Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

E. Dent; J. E. Morley; A. J. Cruz-Jentoft; L. Woodhouse; L. Rodríguez-Mañas; L. P. Fried; J. Woo; I. Aprahamian; A. Sanford; J. Lundy; F. Landi; J. Beilby; F. C. Martin; J. M. Bauer; L. Ferrucci; R. A. Merchant; B. Dong; H. Arai; E. O. Hoogendijk; C. W. Won; A. Abbatecola; T. Cederholm; T. Strandberg; L. M. Gutiérrez Robledo; L. Flicker; S. Bhasin; M. Aubertin-Leheudre; H. A. Bischoff-Ferrari; J. M. Guralnik; J. Muscedere; M. Pahor; J. Ruiz; A. M. Negm; J. Y. Reginster; D. L. Waters; B. Vellas

doi:10.1007/s12603-019-1273-z

Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

E. Dent, J. E. Morley, A. J. Cruz-Jentoft, L. Woodhouse, L. Rodríguez-Mañas, L. P. Fried, J. Woo, I. Aprahamian, A. Sanford, J. Lundy, F. Landi, J. Beilby, F. C. Martin, J. M. Bauer, L. Ferrucci, R. A. Merchant, B. Dong, H. Arai, E. O. Hoogendijk, C. W. WonA. Abbatecola, T. Cederholm, T. Strandberg, L. M. Gutiérrez Robledo, L. Flicker, S. Bhasin, M. Aubertin-Leheudre, H. A. Bischoff-Ferrari, J. M. Guralnik, J. Muscedere, M. Pahor, J. Ruiz, A. M. Negm, J. Y. Reginster, D. L. Waters, B. Vellas

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Original language	English (US)
Pages (from-to)	771-787
Number of pages	17
Journal	Journal of Nutrition, Health and Aging
Volume	23
Issue number	9
DOIs	https://doi.org/10.1007/s12603-019-1273-z
State	Published - Nov 1 2019
Externally published	Yes

Keywords

80 and over
Aged
Frailty/diagnosis
Frailty/therapy*
Patient Care Planning/standards
Practice guideline

ASJC Scopus subject areas

Medicine (miscellaneous)
Nutrition and Dietetics
Geriatrics and Gerontology

Access to Document

10.1007/s12603-019-1273-z

Cite this

Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., ... Vellas, B. (2019). Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. Journal of Nutrition, Health and Aging, 23(9), 771-787. https://doi.org/10.1007/s12603-019-1273-z

Physical Frailty : ICFSR International Clinical Practice Guidelines for Identification and Management. / Dent, E.; Morley, J. E.; Cruz-Jentoft, A. J.; Woodhouse, L.; Rodríguez-Mañas, L.; Fried, L. P.; Woo, J.; Aprahamian, I.; Sanford, A.; Lundy, J.; Landi, F.; Beilby, J.; Martin, F. C.; Bauer, J. M.; Ferrucci, L.; Merchant, R. A.; Dong, B.; Arai, H.; Hoogendijk, E. O.; Won, C. W.; Abbatecola, A.; Cederholm, T.; Strandberg, T.; Gutiérrez Robledo, L. M.; Flicker, L.; Bhasin, S.; Aubertin-Leheudre, M.; Bischoff-Ferrari, H. A.; Guralnik, J. M.; Muscedere, J.; Pahor, M.; Ruiz, J.; Negm, A. M.; Reginster, J. Y.; Waters, D. L.; Vellas, B.

In: Journal of Nutrition, Health and Aging, Vol. 23, No. 9, 01.11.2019, p. 771-787.

Research output: Contribution to journal › Article › peer-review

Dent, E, Morley, JE, Cruz-Jentoft, AJ, Woodhouse, L, Rodríguez-Mañas, L, Fried, LP, Woo, J, Aprahamian, I, Sanford, A, Lundy, J, Landi, F, Beilby, J, Martin, FC, Bauer, JM, Ferrucci, L, Merchant, RA, Dong, B, Arai, H, Hoogendijk, EO, Won, CW, Abbatecola, A, Cederholm, T, Strandberg, T, Gutiérrez Robledo, LM, Flicker, L, Bhasin, S, Aubertin-Leheudre, M, Bischoff-Ferrari, HA, Guralnik, JM, Muscedere, J, Pahor, M, Ruiz, J, Negm, AM, Reginster, JY, Waters, DL & Vellas, B 2019, 'Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management', Journal of Nutrition, Health and Aging, vol. 23, no. 9, pp. 771-787. https://doi.org/10.1007/s12603-019-1273-z

Dent, E. ; Morley, J. E. ; Cruz-Jentoft, A. J. ; Woodhouse, L. ; Rodríguez-Mañas, L. ; Fried, L. P. ; Woo, J. ; Aprahamian, I. ; Sanford, A. ; Lundy, J. ; Landi, F. ; Beilby, J. ; Martin, F. C. ; Bauer, J. M. ; Ferrucci, L. ; Merchant, R. A. ; Dong, B. ; Arai, H. ; Hoogendijk, E. O. ; Won, C. W. ; Abbatecola, A. ; Cederholm, T. ; Strandberg, T. ; Gutiérrez Robledo, L. M. ; Flicker, L. ; Bhasin, S. ; Aubertin-Leheudre, M. ; Bischoff-Ferrari, H. A. ; Guralnik, J. M. ; Muscedere, J. ; Pahor, M. ; Ruiz, J. ; Negm, A. M. ; Reginster, J. Y. ; Waters, D. L. ; Vellas, B. / Physical Frailty : ICFSR International Clinical Practice Guidelines for Identification and Management. In: Journal of Nutrition, Health and Aging. 2019 ; Vol. 23, No. 9. pp. 771-787.

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title = "Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management",

abstract = "Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.",

keywords = "80 and over, Aged, Frailty/diagnosis, Frailty/therapy*, Patient Care Planning/standards, Practice guideline",

author = "E. Dent and Morley, {J. E.} and Cruz-Jentoft, {A. J.} and L. Woodhouse and L. Rodr{\'i}guez-Ma{\~n}as and Fried, {L. P.} and J. Woo and I. Aprahamian and A. Sanford and J. Lundy and F. Landi and J. Beilby and Martin, {F. C.} and Bauer, {J. M.} and L. Ferrucci and Merchant, {R. A.} and B. Dong and H. Arai and Hoogendijk, {E. O.} and Won, {C. W.} and A. Abbatecola and T. Cederholm and T. Strandberg and {Guti{\'e}rrez Robledo}, {L. M.} and L. Flicker and S. Bhasin and M. Aubertin-Leheudre and Bischoff-Ferrari, {H. A.} and Guralnik, {J. M.} and J. Muscedere and M. Pahor and J. Ruiz and Negm, {A. M.} and Reginster, {J. Y.} and Waters, {D. L.} and B. Vellas",

note = "Funding Information: The authors wish to thank MN Vaquero-Pinto and V S{\'a}nchez-Cadenas for coordinating and compiling feedback from both patient consumer groups and healthcare practitioners. ED is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Research Fellowship (Grant ID: #1112672). IA receives National public grant level 2 from the National Council for Scientific and Technological Development (Ministry of Science, Technology, Innovation and Communications, Brazil). Funding Information: The authors wish to thank MN Vaquero-Pinto and V S?nchez-Cadenas for coordinating and compiling feedback from both patient consumer groups and healthcare practitioners. ED is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Research Fellowship (Grant ID: #1112672). IA receives National public grant level 2 from the National Council for Scientific and Technological Development (Ministry of Science, Technology, Innovation and Communications, Brazil). Funding Information: The task force does not recommend presently available pharmacological treatment for the management of frailty (task force agreement with recommendation: 89.5%). This statement was also supported by both healthcare provider reviewing groups. Publisher Copyright: {\textcopyright} 2019, The Author(s).",

year = "2019",

month = nov,

day = "1",

doi = "10.1007/s12603-019-1273-z",

language = "English (US)",

volume = "23",

pages = "771--787",

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T1 - Physical Frailty

T2 - ICFSR International Clinical Practice Guidelines for Identification and Management

AU - Dent, E.

AU - Morley, J. E.

AU - Cruz-Jentoft, A. J.

AU - Woodhouse, L.

AU - Rodríguez-Mañas, L.

AU - Fried, L. P.

AU - Woo, J.

AU - Aprahamian, I.

AU - Sanford, A.

AU - Lundy, J.

AU - Landi, F.

AU - Beilby, J.

AU - Martin, F. C.

AU - Bauer, J. M.

AU - Ferrucci, L.

AU - Merchant, R. A.

AU - Dong, B.

AU - Arai, H.

AU - Hoogendijk, E. O.

AU - Won, C. W.

AU - Abbatecola, A.

AU - Cederholm, T.

AU - Strandberg, T.

AU - Gutiérrez Robledo, L. M.

AU - Flicker, L.

AU - Bhasin, S.

AU - Aubertin-Leheudre, M.

AU - Bischoff-Ferrari, H. A.

AU - Guralnik, J. M.

AU - Muscedere, J.

AU - Pahor, M.

AU - Ruiz, J.

AU - Negm, A. M.

AU - Reginster, J. Y.

AU - Waters, D. L.

AU - Vellas, B.

N1 - Funding Information: The authors wish to thank MN Vaquero-Pinto and V Sánchez-Cadenas for coordinating and compiling feedback from both patient consumer groups and healthcare practitioners. ED is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Research Fellowship (Grant ID: #1112672). IA receives National public grant level 2 from the National Council for Scientific and Technological Development (Ministry of Science, Technology, Innovation and Communications, Brazil). Funding Information: The authors wish to thank MN Vaquero-Pinto and V S?nchez-Cadenas for coordinating and compiling feedback from both patient consumer groups and healthcare practitioners. ED is supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Research Fellowship (Grant ID: #1112672). IA receives National public grant level 2 from the National Council for Scientific and Technological Development (Ministry of Science, Technology, Innovation and Communications, Brazil). Funding Information: The task force does not recommend presently available pharmacological treatment for the management of frailty (task force agreement with recommendation: 89.5%). This statement was also supported by both healthcare provider reviewing groups. Publisher Copyright: © 2019, The Author(s).

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

AB - Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

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KW - Aged

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Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

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