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Significance of frailty for predicting adverse clinical outcomes in different patient groups with specific medical conditions

Bedeutung von Frailty für die Prädiktion unerwünschter klinischer Outcomes bei verschiedenen Patientengruppen mit spezifischen Erkrankungen

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Abstract

Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians. Recently, clinicians and scientists from other medical disciplines, such as cardiology, pulmonology, gastroenterology, nephrology, endocrinology, rheumatology, surgery and critical care medicine also discovered frailty to be an interesting instrument for risk stratification of patients, including younger patients. In this review we highlight the results of recent studies that demonstrated the significance of frailty to predict adverse clinical outcomes in patients with specific medical conditions, such as cardiac, lung, liver and kidney diseases as well as diabetes mellitus, osteoarthritis, trauma patients, patients undergoing surgery and critically ill patients. Multiple studies in patients with the aforementioned specific medical conditions could be identified demonstrating a predictive role of frailty for several adverse clinical outcomes. The association between frailty and adverse clinical outcomes reported in these studies was in part independent of several major potential confounder factors, such as age, sex, race, comorbidities and disabilities and were also detected in younger patients.

Zusammenfassung

Frailty stellt ein wesentliches medizinisches Problem in einer alternden Gesellschaft dar. Sie ist charakterisiert durch verminderte physiologische Reserven verschiedener Organsysteme und eine verminderte Fähigkeit des Organismus auf interne oder externe Stressoren adäquat zu reagieren. Frailty ist mit einem erhöhten Risiko für klinische Ereignisse wie Tod, wiederholte Krankenhauseinweisungen, Notwendigkeit der Unterbringung in einem Pflegeheim, Stürze etc. assoziiert. Frailty ist potenziell reversibel. Des Weiteren führen möglicherweise präventive Maßnahmen bei einigen Risikopatienten zu einer Verhinderung oder einer Verzögerung des Auftretens einer Frailty. Im klinischen Alltag werden Patienten mit komplexen medizinischen Problemen, die meist gebrechlich sind oder ein Risiko für Frailty aufweisen, von einem Geriater betreut. Zuletzt entdeckten auch Kliniker und Wissenschaftler anderer medizinischer Disziplinen wie Kardiologie, Pulmologie, Gastroenterologie, Nephrologie, Endokrinologie, Rheumatologie, Unfallchirurgie/Orthopädie, Chirurgie und Intensivmedizin die Frailty als Instrument für die Risikostratifizierung auch jüngerer Patienten. In diesem Review werden rezente Studien abgehandelt, welche einen prädiktiven Wert der Frailty für klinische Ereignisse bei Patienten mit Herzerkrankungen, Lungenerkrankungen, Lebererkrankungen, Nierenerkrankungen, Diabetes mellitus, rheumatologischen Erkrankungen, Traumapatienten, chirurgischen und intensivmedizinischen Patienten zeigen. Eine Vielzahl von Studien mit o. g. Patientenkollektiven wiesen auch einen prädiktiven Wert der Frailty für klinische Ereignisse wie Tod, Rehospitalisation, Notwendigkeit der Unterbringung in einem Pflegeheim, Abhängigkeit bei Aktivitäten des täglichen Lebens, Stürze etc. nach. Die Assoziation von Frailty und klinischen Ereignissen war in einem Teil dieser Studien unabhängig von potenziellen Faktoren wie Alter, Geschlecht, Rasse, Komorbiditäten sowie funktionellen Einschränkungen und zeigte sich auch bei jüngeren Patienten.

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Authors and Affiliations

  1. Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Hospital of the Congregation of St. Francis Sisters of Vierzehnheiligen, Rathsberger Straße 57, 91054, Erlangen, Germany

    Martin Ritt & Karl-Günter Gaßmann

  2. Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Kobergerstraße 60, 90408, Nürnberg, Germany

    Martin Ritt, Karl-Günter Gaßmann & Cornel Christian Sieber

  3. Department of Internal Medicine and Geriatrics, Hospital of the Order of St. John of God, Prüfeninger Straße 86, 93049, Regensburg, Germany

    Cornel Christian Sieber

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  1. Martin Ritt
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  2. Karl-Günter Gaßmann
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Correspondence to Martin Ritt.

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M. Ritt, K.-G. Gaßmann and C.C. Sieber state that they have no conflict of interests.

This article does not contain any studies with human participants or animals performed by any of the authors except those studies cited accordingly in the references.

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Ritt, M., Gaßmann, KG. & Sieber, C.C. Significance of frailty for predicting adverse clinical outcomes in different patient groups with specific medical conditions. Z Gerontol Geriat 49, 567–572 (2016). https://doi.org/10.1007/s00391-016-1128-8

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