Transitions Between Frailty States Among Community-Living Older Persons

Abstract

Frailty is increasingly recognized as a geriatric syndrome, distinct from disability and comorbidity, that results from a multisystem reduction in reserve capacity, confers high risk for an array of adverse outcomes, and is potentially amenable to prevention and remediation.¹ An important impediment to the development of frailty-specific interventions has been an incomplete understanding of the epidemiology of frailty. Until recently, research on frailty has been slowed by the absence of a standardized and valid operational definition. In a seminal report, Fried et al² proposed that frailty be defined on the basis of the following 5 features: unintentional weight loss, exhaustion, low physical activity, muscle weakness, and slow walking speed, with the presence of 3 or more of these features denoting frailty, 1 or 2 denoting prefrailty, and none denoting no frailty. This 3-level definition for frailty had strong concurrent validity, as evidenced by expected associations with age, chronic conditions, cognitive function, and depressive symptoms, and was independently predictive of several relevant outcomes, including incident falls, hospitalization, worsening disability, and death.²