Frailty

Frailty is an increasingly common condition of late life vulnerability that puts older adults at high risk for adverse health outcomes and early mortality. There are two major conceptualizations of frailty: the physical or frailty phenotype, which suggests that frailty is driven by deep biological changes in multiple physiological systems; and the deficit approach, which suggests frailty is driven by accumulations in comorbidities, functional declines, illnesses, and social and cognitive declines. Many frailty screening assessments have been developed and validated. Some are brief and questions only, while others require physical measurements and/or extensive medical record searching. Choosing a frailty tool should take into consideration the ultimate uses, which may include risk assessment or research into biological basis or intervention development. Specialists are increasingly interested in the identification of those frail older adults who are at highest risk of adverse outcomes in order to mitigate this risk before procedures or treatments or be more aware of the increased risk these patients have for any physical perturbation. This chapter describes the conceptual basis of frailty, outlines several possible tools that can be utilized for frailty assessment, and provides an overview of the biological basis of physical frailty and an overview of approaches that can be taken to manage and thereby potentially improve the outcomes of frail, older adults.