The Journal of Nutrition Health and Aging

, Volume 12, Issue 1, pp 29–37

The I.A.N.A. task force on frailty assessment of older people in clinical practice

  • G. Abellan Van Kan
  • Y. Rolland
  • H. Bergman
  • J. E. Morley
  • S. B. Kritchevsky
  • B. Vellas
  • On Behalf of the Geriatric Advisory Panel
Geriatric Science

Abstract

Frailty is a commonly used term indicating older persons at increased risk for adverse outcomes such as onset of disability, morbidity, institutionalisation or mortality or who experience a failure to integrate adequate responses in the face of stress. Although most physicians caring for older people recognize the importance of frailty, there is still a lack of both consensus definition and consensual clinical assessment tools. The aim of the present manuscript was to perform a comprehensive review of the definitions and assessment tools on frailty in clinical practice and research, combining evidence derived from a systematic review of literature along with an expert opinion of a European, Canadian and American Geriatric Advisory Panel (GAP). There was no consensus on a definition of frailty but there was agreement to consider frailty as a pre-disability stage. Being disability a consequence rather than the cause of frailty, frail older people do not necessary need to be disabled. The GAP considered that disability (as a consequence of frailty) should not be included in frailty definitions and assessment tools. Although no consensual assessment tool could be proposed, gait speed could represent the most suitable instrument to be implemented both in research and clinical evaluation of older people, as assessment of gait speed at usual pace is a quick, inexpensive and highly reliable measure of frailty.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Morley JE, Perry III HM, Miller DK. Something about frailty. J Gerontol Med Sci 2002 (57A); 11: 698–704Google Scholar
  2. 2.
    Morley, J.E. Frailty. In: Principles and Practices of Geriatric Medicine, Fourth Edition, Pathy, M.S.J., Sinclair, A.J. and Morley, J.E., eds, John Wiley & Sons: West Sussex, England, pp 1565–1570, 2006.Google Scholar
  3. 3.
    Morley JE, Haren MT, Rolland Y, Kim MJ. Frailty. Med Clin North Am 2006;90: 837–847PubMedCrossRefGoogle Scholar
  4. 4.
    Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, Ershler WB, Harris T, Fried LP. Research agenda for frailty in older adults: towards a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research conference on frailty in older adults. J Am Geriatr Soc 2006;54: 991–1001PubMedCrossRefGoogle Scholar
  5. 5.
    Rockwood K. Frailty and its definition: a worthy challenge. J Am Geriatr Soc 2005;53: 1069–1070PubMedCrossRefGoogle Scholar
  6. 6.
    Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community-living older persons. Arch Intern Med 2006; 166: 418–423PubMedCrossRefGoogle Scholar
  7. 7.
    Hogan DB, Mac Knight C, Bergman H, on behalf of the steering committee Canadian Initiative on Frailty and Aging. Models, definitions, and criteria of frailty. Aging Clin Exp Res. 2003; 15(3 Suppl): l-29Google Scholar
  8. 8.
    Rockwood K, Fox RA, Stolee P, Robertson D, Beattie L. Frailty in elderly people: an evolving concept. Can Med Assoc J 1994; 150(4): 489–495Google Scholar
  9. 9.
    Brown JV, Wykle MH, Cowling WR. Failure to thrive in older persons: a concept derived. Gerontologist 1988;28: 809–812Google Scholar
  10. 10.
    Stone R, Cafferata GL, Sangl J. Caregivers of the frail elderly: a national profile. Gerontologist 1987;29: 616–626Google Scholar
  11. 11.
    Strawbridge WJ, Shema SJ, Balfour JL, Higby HR, Kaplan GA. Antecedents of frailty over three decades in an older cohort. J Gerontol Psychol Sci Soc Sci 1998 (53B);1: S9-S16Google Scholar
  12. 12.
    vanIersel MB, Rikkert MG. Frailty criteria give heterogeneous results when applied in clinical practice. J Am Geriatr Soc 2006;54: 728–729PubMedCrossRefGoogle Scholar
  13. 13.
    Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD. Designing Randomized controlled trials aimed at preventing or delaying functional decline and disability in frail older persons: a Consensus Report. J Am Geriatr Soc 2004;52: 625–634PubMedCrossRefGoogle Scholar
  14. 14.
    Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, Ershler WB, Harris T, Fried LP. Research agenda for frailty in older adults: towards a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research conference on frailty in older adults. J Am Geriatr Soc 2006;54: 991–1001PubMedCrossRefGoogle Scholar
  15. 15.
    Bergman H, Ferruci L, Guralnik J et al. Frailty: an emerging research and clinical paradigm-Issues and controversies. J Gerontol Biol Sci Med Sci 2007;62(7): 731–737Google Scholar
  16. 16.
    Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, Zeger SL, Fried LP. Phenotype of frailty: characterisation in the Women’s Health and Aging Studies. J Gerontol Biol Sci Med Sci 2006;61A: 262–266Google Scholar
  17. 17.
    Fried LP, Tangen CM, Walston J Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA for the Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol Biol Sci Med Sci 2001;56A: M146-M156Google Scholar
  18. 18.
    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol Biol Sci Med Sci 2004; 59(3): 255–263Google Scholar
  19. 19.
    Ble A, Cherubini A, Volpato S, Bartali B, Walston JD, Windham BG, Bandinelli S, Lauretani F, Guralnik JM, Ferrucci L. Lower plasma levels vitamin E levels are associated with the frailty syndrome: the InCHIANTI study. J Gerontol Bio Sci Med Sci 2006;61A: 278–283Google Scholar
  20. 20.
    Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc 2005;53: 1321–1330PubMedCrossRefGoogle Scholar
  21. 21.
    Ottenbacher KJ, Ostir GV, Peek MK, Al Snih S, Raji MA, Markides KS. Frailty in Mexican American older adults. J Am Geriatr Soc 2005; 53(9): 1524–1531PubMedCrossRefGoogle Scholar
  22. 22.
    Gill TM, Baker DI, Gottschalk M, Peduzzi P, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002;347(14): 1068–1074PubMedCrossRefGoogle Scholar
  23. 23.
    Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hebert R, Hogan DB. A brief clinical instrument to classify frailty in elderly people. Lancet 1999;353: 205–206PubMedCrossRefGoogle Scholar
  24. 24.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173(5): 489–495PubMedGoogle Scholar
  25. 25.
    Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatrics 2002;2: 1PubMedCrossRefGoogle Scholar
  26. 26.
    Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a Standardized Comprehensive Geriatric Assessment. J Am Geriatr Soc 2004;52: 1929–1933PubMedCrossRefGoogle Scholar
  27. 27.
    Chin A Paw MJM, deGroot LCPGM, vanGend SV, Schoterman MHC, Schouten EG, Schroll M, vanStaveren WA. Inactivity and weight loss: effective criteria to identify frailty. J Nutr Health Aging 2003;7(l): 55–60Google Scholar
  28. 28.
    Chin A Paw MJM, Dekker JM, Feskens EJM, Schouten EG, Kromhout D. How to select a frail elderly population? A comparison of three working definitions. J Clin Epidemiol 1999;52(ll): 1015–1021Google Scholar
  29. 29.
    Guralnik JM, Ferrucci L, Simonsick EM et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332: 556–561PubMedCrossRefGoogle Scholar
  30. 30.
    Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, Fox M, Guralnik JM. Physical Performance Measures in the Clinical Setting. J Am Geriatr Soc 2003;51: 314–322PubMedCrossRefGoogle Scholar
  31. 31.
    Studenski S, Hayes RP, Leibowitz RQ, Bode R, Lavery L, Walston J, Duncan P, Perera S. Clinical global impression of change in Physical frailty: development of a measure based on clinical judgement. J Am Geriatr Soc 2004; 52: 1560–1566PubMedCrossRefGoogle Scholar
  32. 32.
    Nourhashemi F, Andrieu S, Gillette-Guyonnet S, Vellas B, Albarede JL, Grandjean H. Instrumental activities of daily living as a potential marker of frailty. A study of 7364 community-dwelling elderly women (the EPIDOS study). J Gerontol Biol Sci Med Sci 2001;56A: 448–453Google Scholar
  33. 33.
    Blaum CS, Xue QL, Michelon E, Semba R, Fried LP. The association between obesity and the frailty syndrome in older women: The Women’s Health and Aging Studies. J Am Geriatr Soc 2005;53: 927–934PubMedCrossRefGoogle Scholar
  34. 34.
    Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP. Identifying frailty in hospitalized older adults with significant coronary heart disease. J Am Geriatr Soc 2006;54: 1674–1681PubMedCrossRefGoogle Scholar
  35. 35.
    Puts MTE, Visser M, Twisk JWR, Deeg DJH, Lips P. Endocrine and inflammatory markers as predictors of frailty. Clinical endocrinology 2005;63: 403–411PubMedCrossRefGoogle Scholar
  36. 36.
    Rolland Y, Lauwers-Cances V, Cesari M, Vellas B, Pahor M, Grandjean H. Physical performance measures as predictors of mortality in a cohort of community-dwelling older French women. Eur J Epidemiol 2006;21 (2)113–122PubMedCrossRefGoogle Scholar
  37. 37.
    Sydall H, Cooper C, Martin F, Briggs R, Sayer AA. Is grip strength a useful single marker of frailty? Age and Ageing 2003;32: 650–656]CrossRefGoogle Scholar
  38. 38.
    Bautmans I, Gorus E, Njemini R, Mets T. Handgrip performance in relation to self-perceived fatigue, physical functioning and circulating IL-6 in elderly persons without inflammation. BMC Geriatrics 2007;7: 5PubMedCrossRefGoogle Scholar
  39. 39.
    Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, Gary P. Overview of the MNA-its history and challenges. J Nutr Health Aging 2006; 10(6): 456–463PubMedGoogle Scholar
  40. 40.
    Vellas B, Wayne SJ, Romero L, Baumgartner RN, Rubenstein LZ, Garry PJ. One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc. 1997 Jun;45(6): 735–8PubMedGoogle Scholar
  41. 41.
    Bergman H, Hogan D, Karunananthan S. Frailty: Clinically relevant tool? Canadian Journal of Geriatrics 2007, in press.Google Scholar
  42. 42.
    Guralnik JM, Ferrucci L, Pieper CF et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the Short Physical Performance Battery. J Gerontol Med Sci 2000;55A: 221–231Google Scholar
  43. 43.
    Cesari M, Kritchevsky SB, Penninx BWHJ, Nicklas BJ et al. Pronostic value of usual gait speed in well-functioning older people. Results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2005;53: 1675–1680PubMedCrossRefGoogle Scholar
  44. 44.
    Rolland Y, Cesari M, Miller ME, Penninx BW, Atkinson HH and Pahor M. Reliability of the 400-m usual pace walk test as an assessment of mobility limitation in older adults. J Am Geriatr Soc 2004;52: 972–976PubMedCrossRefGoogle Scholar

Copyright information

© Spinger-Verlag France and Serdi Éditions 2008

Authors and Affiliations

  • G. Abellan Van Kan
    • 1
  • Y. Rolland
    • 1
  • H. Bergman
    • 2
  • J. E. Morley
    • 3
  • S. B. Kritchevsky
    • 4
  • B. Vellas
    • 1
  • On Behalf of the Geriatric Advisory Panel
  1. 1.Department of Geriatric MedicineUniversity Hospital Toulouse, INSERM U558, University of Toulouse IIIToulouseFrance
  2. 2.Canadian Initiative on Frailty and Aging, Solidage Research GroupMcGill/Université de Montreal/Jewish General HospitalQuebecCanada
  3. 3.Division of Geriatric MedicineSaint Louis University Medical CenterSaint LouisUSA
  4. 4.Wake Forest University School of MedicineWinston-SalemUSA
  5. 5.Department of Geriatric MedicinePavillon J.P. Junod, CHU ToulouseToulouse cedex 9France

Personalised recommendations