Toward an Understanding of Frailty

• Frail elderly
• Aged, 80 and over
• Geriatric assessment
• Metabolic diseases
• Cytokines

Health care providers who serve an aging population inherently associate the word frailty with patients whom they perceive as frail. Although frailty is not confined to elderly persons, it is more frequently observed in persons older than 85 years of age (the “oldest old”) (1). This is because limitations and diseases associated with aging are an inseparable part of frailty (2-5). As a result, frailty remains more a constellation of many conditions than a discrete clinical entity, and it certainly does not have a precise scientific meaning (6). Frailty is often identified by words that express a similar state, such as “feeble,” or, as the French describe it, “fragilité” (7). Speechly and Tinetti (8) contrasted “frail” with “vigorous” in a study of elderly community dwellers.

These limitations in defining frailty make its actual prevalence uncertain. Strawbridge and colleagues (9) noted the breadth of the conceptual range of frailty: On the one hand, it might include one or more conditions associated with old age (and, thus, most older persons would be frail) (10); on the other hand, it might be limited to severely disabled persons (in which case only a small proportion of older persons would be frail). But even if frailty is not universal and represents a subset of the many persons who have attained advanced age and remain vigorous, it nevertheless assumes an importance out of proportion to its prevalence. There is a high toll in personal suffering, caregiver burden, costs of health care, medication use, and hospitalization, all of which signify enhanced health care demands by any measure of health resources utilization.

Defining frailty may be like attempting to “know the dancer from the dance”; nevertheless, I attempt to present an understanding of frailty by describing many of its clinical correlates and considering …