Frailty: Tough to Define

As researchers continue to develop tools for assessing frailty in the elderly and measuring its ability to predict surgical outcomes, one question keeps popping up: Just what is frailty?

“Unfortunately, that’s a tough one. It hasn’t really been comprehensively defined,” said Dr. Stachler. “There are quite a few different interpretations and, in some cases, disagreements on what should be included.”

Dr. Stachler is an avid student of the concept of frailty, based on his own research into the concept and on validating its utility as a predictive tool. In his reading of the literature, he’s come up with a broad working definition. Frailty, he noted, “is a state of reduced physiologic capacity and increased susceptibility to disability due to age-related loss of physical, cognitive, social, and psychological functioning” (CMAJ. 2005;173:489-495; Ann Surg. 2009;250:449-455).

He added that, based on several studies (J Gerontol A Biol Sci Med Sci. 2001;56:146-156; J Gerontol A Biol Sci Med Sci. 2004;59:255-263), frailty is also a distinct clinical syndrome that is characterized by the following:

•  Unintentional weight loss (>10 lbs in past year);
•  Self-reported exhaustion;
•  Weakness (assessed by grip strength);
•  Slow walking speed; and
•  Low physical activity.

“Basically, these patients suffer from a biologic syndrome that makes them vulnerable to adverse surgical outcomes,” Dr. Stachler said. “It often presents as an accumulation of deficits; it can be measured, even if there is some disagreement on the specific conditions involved; and it should be factored into your management strategies for older patients.”—DB