Clinical Frailty Scale

Excerpt

Across the globe, the geriatric population is increasing, making frailty a concern of increasing importance for healthcare systems. Frailty is a multidimensional geriatric syndrome associated with poor health outcomes and will continue to place a substantial and increasing burden on healthcare systems. Frailty represents a decreased physiologic reserve and function that is more prevalent with increasing age. It is characterized by increasing vulnerability to physiologic stressors.

Frailty is the result of cumulative cellular damage from diverse etiologies over the life of the individual—typical aging results in loss of homeostatic reserve in physiological systems. However, despite the loss of these reserves, many individuals still function well with aging. Any stress or insult to these physiologic reserves can result in an older adult decompensating and thus causing increased frailty. Patients can be categorized as robust, pre-frail, or frail, depending on the degree of physiological and functional decline.

Frailty can develop due to factors such as (i) socio-demographic influences (e.g. poverty, living alone, low education level); (ii) psychological factors (e.g. depression); (iii) nutritional issues (e.g. malnutrition); (iv) polypharmacy; (v) diseases and complications (inflammatory states, cancer, endocrine disorders, dementia); and (v) low physical activity. Despite the importance of frailty, there is currently no internationally recognized standard definition due to its complex etiology and the inherent difficulty in distinguishing frailty from both aging and disability. Irrespective of definitions, it is clear that frailty is an important geriatric syndrome, which is dynamic, fluctuates over time, and reflects multisystem dysfunction. Given its importance, since the mid-1990s, frailty scores have been developed to help quantify the degree of disability from frailty.