The number of people age 60 and older will be approximately 2 billion people by 2050.1,2 Faced with that number, it is imperative that pharmacists and healthcare professionals arm themselves with tools to recognize and address the complexities and healthcare challenges that come with age, including frailty.
Theoretically, frailty can occur at any age. The significance of frailty in the geriatric population lies not only on the frequency with which it occurs, but also its association with underlying illnesses, and that it is often a precursor to other adverse events in aging patients.
Because standardized and validated screenings to diagnose frailty are lacking, all healthcare providers must educate themselves about frailty. Community pharmacists, in particular, can use their frequent patient contact and accessibility to identify, screen, and refer patients who are frail or at risk for becoming frail.
What Is Frailty?
A frailty index to screen patients exists, but there is no consensus on how to define or screen for frailty. One definition of frailty is a condition that reduces an individual’s chances of recovering from a traumatic or stressful event.4 Unable to return homeostasis or the previous baseline, these stressors put these patients at risk for falls, hospitalizations, disability, delirium, and death.5 Physiologically, resilience declines with age, and as the hypothalamus-pituitary-adrenal (HPA) axis begins to fail over time, so does one’s ability to recover from stress.5, 6 Furthermore, illness accelerates the aging process, and aging itself compromises one’s ability to recover from stress and return to one’s original functional state.
According to one study, frail subjects have a mortality risk six times that of non-frail subjects.5 The degree to which an individual exhibits signs of frailty may help forecast poor prognosis and the risk for adverse events.
Another clinical definition of frailty is a catch-all that not only refers to gait and muscle tone, but also signs and symptoms associated with mental health, including cognition and social behaviors.5,7 Under this definition, frailty can be broken down into three categories: physical frailty, cognitive frailty, and psychosocial frailty.5
A patient who is physically frail has three to five of the following signs and symptoms:
- Decreased muscle strength
- Slow movement or walking speed
- Decreased physical activity
- Weight loss.5
They may also have a shrinking in physical size.7 Patients classified as pre-physically frail exhibit one to two of these traits, but the importance of early identification and referral of patients who are pre-frail cannot be understated. Weakness is often the first symptom for pre-frailty, and caught early, can prevent the rapid progression to full-blown physical frailty.
The earlier patients with signs of frailty can be guided to treatment, the greater the chances of improvement, and reducing the likelihood and/or severity of complications. In some cases, frailty can be reversed. Cognitive Frailty class="text">Cognitive frailty is a more complex category and can be more difficult to identify. Several factors contribute to the potential for misdiagnosis or missed diagnosis: Cognitive frailty often mimics signs of dementia and is best distinguished through biomarker testing for beta-amyloid plaques and neurodegeneration, along with evaluating the patient for signs of cognitive impairment.7
- Buckinx F, Rollard Y, Reginster JY, Ricour C, Petermans J, Bruyére O. Burden of frailty in elderly populations: perspectives of a public health challenge. Arch Public Health. 2015;73(1):19. Available at: https://www.nbi.nm.nih.gov/pmc/articles/PMC4392630
- Current Global Population. The Worldometers website. Available at: http://www.worldometers.info/world-population/. Accessed on March 13, 2018.
- https://www.merriam-webster.com/dictionary/frail. Accessed on March 3, 2018.
- Clegg A, Youn J, Illiffe S, Older Rikkert M, Rockwood K. Frailty in older people. Lancet. 2013:381(9868):752-762. DOI: 10.1016/S0140-6736(12)62167-9
- Fried LP, Tangen CM, Waltson J.Fraiilty in older adults: evidence for a phenotype.J Gerontol A Bio Sci Med Sci. 2001:56A(3):M146-M156.
- Gupta D. Morley JE. Hypothalmalmic-pituitary-adrenal (HPA) axis and aging. Comorbid Physiol 2014 Oct;4(4: 1495-510. DOI: 10.1002/cphy.c130049.
- Qingwei R, Zhuouwei Y, Ma C, Zhijun B, Jin L, Wei H. Cognitive frailty, a novel target for the prevention of elderly dependency. Aging Res Rev. 2015(20)1-10DOI: 10.1016/j.arr.2014.12.004.
- Mulasso A, Roppolo M, Giannotta F, Rabaglietti E. Associations of frailty and psychosocial factors with autonomy in daily activities: a cross-sectional study in Itailian community-dwelling older adults. Clin Interv Aging 2016; 11:37-45. DOI:10.2147CIA.S95182.