Promoting access to innovation for frail old persons
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Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate.
The purpose of this paper is to present expert’s positions on the main aspects of the frailty syndrome in the older persons.
Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG).
Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from “very fit” to “severely frail,” but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice.
Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.
Key wordsOlder persons frailty vulnerability diagnostic and workshop
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- 3.Bergman H, Hogan D, Karunananthan S: Frailty: A clinically relevant concept? Canadian J of Geriatrics 2008, 11:124–128.Google Scholar
- 8.Rodriguez-Manas L, Feart C, Mann G, Vina J, Chatterji S, Chodzko-Zajko W, Gonzalez-Colaco Harmand M, Bergman H, Carcaillon L, Nicholson C, et al: Searching for an Operational Definition of Frailty: A Delphi Method Based Consensus Statement. The Frailty Operative Definition-Consensus Conference Project. J Gerontol A Biol Sci Med Sci 2012.Google Scholar
- 15.Rockwood K, Mitnitski A. How might deficit accumulation give rise to frailty? J Frailty Aging 2012;1:8–12Google Scholar
- 24.Carcaillon L, García-García FJ, Tresguerres JA, Gutiérrez Avila G, Kireev R, Rodríguez-Mañas L.. Higher Levels of Endogenous Estradiol are Associated with Frailty in Postmenopausal Women from the Toledo Study for Healthy Aging. J Clin Endocrinol Metabol 2012 Jun 7 (Epub ahead of print)Google Scholar
- 27.Birnie K, Cooper R, Martin RM, Kuh D, Sayer AA, Alvarado BE, Bayer A, Christensen K, Cho SI, Cooper C, et al: Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis. PLoS One 2011, 6:e15564.PubMedCrossRefGoogle Scholar
- 32.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, et al: Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010, 39:412–423.PubMedCrossRefGoogle Scholar
- 36.Retornaz, F*, Monette J, Batist G, Monette M, Sourial N, Small D, Caplan S, Wan-Chow-Wah D, Puts MTE*, Bergman H. Usefulness of frailty markers in the assessment of the health and functional status of older cancer patients referred for chemotherapy: a pilot study. J Gerontol Med Sci. 2008;63A,: 518–522CrossRefGoogle Scholar
- 39.Puts MT, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H: Does frailty predict hospitalization, emergency department visits, and visits to the general practitioner in older newly-diagnosed cancer patients? Results of a prospective pilot study. Crit Rev Oncol Hematol 2009, 76:142–151.PubMedCrossRefGoogle Scholar
- 40.Tan KY, Kawamura YJ, Tokomitsu A, Tang T: Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg 2011.Google Scholar
- 44.Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, Morin JF, Langlois Y, Ohayon SM, Monette J, et al: Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes 2012, 5:222–228.PubMedCrossRefGoogle Scholar
- 45.Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, Perrault LP, Alexander KP, Langlois Y, Dendukuri N, et al: Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010, 56:1668–1676.PubMedCrossRefGoogle Scholar
- 46.Chen PJ, Lin MH, Peng LN, Liu CL, Chang CW, Lin YT, Chen LK: Predicting Cause-Specific Mortality of Older Men Living in the Veterans Home by Handgrip Strength and Walking Speed: A 3-Year, Prospective Cohort Study in Taiwan. J Am Med Dir Assoc 2012.Google Scholar
- 51.Pahor M, Blair SN, Espeland M, Fielding R, Gill TM, Guralnik JM, Hadley EC, King AC, Kritchevsky SB, Maraldi C, et al: Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci 2006, 61:1157–1165.PubMedCrossRefGoogle Scholar