Minimising frailty and its consequences

It is important to understand frailty as it can inform the best treatment plans and help provide the most appropriate goal-directed care for older people. The ageing process is inevitable across all animal species and is accompanied by accumulated molecular and cellular damage, resulting in the decline of physiological systems over one's lifespan. Therefore, frailty can be defined as a state of vulnerability, which develops through a cumulative and age-related decline in physiological functioning, which results in depleting homeostatic reserves, vulnerability and sudden changes in health status, triggered by minor stressor events (Clegg et al, 2013). It is estimated that between a quarter and half of people aged over 85 years are frail, which makes them significantly more at risk of falls, disability and death, and while alive, in need of long-term care (Clegg et al, 2013).

Clegg et al (2013) proposed two models of frailty, namely the phenotype model and the cumulative deficit model. The phenotype model has five symptoms: unintentional weight loss; self-reported exhaustion; low energy expenditure; slow gait speed; and weak grip strength. The cumulative deficit model was derived from a large Canadian prospective cohort study, which developed and tested a frailty index using 92 variables (symptoms, abnormal laboratory values, diseases and disabilities). There is considerable overlap between these models and importantly, they both demonstrate strong predictive validity, although the continuous frailty index shows better discriminant validity regarding people with moderate versus severe frailty. Both models have spurred the development of various assessments/tools of frailty, which enable clinicians to move away from age-based assumptions and organ specific interventions, and adopt a more holistic approach to the routine care of older people, including prophylactic exercise and nutritional interventions. To this end, Dent et al (2019) recommended individually tailored/person-centred interventions to preserve an individual's independence, physical function and cognition once frailty has been identified through assessment, so that it does not become an expression of ageism within the service provision.