Frailty Syndrome: A Transitional State in a Dynamic Process

被引:416
作者
Lang, Pierre-Olivier [1 ,2 ,3 ]
Michel, Jean-Pierre [1 ,2 ]
Zekry, Dina [1 ,2 ]
机构
[1] Univ Hosp Geneva, Geneva, Switzerland
[2] Univ Geneva, Sch Med, Dept Rehabil & Geriatr, CH-1211 Geneva, Switzerland
[3] Univ Reims, Fac Med, Reims, France
关键词
Frailty; Physiopathology; Prevention; COMPREHENSIVE GERIATRIC ASSESSMENT; OLDER-ADULTS; FUNCTIONAL DECLINE; CARDIOVASCULAR HEALTH; VULNERABLE ELDERS; DISABILITY; PEOPLE; COMMUNITY; INFLAMMATION; COAGULATION;
D O I
10.1159/000211949
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Frailty has long been considered synonymous with disability and comorbidity, to be highly prevalent in old age and to confer a high risk for falls, hospitalization and mortality. However, it is becoming recognized that frailty may be a distinct clinical syndrome with a biological basis. The frailty process appears to be a transitional state in the dynamic progression from robustness to functional decline. During this process, total physiological reserves decrease and become less likely to be sufficient for the maintenance and repair of the ageing body. Central to the clinical concept of frailty is that no single altered system alone defines it, but that multiple systems are involved. Clinical consensus regarding the phenotype which constitutes frailty, drawing upon the opinions of numerous authors, shows the characteristics to include wasting (loss of both muscle mass and strength and weight loss), loss of endurance, decreased balance and mobility, slowed performance, relative inactivity and, potentially, decreased cognitive function. Frailty is a distinct entity easily recognized by clinicians, with multiple manifestations and with no single symptom being sufficient or essential in its presentation. Manifestations include appearance (consistent or not with age), nutritional status (thin, weight loss), subjective health rating (health perception), performance (cognition, fatigue), sensory/physical impairments (vision, hearing, strength) and current care (medication, hospital). Although the early stages of the frailty process may be clinically silent, when depleted reserves reach an aggregate threshold leading to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral and biological markers. Thus, a better understanding of these clinical changes and their underlying mechanisms, beginning in the pre-frail state, may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible. We therefore provide an update of the physiopathology and clinical and biological characteristics of the frailty process and speculate on possible preventative approaches. Copyright (C) 2009 S. Karger AG, Basel
引用
收藏
页码:539 / 549
页数:11
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