4817: 4792: 4791:

Usher T, Buta B, Thorpe RJ, Huang J, Samuel LJ, Kasper JD, et al. (January 2021).

4591: 4494: 4467: 4408: 4381: 4357: 4332: 4267: 4242: 4223: 4165: 4140: 4116: 4091: 3985: 3960: 3895: 3860: 3790: 3766:"Frailty Is Associated With Adverse Postoperative Outcomes After Lung Cancer Resection" 3765: 3613: 3588: 3488: 3463: 3444: 3395: 3370: 3346: 3321: 3297: 3272: 3248: 3221: 3202: 3077: 2990: 2938: 2913: 2889: 2864: 2791: 2766: 2718: 2691: 2667: 2640: 2616: 2591: 2567: 2542: 2303: 2172: 2147: 2119: 2094: 2070: 2045: 2021: 1996: 1972: 1947: 1841: 1816: 1789: 1764: 1696: 1611: 1584: 1560: 1535: 1506: 1479: 1455: 1430: 1384: 1336: 1311: 1287: 1260: 1236: 1211: 1134: 1109: 954: 929: 607: 195: 180: 172: 3652: 3564: 3548:"Palliative care consultations: how do they impact the care of hospitalized patients?" 3547: 2863:

Whitson HE, Cohen HJ, Schmader KE, Morey MC, Kuchel G, Colon-Emeric CS (August 2018).

2496: 928:

Whitson HE, Cohen HJ, Schmader KE, Morey MC, Kuchel G, Colon-Emeric CS (August 2018).

4822: 4773: 4722: 4678: 4637: 4583: 4548: 4499: 4448: 4413: 4362: 4313: 4272: 4215: 4201: 4170: 4121: 4107: 4072: 4031: 3990: 3941: 3900: 3841: 3795: 3746: 3711: 3656: 3618: 3569: 3528: 3493: 3436: 3400: 3351: 3302: 3253: 3206: 3194: 3153: 3118: 3095:

Serra-Prat M, Sist X, Domenich R, Jurado L, Saiz A, Roces A, et al. (May 2017).

3069: 3031: 3026: 3009: 2982: 2978: 2943: 2894: 2845: 2796: 2723: 2672: 2621: 2572: 2516: 2477: 2436: 2392: 2344: 2295: 2260: 2224: 2177: 2124: 2075: 2026: 1995:

Wang GC, Talor MV, Rose NR, Cappola AR, Chiou RB, Weiss C, et al. (March 2010).

1977: 1928: 1887: 1846: 1794: 1742: 1688: 1684: 1652: 1616: 1565: 1511: 1460: 1411: 1388: 1376: 1341: 1292: 1241: 1192: 1139: 1064: 995: 959: 834:

As of September 2021, ongoing clinical trials on frailty syndrome in the US include:

50: 42: 3448: 3081: 2307: 1700: 709:

slowed walking speed, defined as lowest population quartile on 4-minute walking test

4812: 4804: 4763: 4753: 4712: 4699:

Zeidan RS, McElroy T, Rathor L, Martenson MS, Lin Y, Mankowski RT (December 2023).

4668: 4627: 4619: 4595: 4575: 4538: 4534: 4530: 4489: 4479: 4440: 4403: 4393: 4352: 4344: 4303: 4262: 4254: 4205: 4197: 4160: 4152: 4111: 4103: 4062: 4021: 3980: 3972: 3931: 3890: 3880: 3831: 3823: 3785: 3777: 3738: 3703: 3648: 3608: 3600: 3559: 3520: 3483: 3479: 3475: 3428: 3390: 3386: 3382: 3341: 3333: 3292: 3284: 3243: 3233: 3184: 3145: 3108: 3061: 3021: 3010:"Age-related decline in physical activity: a synthesis of human and animal studies" 2994: 2974: 2933: 2925: 2884: 2876: 2835: 2827: 2786: 2778: 2713: 2703: 2662: 2652: 2611: 2603: 2562: 2554: 2508: 2467: 2426: 2382: 2334: 2287: 2252: 2214: 2167: 2159: 2114: 2106: 2065: 2057: 2016: 2008: 1967: 1959: 1918: 1877: 1836: 1828: 1784: 1776: 1732: 1680: 1644: 1606: 1596: 1555: 1547: 1501: 1491: 1450: 1442: 1368: 1331: 1323: 1282: 1272: 1231: 1223: 1129: 1121: 1054: 1046: 949: 941: 910: 404: 4913: 4895: 4877: 4859: 4841: 4227: 3917: 2201:, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, et al. (March 2006). 1864:

Varadhan R, Walston J, Cappola AR, Carlson MC, Wand GS, Fried LP (February 2008).

1108:

Xue QL, Tian J, Walston JD, Chaves PH, Newman AB, Bandeen-Roche K (January 2020).

733:

Individuals needing additional assistance to perform everyday activities of living

4067: 4050: 3885: 3781: 3337: 2782: 2110: 1648: 679: 324: 211: 207: 119: 72:

estimated that 4-16% of the population over 65 years old is living with frailty.

4717: 4700: 4579: 4243:"Association of low vitamin D levels with the frailty syndrome in men and women" 3464:"Protein and energy supplementation in elderly people at risk from malnutrition" 3189: 3172: 3149: 2607: 2558: 2203:"Phenotype of frailty: characterization in the women's health and aging studies" 712:

low physical activity such that persons would only rarely undertake a short walk

4797: