frailty
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Introduction
A multifactorial state of decreased physiologic reserves & increased vulnerability to stress, including fragility, or weakness in physical or mental health, with decreased reserves in multiple organ systems.
The concept of frailty has extended to include social frailty[47]
Etiology
- secondary to acute event
- hospitalization
- surgery
- immobility
- acute illness
- extreme heat exposure or cold exposure[31]
- end-stage of chronic disease(s)
- risk factors
- older age*
- female gender
- heavier weight at baseline, metabolic syndrome
- general & abdominal obesity during adulthood increases risk of frailty in older age[46]
- lower self-assessed health status
- presence of > 5 illnesses[32]
- osteoarthritis
- cognitive impairment*
- lower education level
- medications[31]
- depression
- hearing loss[33]
- poor oral hygiene[45]
- HIV1 infection[7][39] (largely driven by comorbidities[41])
- predictors of frailty
- sarcopenia
- fatigue (exhaustion)
- multiple contibutory factors stronger predictor than any one factor[7]
- in patients with osteoarthritis, fatigue is the strongest predictor of reduced activity & frailty > weight loss, decreased strength, or diminished walking speed
- idiopathic
* not all elderly are frail[32]
* frailty able to improve with good cognitive function[56]
Epidemiology
- 3-7% of individuals 65-75 years of age[4]
- 20-40% of individuals > 80 years of age
Pathology
- decline in neuromuscular function
- sarcopenia
- decreased grip strength
- osteoporosis
- diminished ability to respond to stress (homeostenosis)
- decline in maximal oxygen consumption[3]
- fatigue, easy exhaustion
- psychomotor slowing
- slow walking speed* if ambulatory
- decline in maximal oxygen consumption[3]
- comorbidities
- 7% of frail elderly have no known comorbidity
- 25% of frail elderly have 1 comorbidity
- > 5 comorbidities is a risk factor[32]
- inflammation may play role
* best predictor of disability, long-term nursing home placement, mortality
History
- activities of daily living[31]
- support system
- alcohol, tobacco, physical activity[31]
Physical examination
- standard exam
- attention to orthostatics, rigidity, muscle strength, vision, hearing
* frailty state likely to decline with poor physical function but able to improve with good cognitive function[56]
Clinical manifestations
- presents with multiple aspects of functional decline[7]
- weight loss, unintentional* (> 10 lbs or 5%) over past year)
- muscle weakness*
- grip strength using hand dynamometer
- fatigue, exhaustion, low energy*
- bradykinesia*
- dyspnea on exertion
- loss of mobility
- gait speed is a useful performance measure[14]
- slow walking speed*
- inability to walk 6 meters in < 8 seconds[27]; < 0.8 m/sec[7]
- best predictor of disability, long-term nursing home placement, mortality
- slow walking speed*
- timed get-up & go test is another useful performance measure[7]
- difficulty climbing a flight of stairs*
- difficulty walking one block*
- gait speed is a useful performance measure[14]
- low activity level*
- anorexia
- >= 5 illnesses*
- develops in slow, stepwise process[4]
* any 3 of criteria define frailty[7][16]
* different sources provide different criteria
* fatigue predicts low activity level[7]
* also see frailty score[16]
* no gold standard for screening for frailty in clinical practice[7]
Laboratory
- serum 25-hydroxyvitamin D:[7][19][20]
- both low & high levels associated with increased likelihood of frailty
- high serum IL6 is common[12]
- high serum cortisol may play a role[12]
- as indicated[31]
- low serum creatinine is associated with sarcopenia & frailty[49]
- serum cystatin C/creatine ratio more accurately assesses renal function (not directly affected by muscle mass)[65]
- association between Toxoplasma gondii IgG ELISA serointensity & frailty[59]
* frailty state likely to decline with low serum albumin, high serum CRP but able to improve with good cognitive function[56]
Diagnostic procedures
Complications
- inability to perform activities of daily living, fluctuating disability
- recurrent falls
- transient impairment in cerebral oxygenation due to impaired diastolic BP recovery at 30 seconds after standing[44]
- diminished mobility
- spiraling decline in vitality, diminished quality of life[32]
- delirium is common
- increased risk of mild cognitive impairment & dementia[29]
- hospitalization
- increased risk for hospitalization[32]
- longer hospital stay[32]
- has not been associated with nursing home placement (GRS)[7]
- increased likelihood of discharge to skilled nursing facility (MKSAP)[32]
- frailty predicts higher 30 day mortality, longer hospital stay, & 30-day emergency department visits in hospitalized elderly[7]
- not associated with increased length of hospital stay[7]
- frail patients unlikely to survive to hospital discharge following in-hospital cardiopulmonary arrest[28]
- no benefit for routine PCI after NSTEMI in frail elderly[54]
- common among hospitalized elderly with community-acquired pneumonia[58]
- associated with increased mortality, longer hospitalization, & duration of antibiotic therapy[58]
- frailty predicts postoperative complications (see frailty score)[7]
- even low-risk procedures are hazardous for frail patients[50]
- excess risk of death
- frailty is associated with excess risk for postoperative mortality after elective surgery[13]
- RR = 36 in the first few postoperative days
- RR = 2.0 at 90 days
- excess risk for 1 year postoperative mortality after specific surgeries:
- total knee replacement, 4% vs 1%
- total hip replacement, 9% vs 2%
- large bowel surgery, 21% vs 10%
- peripheral artery bypass, 24% vs 12%
- esophagectomy or gastrectomy, 43% vs 21%
- frailty is associated with excess risk for postoperative mortality after elective surgery[13]
- disease interaction(s) of atrial fibrillation with frailty
- disease interaction(s) of metabolic syndrome with frailty
- disease interaction(s) of hypertension with frailty
Management
- exercise may be of benefit[9][25]
- multicomponent exercise with a resistance-based training component is associated with improved physical function (muscle strength, balance) & better health outcomes (less disability, fewwer falls) in frail elderly (GRS11)[7]
- multicomponent exercise consisting of balance, flexibility, resistance training & aerobic activity is more effective than resistance training or aerobic exercise alone (GRS9)[7]
- resistance training
- aerobic exercise
- adherence to exercise is high, risk of adverse events low (GRS9)[7]
- higher intensity exercise feasible, but effects similar to lower intensity exercise (GRS9)[7]
- frail elderly may benefit from a moderate-intensity exercise[25]
- exercise continued for > 5 months results in greater benefits (GRS9)[7]
- stretching
- tai chi[4]
- yoga may benefit frail elderly but may not offer benefit over exercise[55]
- minimize polypharmacy[31]
- risks of anticoagulation for atrial fibrillation in demented frail elderly may exceed benefits[52]
- treat depression[31]
- frailty able to improve with good cognitive function[56]
- hormone replacement of little benefit
- testosterone replacement may benefit elderly men with low serum testosterone
- growth hormone of no benefit
- DHEA of no benefit
- calcium & vitamin D may improve sarcopenia (if vitamin D deficiency)[37]
- zinc supplementation (10-21 mg/day) may reduce risk of impaired lower-extremity function & frailty among community-dwelling older adults[35]
- no proven role of antioxidants
- if frailty associated with sarcopenia, an increase in high-quality protein + calories of benefit[7]
- formerly, caloric intake &/or increased protein intake of no benefit[7]
- increased consumption of fruits & vegetables reduces later life frailty in middle-age African Americans[7]
- adherence to a Mediterranean-style diet & higher total carotenoid intake may delay or prevent later life frailty, especially in adults < 60 years[42]
- in elderly (mean age 84 years) better quality diet is inversely associated with incidence of frailty[61]
- exercise & nutritional intervention improves physical function in prefrail elderly[42]
- positive attitude attenuates physical & mental decline associated with frailty[4]
Hospitalization & Surgery
- frailty assessment & frailty score for hospitalized elderly
- frail elderly benefit the most from intensive physical cardiac rehabilitation after hospitalization for acute heart failure[53]
- Hospital Elder Life Program (HELP) may be of benefit in reducing risk of postoperative frailty
- in-hospital multicomponent intervention targeted to frailty is safe & improves health-related quality of life[57]
- surgery:
- preoperative evalution with a frailty score >= 42 resulting in surgeons re-evaluating the benefits of elective surgery &, if continuing, to engaging in frailty-informed shared decision lowers postoperative mortality[51]
prognosis
- whether or no it may be possible to reverse frailty, may depend on how frailty is assessed[60]
- it may be possible to improve a severely frail state to a pre-frail or mildly frail stat[60]
- frailty by itself is not considered a hospice diagnosis[63]
Notes
- also see frailty score[16]
- no gold standard in screening for frailty[7]
- electronic frailty tools not useful for primary care-based population screening[62]
More general terms
More specific terms
Additional terms
- frailty score; FRAIL scale, frailty index, Edmonton Frail Scale
- Hospital Elder Life Program (HELP)
- osteoporosis
- prefrailty
- sarcopenia
References
- ↑ http://www.freedictionary.org
- ↑ Hirsch, Calvin, UC Davis grand rounds, Sept 14, 2006
- ↑ 3.0 3.1 Hollenberg M, Yang J, Haight TJ, Tager IB. Longitudinal changes in aerobic capacity: implications for concepts of aging. J Gerontol A Biol Sci Med Sci. 2006 Aug;61(8):851-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16912104
- ↑ 4.0 4.1 4.2 4.3 4.4 Ahmed N et al, Frailty: An emerging geriatrics syndrome Am J Med 2007, 120:748 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17765039
- ↑ Morley J et al, Frailty and hormones Rev Endocr Metab Disord 2005, 6:101 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15843881
- ↑ Ensrud KE et al. Circulating 25-hydroxyvitamin D levels and frailty status in older women. J Clin Endocrinol Metab 2010 Dec; 95:5266. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21131545
- ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Bandeen-Roche K, Xue QL et al Phenotype of frailty: characterization in the women's health and aging studies. J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):262-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16567375
- ↑ 9.0 9.1 Theou O, Stathokostas L, Roland KP et al The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res. 2011 Apr 4;2011:569194. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21584244
- ↑ Beasley JM, LaCroix AZ, Neuhouser ML et al Protein intake and incident frailty in the Women's Health Initiative observational study. J Am Geriatr Soc. 2010 Jun;58(6):1063-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20487071
- ↑ Kenny AM, Boxer RS, Kleppinger A et al Dehydroepiandrosterone combined with exercise improves muscle strength and physical function in frail older women. J Am Geriatr Soc. 2010 Sep;58(9):1707-14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20863330
- ↑ 12.0 12.1 12.2 Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet. 2013;381:752-762 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23395245
- ↑ 13.0 13.1 McIsaac DI, Bryson GL, van Walraven C. Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery: A Population- Based Cohort Study. JAMA Surg. 2016 Jun 1;151(6):538-45. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26791334
Mosquera C, Spaniolas K, Fitzgerald TL. Impact of frailty on surgical outcomes: The right patient for the right procedure. Surgery. 2016 Aug;160(2):272-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27267548
Panayi AC, Orkaby AR, Sakthivel D et al. Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. Am J Surg. 2019;218(2):393-400 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30509455 PMCID: PMC6536365 Free PMC article https://www.americanjournalofsurgery.com/article/S0002-9610(18)31242-X/fulltext - ↑ 14.0 14.1 Yano Y, Inokuchi T, Kario K. Walking speed is a useful marker of frailty in older persons. JAMA Intern Med. 2013 Feb 25;173(4):325-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23440240
- ↑ Cameron ID, Fairhall N, Langron C et al A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Med. 2013 Mar 11;11:65. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23497404 Free PMC Article
- ↑ 16.0 16.1 16.2 16.3 Shamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Ageing Res Rev. 2013 Mar;12(2):719-36. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22426304
- ↑ Bagshaw SM, Stelfox HT, McDermid RC Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ. 2014 Feb 4;186(2):E95-102. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24277703 Free PMC Article
- ↑ Periyakoil VS. Frailty as a terminal illness. Am Fam Physician. 2013 Sep 15;88(6):363-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24134043 Free PMC Article
- ↑ 19.0 19.1 Shardell M, D'Adamo C, Alley DE et al Serum 25-hydroxyvitamin D, transitions between frailty states, and mortality in older adults: the Invecchiare in Chianti Study. J Am Geriatr Soc. 2012 Feb;60(2):256-64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22283177 Free PMC Article
Shardell M, Hicks GE, Miller RR et al Association of low vitamin D levels with the frailty syndrome in men and women. J Gerontol A Biol Sci Med Sci. 2009 Jan;64(1):69-75. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19164273 Free PMC Article - ↑ 20.0 20.1 Smit E, Crespo CJ, Michael Y et al The effect of vitamin D and frailty on mortality among non- institutionalized US older adults. Eur J Clin Nutr. 2012 Sep;66(9):1024-8. doi:http://dx.doi.org/ 10.1038/ejcn.2012.67. Epub 2012 Jun 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22692022
- ↑ Gaillard C, Alix E, Salle A, Berrut G, Ritz P. Energy requirements in frail elderly people: a review of the literature. Clin Nutr. 2007 Feb;26(1):16-24. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17034905
- ↑ Barberi L, Scicchitano BM, De Rossi M et al Age-dependent alteration in muscle regeneration: the critical role of tissue niche. Biogerontology. 2013 Jun;14(3):273-92. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23666344 Free PMC Article
- ↑ Ho YY, Matteini AM, Beamer B et al Exploring biologically relevant pathways in frailty. J Gerontol A Biol Sci Med Sci. 2011 Sep;66(9):975-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21743092 Free PMC Article
- ↑ Ensrud KE, Ewing SK, Taylor BC, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med. 2008 Feb 25;168 (4):382-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18299493 A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men.
Ensrud KE, Ewing SK, Cawthon PM et al Osteoporotic Fractures in Men Research Group. J Am Geriatr Soc. 2009 Mar;57(3):492-8. Epub 2009 Feb 22. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19245414 Free PMC Article
Identifying Frail Patients in Practice https://www.unmc.edu/patient-safety/_documents/sof-criteria-for-frailty.pdf - ↑ 25.0 25.1 25.2 Trombetti A, Hars M, Hsu FC et al Effect of Physical Activity on Frailty: Secondary Analysis of a Randomized Controlled Trial. Ann Intern Med. 2018. Jan 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29310138 <Internet> http://annals.org/aim/article-abstract/2668215/effect-physical-activity-frailty-secondary-analysis-randomized-controlled-trial
Brown RT, Covinsky KE. Frailty as an Outcome in Geriatrics Research: Not Ready for Prime Time? Ann Intern Med. 2018. Jan 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29310132 <Internet> http://annals.org/aim/article-abstract/2668420/frailty-outcome-geriatrics-research-ready-prime-time - ↑ Gilbert T, Neuburger J, Kraindler J et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: An observational study. Lancet 2018 May 5; 391:1775. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29706364 Free PMC Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30668-8/fulltext
Searle SD, Rockwood K. What proportion of older adults in hospital are frail? Lancet 2018 May 5; 391:1751. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29706363 Free Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30907-3/fulltext - ↑ 27.0 27.1 Odden MC et al. Rethinking the association of high blood pressure with mortality in elderly adults: The impact of frailty. Arch Intern Med 2012 Aug 13/27; 172:1162 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22801930 Free PMC Article
- ↑ 28.0 28.1 Ibitoye SE, Rawlinson S, Cavanagh A et al Frailty status predicts futility of cardiopulmonary resuscitation in older adults. Age and Ageing. June 5, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32500916 https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afaa104/5851510?redirectedFrom=fulltext
- ↑ 29.0 29.1 Meglio M Health-Deficit Accumulation Affects Risk for Mild Cognitive Impairment, Dementia. NeurologyLive. 2020. Nov 17. https://www.neurologylive.com/view/health-deficit-accumulation-affects-chance-of-mild-cognitive-impairment-dementia
- ↑ Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol Med Sci. 2001;56A:M146-M156 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26273019 PMCID: PMC4715230 Free PMC article
- ↑ 31.0 31.1 31.2 31.3 31.4 31.5 31.6 31.7 Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
- ↑ 32.0 32.1 32.2 32.3 32.4 32.5 32.6 32.7 Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021
- ↑ 33.0 33.1 Yevenes-Briones H, Caballero FF, Struijk EA et al Association Between Hearing Loss and Impaired Physical Function, Frailty, and Disability in Older Adults A Cross-sectional Study. JAMA Otolaryngol Head Neck Surg. 2021;147(11):951-958. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34554203 PMCID: PMC8461549 (available on 2022-09-23) https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2784550
- ↑ Callahan KE The future of frailty: Opportunity is knocking. J Am Geriatr Soc. 2021. October 25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34694001 Free PMC article.
- ↑ 35.0 35.1 Vega-Cabello V, Caballero FF, Lana A et al Association of zinc intake with risk of impaired physical function and frailty among older adults. The Journals of Gerontology: 2022. Jan 16. Series A, glac014 PMID: https://www.ncbi.nlm.nih.gov/pubmed/3503411 https://academic.oup.com/biomedgerontology/advance-article-abstract/doi/10.1093/gerona/glac014/6509031
- ↑ Dent E, Morley JE, Cruz-Jentoft AJ et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23(9):771-787 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31641726 PMCID: PMC6800406 Free PMC article https://link.springer.com/article/10.1007/s12603-019-1273-z
- ↑ 37.0 37.1 Ju SY, Lee JY, Kim DH. Low 25-hydroxyvitamin D levels and the risk of frailty syndrome: a systematic review and dose-response meta-analysis. BMC Geriatr. 2018;Sep 4;18(1):206 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30180822 PMCID: PMC6124011 Free PMC article https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-018-0904-2
- ↑ Travers J, Romero-Ortuno R, Bailey J et al. Delaying and reversing frailty: a systematic review of primary care interventions. Br J Gen Pract. 2019;69(678):e61-e69 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30510094 PMCID: PMC6301364 Free PMC article https://bjgp.org/content/69/678/e61
- ↑ 39.0 39.1 Kooij KW, Wit FW, Schouten J et al. HIV infection is independently associated with frailty in middle-aged HIV type 1- infected individuals compared with similar but uninfected controls. AIDS. 2016;30(2):241-250 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26684821 https://journals.lww.com/aidsonline/Fulltext/2016/01140/HIV_infection_is_independently_associated_with.10.aspx
- ↑ Fukui SM, Piggott DA, Erlandson KM. Inflammation strikes again: frailty and HIV. Curr HIV/AIDS Rep. 2018;15(1):20-29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29411315
- ↑ 41.0 41.1 Lellouche L, Gutierrez LA, Leclercq P et al. Frailty in aging people living with HIV: A matched controlled study. J Acquir Immune Defic Syndr 2021 Jul 6; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34238822 https://journals.lww.com/jaids/Abstract/9000/Frailty_in_Aging_People_Living_With_HIV__a_matched.95850.aspx
- ↑ 42.0 42.1 42.2 Liu C, Xu H, Chen L, Zhu M. Exercise and nutritional intervention for physical function of the prefrail: a systematic review and meta-analysis. J Am Med Dir Assoc. 2022 Jun 10;S1525-8610 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35697124 https://www.jamda.com/article/S1525-8610(22)00399-1/fulltext
- ↑ Millar CL, Costa E, Jacques PF, Dufour AB, Kiel DP, Hannan MT, Sahni S. Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: Results from the Framingham Offspring Study. Am J Clin Nutr. 2022 May 12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35551593
- ↑ 44.0 44.1 Perez-Denia L, Claffey P, Byrne L et al Increased multimorbidity is associated with impaired cerebral and peripheral hemodynamic stabilization during active standing. J Am Geriatr Soc. 2022. May 10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35535653 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17810
- ↑ 45.0 45.1 Jiang Z, Liu X, Lu Y Unhealthy oral status contributes to the older patients with cognitive frailty: an analysis based on a 5-year database. BMJ Geriatr. 2022 Dec 19;22(1):980. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36536305 PMCID: PMC9764571 Free PMC article
- ↑ 46.0 46.1 Uchai S, Frost Andersen L, Arnesdatter Hopstock L et al Body mass index, waist circumference and pre-frailty/frailty: the Tromso study 1994-2016 BMJ Open. 2023 13(2):e065707 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36690391 Free article
- ↑ 47.0 47.1 Tumolo J Social Frailty May Affect Nearly 1 in 4 Older Adults Globally. Annals of Long-Term Care. 2023. Feb 1 https://www.hmpgloballearningnetwork.com/site/altc/news/social-frailty-may-affect-nearly-1-4-older-adults-globally - Zhang XM, Cao S, Gao M, Xiao S, Xie X, Wu X. The prevalence of social frailty among older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2023;24(1):29-37.e9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36402197 Free article https://www.jamda.com/article/S1525-8610(22)00789-7/fulltext
- ↑ 48.0 48.1 Chin M, Kendzerska T, Inoue J et al Comparing the Hospital Frailty Risk Score and the Clinical Frailty Scale Among Older Adults With Chronic Obstructive Pulmonary Disease Exacerbation. JAMA Netw Open. 2023;6(2):e2253692. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36729458 PMCID: PMC9896302 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800901
- ↑ 49.0 49.1 Loria A et al. Low preoperative serum creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. Ann Surg 2023 Feb; 277:246. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36448909 https://journals.lww.com/annalsofsurgery/Abstract/2023/02000/Low_Preoperative_Serum_Creatinine_is_Common_and.12.aspx
- ↑ 50.0 50.1 Collins CE et al. Frailty in emergency general surgery: Low-risk procedures pose similar risk as high-risk procedures for frail patients. Surgery 2023 Feb; 173:485 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36435653 https://www.surgjournal.com/article/S0039-6060(22)00863-7/fulltext
- ↑ 51.0 51.1 Varley PR et al. Association of routine preoperative frailty assessment with 1-year postoperative mortality. JAMA Surg 2023 Feb 22; e228341; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36811872 https://jamanetwork.com/journals/jamasurgery/fullarticle/2801764
Ghneim M et al. Frailty assessment in the older adult surgical patient - Crucial questions for the future. JAMA Surg 2023 Feb 22; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36811899 https://jamanetwork.com/journals/jamasurgery/fullarticle/2801769 - ↑ 52.0 52.1 Wang W et al. Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation. J Am Geriatr Soc 2023 Feb; 71:394-403. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36273408 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18079
Ouellet GM et al. Benefits and harms of oral anticoagulants for atrial fibrillation in nursing home residents with advanced dementia. J Am Geriatr Soc 2023 Feb; 71:561-568 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36310367 PMCID: PMC9957933 (available on 2024-02-01) https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18108 - ↑ 53.0 53.1 Pandey A, Kitzman DW, Nelson MB et al. Frailty and effects of a multidomain physical rehabilitation intervention among older patients hospitalized for acute heart failure: A secondary analysis of a randomized clinical trial. JAMA Cardiol 2023 Jan 4; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36598761 PMCID: PMC9857661 (available on 2024-01-04) https://jamanetwork.com/journals/jamacardiology/fullarticle/2799721
- ↑ 54.0 54.1 Sanchis J, Bueno H, Minana G et al Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non-ST-Segment Elevation Acute Myocardial Infarction. A Randomized Clinical Trial. JAMA Intern Med. Published online March 6, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36877502 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802028
- ↑ 55.0 55.1 Loewenthal J, Innes KE, Mitzner M et al Effect of Yoga on Frailty in Older Adults. A Systematic Review. Ann Intern Med. 2023. March 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36913687 Review. https://www.acpjournals.org/doi/10.7326/M22-2553
- ↑ 56.0 56.1 56.2 56.3 56.4 Li J, Zhu M, Zhao S, Liu X. Factors associated with frailty transitions among the old-old in a community. Geriatr Gerontol Internat. 2023. April 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37186132 https://onlinelibrary.wiley.com/doi/abs/10.1111/ggi.14579
- ↑ 57.0 57.1 Fountotos R, Ahmad F, Bharaj N et al Multicomponent intervention for frail and pre-frail older adults with acute cardiovascular conditions: The TARGET-EFT randomized clinical trial. J Am Geriatr Soc. 2023 May;71(5):1406-1415. Epub 2023 Jan 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36645227 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18228
- ↑ 58.0 58.1 58.2 Zhao H, Tu J, She Q et al Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study. BMC Geriatrics. 2023 23(1):308. May 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37198576 PMCID: PMC10193599 Free PMC article https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-04029-3
- ↑ 59.0 59.1 Mohyuddin H, Laffon B, Teixeira JP et al Toxoplasma gondii IgG Serointensity Is Positively Associated With Frailty. J Gerontol A Biol Sci Med Sci. 2023 Nov 6:glad228 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37939652 https://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/glad228/7334598
- ↑ 60.0 60.1 60.2 Kolle AT, Lewis KB, Lalonde M et al. Reversing frailty in older adults: a scoping review. BMC Geriatr 2023. 23, 752, Nov 17 https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-04309-y
- ↑ 61.0 61.1 Goshen A, Goldbourt U, Benyamini Y et al Diet Quality and Incident Frailty in Adults 65 Years or Older: The Israeli Longitudinal Study on Aging. Mayo Clinic Proceedings. 2023. 98(12):1774-1784. December PMID: https://www.ncbi.nlm.nih.gov/pubmed/38043995 https://www.mayoclinicproceedings.org/article/S0025-6196(23)00408-1/fulltext
Pignolo RJ Successful Aging: The Longer One Lives, the Better One Has Eaten? Mayo Clinic Proceedings. 2023. 98(12):1751-17852. December PMID: https://www.ncbi.nlm.nih.gov/pubmed/38043990 https://www.mayoclinicproceedings.org/article/S0025-6196(23)00507-4/fulltext - ↑ 62.0 62.1 Brack C, Kynn M, Murchie P, et al. Validated frailty measures using electronic primary care records: a review of diagnostic test accuracy. Age Ageing. 2023 Nov 2;52(11):afad173. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37993406
- ↑ 63.0 63.1 NEJM Knowledge+
Crooms RC, Gelfman LP. Palliative Care and End-of-Life Considerations for the Frail Patient. Anesth Analg. 2020 Jun;130(6):1504-1515. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32384340 PMCID: PMC7536652 Free PMC article. Review. - ↑ 64.0 64.1 Oei S, Millar CL, Nguyen Lily TN et al Higher intake of dietary flavonols, specifically dietary quercetin, is associated with lower odds of frailty onset over 12 years of follow-up among adults in the Framingham Heart Study. Am J Clin Nutr. 2023 Jul;118(1):27-33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37061164 PMCID: PMC10447475 (available on 2024-04-13)
- ↑ 65.0 65.1 An JN, Kim JK, Lee HS, Kim SG, Kim HJ, Song YR. Serum cystatin C to creatinine ratio is associated with sarcopenia in non-dialysis-dependent chronic kidney disease. Kidney Res Clin Pract. 2022 Sep;41(5):580-590. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35791742 PMCID: PMC9576455 Free PMC article.