Department of Rehabilitation and Geriatrics, Medical School and University Hospitals of Geneva, Chemin du Pont-Bochet, 3. CH-1226 Thônex-Geneva
Frailty has long been considered synonymous with disability and co-morbidity, to be highly prevalent in old age and to confer high risk for falls, hospitalization, and mortality. However it is becoming recognized that frailty may be a distinct clinical syndrome with a biologic basis. The frailty process appears as a transitional state in the dynamic progression from robustness through to functional decline. During this process, total physiological reserves decrease, and become less likely to be sufficient to maintain and repair the ageing body. The lack of consensus on the definition of frailty is partially related to the widespread use of the expression for different aspects of the condition. Longitudinal studies have demonstrated that slow gait, fatigue, exhaustion, anorexia, unintentional weight loss and reduced muscle strength should all be considered as major symptoms of frailty. At the stage of frailty, clinicians can easily distinguish frail from non-frail older adults using factors such as 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). The process of “becoming frail” is silent and insidious. A better understanding of these clinical changes and their underlying mechanisms, beginning with 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 preventive approaches.