Frailty in primary care: A review of its conceptualization and implications for practice

BMC Medicine

Volumn 10, Issue , 2012, Pages

  Lacas, Alethea ^a   Rockwood, Kenneth ^a  

^a DALHOUSIE UNIVERSITY   (Canada)

Author keywords

Comprehensive geriatric assessment; Frailty; Frailty index; Primary care

Indexed keywords

CLINICAL PRACTICE; DAILY LIFE ACTIVITY; ELDERLY CARE; FAMILY MEDICINE; FRAIL ELDERLY; GENERAL PRACTITIONER; HEALTH STATUS; HUMAN; MEDICAL PRACTICE; MEDICAL SPECIALIST; PATIENT CARE; PRIMARY MEDICAL CARE; REVIEW; AGED; GERIATRIC ASSESSMENT; HEALTH CARE; HEALTH CARE QUALITY; PERSONALIZED MEDICINE; PRACTICE GUIDELINE; PRIMARY HEALTH CARE;

AGED; AGED, 80 AND OVER; COMPREHENSIVE HEALTH CARE; FRAIL ELDERLY; GERIATRIC ASSESSMENT; HEALTH SERVICES FOR THE AGED; HUMANS; INDIVIDUALIZED MEDICINE; PATIENT-CENTERED CARE; PRACTICE GUIDELINES AS TOPIC; PRIMARY HEALTH CARE; QUALITY OF HEALTH CARE;

EID: 84855604816     PISSN: None     EISSN: 17417015     Source Type: Journal    
DOI: 10.1186/1741-7015-10-4     Document Type: Review

References (81)

1. McGeorge SJ. Unravelling the differences between complexity and frailty in old age: findings from a constructivist grounded theory study. J Psychiatr Ment Health Nurs 2011, 18:67-73. 10.1111/j.1365-2850.2010.01630.x, 21214686.
2. Kirkwood TB. Changing complexity in aging: a metric not an hypothesis. Neurobiol Aging 2002, 23:21-22. 10.1016/S0197-4580(01)00260-3, 11755013.
3. Kang HG, Costa MD, Priplata AA, Starobinets OV, Goldberger AL, Peng CK, Kiely DK, Cupples LA, Lipsitz LA. Frailty and the degradation of complex balance dynamics during a dual-task protocol. J Gerontol A Biol Sci Med Sci 2009, 64:1304-1311. 2781784, 19679739.
4. Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, Guralnik JM, Leng SX, Semba RD, Walston JD, Blaum CS, Bandeen-Roche K. Nonlinear multisystem physiological dysregulation associated with frailty in older women: implications for etiology and treatment. J Gerontol A Biol Sci Med Sci 2009, 64:1049-1057. 2737590, 19567825.
5. Rockwood K, Mitnitski A. Frailty, fitness and the mathematics of deficit accumulation. Rev Clin Gerotnol 2007, 17:1-12.
6. Jervis R. System Effects. Complexity in Political and Social Life 1997, 23-38. Princeton, NJ: Princeton University Press.
7. Kirkwood TB. Systems biology of ageing and longevity. Philos Trans R Soc Lond B Biol Sci 2011, 366:64-70. 10.1098/rstb.2010.0275, 3001307, 21115531.
8. Vaupel JW, Manton KG, Stallard E. The impact of heterogeneity in individual frailty on the dynamics of mortality. Demography 1979, 16:439-454. 10.2307/2061224, 510638.
9. Beard RE. Some aspects of theories of mortality cause of death analysis, forecasting and stochastic processes. Biological Aspects of Demography 1971, 557-568. London: Taylor & Francis, Brass W.
10. Rubenstein LZ, Goodwin M, Hadley E, Patten SK, Rempusheski VF, Reuben D, Winograd CH. Working group recommendations: targeting criteria for geriatric evaluation and management research. J Am Geriatr Soc 1991, 39:37S-41S.
11. Conroy S. Defining frailty - the Holy Grail of geriatric medicine. J Nutr Health Aging 2009, 13:389. 10.1007/s12603-009-0050-9, 19300887.
12. Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BL. Frailty in elderly people: an evolving concept. CMAJ 1994, 150:489-495. 1486322, 8313261.
13. Fried LP, Darer J, Walston J. Frailty. Geriatric Medicine: An Evidence-Based Approach 2003, 1067-1078. New York: Springer-Verlag, Cassel CK, Leipzig RM, Cohen HJ, Larson EB, Meier DE, 4.
14. American Geriatrics Society Comprehensive geriatric assessment position statement on long term care. Ann Longterm Care 2006, 14:34-35. American Geriatrics Society.
15. Gill TM, Gahbauer EA, Han L, Allore HC. Trajectories in the last year of life. N Eng J Med 2010, 362:1173-1180.
16. Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Monaghan N, Aggar C, Gill L, Cameron ID. A guide to treating frailty. BMC Med 2011, 9:83. 10.1186/1741-7015-9-83, 3146844, 21733149.
17. Pel-Littel RE, Schuurmans MJ, Emmelot-Vonk MH, Verhaar HJ. Frailty: defining and measuring of a concept. J Nutr Health Aging 2009, 13:390-394. 10.1007/s12603-009-0051-8, 19300888.
18. Crome P, Lally F. Frailty: joining the giants. CMAJ 2011, 183:889-890. 10.1503/cmaj.110626, 21540170.
19. Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med 2010, 26:275-286. 10.1016/j.cger.2010.02.002, 20497846.
20. Singh M, Alexander K, Rogers VL, Rihal CS, Whitson HE, Lerman A, Jahangir A, Nair KS. Frailty and it potential relevance to cardiovascular care. Mayo Clin Proc 2008, 83:114611-53.
21. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, . Cardiovascular Health Study Collaborative Research Group Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56:M146-156. 10.1093/gerona/56.3.M146, 11253156, Cardiovascular Health Study Collaborative Research Group.
22. Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hebert R, Hogan DB. A brief clinical instrument to classify frailty in elderly people. Lancet 1999, 353:205-206. 10.1016/S0140-6736(98)04402-X, 9923878.
23. Mitnitski A, Song X, Skoog I, Broe GA, Cox JL, Grunfeld E, Rockwood K. Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc 2005, 53:2184-2189. 10.1111/j.1532-5415.2005.00506.x, 16398907.
24. Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 2011, 27:17-26. 10.1016/j.cger.2010.08.008, 21093719.
25. Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr 2008, 8:24. 10.1186/1471-2318-8-24, 2573877, 18826625.
26. Lindley RI. Drug trials for older people. J Gerotol A Biol Sci Med Sci 2011,
27. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005, 173:489-495. 10.1503/cmaj.050051, 1188185, 16129869.
28. Gu D, Dupre ME, Sautter J, Zhu H, Liu Y, Yi Z. Frailty and mortality among Chinese at advanced ages. J Gerontol B Psychol Sci Soc Sci 2009, 64:279-289. 2655172, 19196691.
29. Mitnitski A, Song X, Rockwood K. Improvement and decline in health status from late middle age: modeling age-related changes in deficit accumulation. Exp Gerontol 2007, 42:1109-1115. 10.1016/j.exger.2007.08.002, 17855035.
30. Shi J, Song X, Yu P, Tang Z, Mitnitski A, Fang X, Rockwood K. Analysis of frailty and survival from late middle age in the Beijing Longitudinal Study of Aging. BMC Geriatr 2001, 11:17.
31. Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 2008, 56:898-903. 10.1111/j.1532-5415.2008.01656.x, 2703425, 18363679.
32. Kulminski AM, Arbeev KG, Christensen K, Mayeux R, Newman AB, Province MA, Hadley EC, Rossi W, Perls TT, Elo IT, Yashin AI. Do gender, disability and morbidity affect aging rate in the LLFS? Application of indices of cumulative deficits. Mech Ageing Dev 2011, 132:195-201. 10.1016/j.mad.2011.03.006, 21463647.
33. Goggins WB, Woo J, Sham A, Ho SC. Frailty index as a measure of biological age in a Chinese population. J Gerontol A Biol Sci Med Sci 2005, 60:1046-1051. 10.1093/gerona/60.8.1046, 16127111.
34. Yang Y, Lee LC. Dynamics and heterogeneity in the process of human frailty and aging: evidence from the U.S. older adult population. J Gerontol B Psychol Sci Soc Sci 2010, 65B:246-255. 10.1093/geronb/gbp102, 2981448, 20007299.
35. Garcia-Gonzalez JJ, Garcia Pena C, Franco-Marina F, Gutierrez-Robledo LM. A frailty index to predict the mortality risk in a population of senior Mexican adults. BMC Geriatr 2009, 9:47. 10.1186/1471-2318-9-47, 2776593, 19887005.
36. Dupre ME, Gu D, Warner DF, Yi Z. Frailty and type of death among older adults in China: prospective cohort study. BMJ 2009, 338:b1175. 10.1136/bmj.b1175, 2667569, 19359289.
37. Hubbard RE, Rockwood K. Frailty in older women. Maturitas 2011, 69:203-207. 10.1016/j.maturitas.2011.04.006, 21570783.
38. Ravaglia G, Forti P, Lucicesare A, Pisacane N, Rietti E, Patterson C. Development of an easy prognostic score for frailty outcomes in the aged. Age Ageing 2009, 37:161-166.
39. Kamaruzzaman S, Ploubidis GB, Fletcher A, Ebrahim S. A reliable measure of frailty for a community dwelling older population. Health Qual Life Outcomes 2010, 8:123. 10.1186/1477-7525-8-123, 2988728, 21029450.
40. Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, Dam TT, Marshall LM, Orwoll ES, Cummings SR. Osteoporotic Fractures in Men Research Group. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc 2009, 57:492-498. 10.1111/j.1532-5415.2009.02137.x, 2861353, 19245414.
41. Song X, Mitnitski A, MacKnight C, Rockwood K. Assessment of individual risk of death using self-report data: an artificial neural network compared with a frailty index. J Am Geriatr Soc 2004, 52:1180-1184. 10.1111/j.1532-5415.2004.52319.x, 15209659.
42. Song X, Mitnitski A, Cox J, Rockwood K. Comparison of machine learning techniques with classical statistical models in predicting health outcomes. Stud Health Technol Inform 2004, 107:736-740.
43. Rockwood K, Andrew M, Mitnitksi A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol Med Sc 2007, 62A:738-743.
44. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, Tracy JK, Cummings SR. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 2008, 168:382-389. 10.1001/archinternmed.2007.113, 18299493.
45. Panza F, Solfrizzi V, Frisardi V, Maggi S, Sancarlo D, Adante F, D'Onofrio G, Seripa D, Pilotto A. Different models of frailty in predementia and dementia syndromes. J Nutr Health Aging 2011, 15:711-719. 10.1007/s12603-011-0126-1, 21968870.
46. Rockwood K, Jones D, Wang Y, Carver D, Mitnitski A. Failure to complete performance-based measures is associated with poor health status and an increased risk of death. Age Ageing 2007, 36:225-228. 10.1093/ageing/afl160, 17259639.
47. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007, 55:780-791. 10.1111/j.1532-5415.2007.01156.x, 2409147, 17493201.
48. Weiss CO. Frailty and chronic diseases in older adults. Clin Geriatr Med 2011, 27:39-52. 10.1016/j.cger.2010.08.003, 21093721.
49. Mallery LH, Moorhouse P. Respecting frailty. J Med Ethics 2011, 37:126-128. 10.1136/jme.2010.040147, 21097941.
50. Ko FC. The clinical care of frail, older adults. Clin Geriatr Med 2011, 27:89-100. 10.1016/j.cger.2010.08.007, 21093725.
51. De Lepeleire J, Iliffe S, Mann E, Degryse JM. Frailty: an emerging concept for general practice. Br J Gen Pract 2009, 59:e177-182. 10.3399/bjgp09X420653, 2673187, 19401013.
52. Brown NA, Zenilman ME. The impact of frailty in the elderly on the outcome of surgery in the aged. Adv Surg 2010, 44:229-249. 10.1016/j.yasu.2010.05.014, 20919524.
53. Makary MA, Segev DI, Pronovost PJ, Syin D, Banden-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010, 210:901-908. 10.1016/j.jamcollsurg.2010.01.028, 20510798.
54. Robinson TN, Eiseman B, Wallace JI, Church SD, McFann KK, Pfister SM, Sharp TJ, Moss M. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg 2009, 250:449-455.
55. Afilalo J, Karunananthan S, Eisenberg MJ, Alexander KP, Bergman H. Role of frailty in patients with cardiovascular disease. Am J Cardiol 2009, 103:1616-1621. 10.1016/j.amjcard.2009.01.375, 19463525.
56. Singh M, Alexander K, Roger VL, Rihal CS, Whitson HE, Lerman A, Jahangir A, Nair KS. Frailty and its potential relevance to cardiovascular care. Mayo Clin Proc 2008, 83:1146-1153. 10.4065/83.10.1146, 2704096, 18828975.
57. Hastings SN, Purser JL, Johnson KS, Sloane RJ, Whitson HE. Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. J Am Geriatr Soc 2008, 56:1651-1657. 10.1111/j.1532-5415.2008.01840.x, 2676906, 18691282.
58. Robinson TN, Wu DS, Stiegmann GV, Moss M. Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg 2011, 202:511-514. 10.1016/j.amjsurg.2011.06.017, 21890098.
59. Pulignano G, Del Sindaco D, Di Lenarda A, Tarantini L, Cioffi G, Gregori D, Tinti MD, Monzo L, Minardi G. Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study. J Cardiovasc Med 2010, 11:739-747.
60. Monteserin R, Brotons C, Moral I, Altimir S, San José A, Santaeugenia S, Sellarès J, Padrós J. Effectiveness of a geriatric intervention in primary care: a randomized clinical trial. Fam Pract 2010, 27:239-245. 10.1093/fampra/cmp101, 20053673.
61. Braithwaite RS, Fiellin D, Justice AC. The payoff time: a flexible framework to help clinicians decide when patients with comorbid disease are not likely to benefit from practice guidelines. Med Care 2009, 47:610-617. 10.1097/MLR.0b013e31819748d5, 3077952, 19433991.
62. Boockvar KS, Meier DE. Palliative care for frail older adults: "there are things I can't do anymore that I wish I could.". JAMA 2006, 296:2245-2253. 10.1001/jama.296.18.2245, 17090771.
63. Heckman GA. Integrated care for the frail elderly. Healthc Pap 2011, 11:62-68. discussion 86-91.
64. Patterson C. Development of an easy prognostic score for frailty outcomes in the aged. Age Ageing 2008, 37:161-166. 10.1093/ageing/afm195, 18238805.
65. Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, Roth C, MacLean CH, Shekelle PG, Sloss EM, Wenger NS. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 2001, 49:1691-1699. 10.1046/j.1532-5415.2001.49281.x, 11844005.
66. Melzelthin SF, Daniels R, van Rossum E, de Witte L, van den Heuvel WJ, Kempen GI. The psychometric properties of three self-report screening instruments for identifying frail older people in the community. BMC Public Health 2010, 10:176. 10.1186/1471-2458-10-176, 2868816, 20353611.
67. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing 2006, 35:526-529. 10.1093/ageing/afl041, 16757522.
68. Ravaglia G, Forti P, Lucicesare A, Pisacane N, Rietti E, Patterson C. Development of an easy prognostic score for frailty outcomes in the aged. Age Ageing 2008, 37:161-166. 10.1093/ageing/afm195, 18238805.
69. Li CM, Chen CY, Li CY, Wang WD, Wu SC. The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trial. Arch Gerontol Geriatr 2010, (Suppl 1):S39-42.
70. Cavazzini C, Conti M, Bandinelli S, Gangemi S, Gallinella M, Lauretani F, Lucci G, Windham BG, Guralnik JM, Ferrucci L. Screening for poor performance of lower extremity in primary care: the Camucia Project. Aging Clin Exp Res 2005, 16:331-336.
71. Bandinelli S, Lauretani F, Boscherini V, Gandi F, Pozzi M, Corsi AM, Bartali B, Lova RM, Guralnik JM, Ferrucci L. A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI Study. Design and baseline evaluation. Aging Clin Exp Res 2006, 18:359-366. 2659809, 17167299.
72. Romero-Orturo R, Walsh CD, Lawlor BA, Kenny RA. A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 2010, 10:57. 10.1186/1471-2318-10-57, 2939541, 20731877.
73. Maly RC, Hirsch SH, Reuben DB. The performance of simple instruments in detecting geriatric conditions and selecting community-dwelling older people for geriatric assessment. Age Ageing 1997, 26:223-231. 10.1093/ageing/26.3.223, 9223719.
74. De L. Letter to the Editor. Age Ageing 2008, 37:484-485. 10.1093/ageing/afn115, 18515292.
75. Melis RJ, van Eijken MI, Teerenstra S, van Achterberg T, Parker SG, Borm GF, van de Lisdonk EH, Wensing M, Olde Rikkert MG. A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). J Gerontol A Biol Sci Med Sci 2008, 63:283-290. 10.1093/gerona/63.3.283, 18375877.
76. Berks J, McCormick R. Screening for alcohol misuse in elderly primary care patients: a systematic literature review. Int Psychogeriatr 2008, 20:1090-1103. 10.1017/S1041610208007497, 18538045.
77. Cigolle CT, Blaum CS, Halter JB. Diabetes and cardiovascular disease prevention in older adults. Clin Geriatr Med 2009, 25:607-641. 10.1016/j.cger.2009.09.001, 19944264.
78. Siris ES, Baim S, Nattiv A. Primary care use of FRAX: absolute fracture risk assessment in postmenopausal women and older men. Postgrad Med 2010, 122:82-90. 10.3810/pgm.2010.01.2102, 20107292.
79. Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R, . US Preventive Services Task Force Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2010, 153:815-825. US Preventive Services Task Force.
80. Bettelli G. Preoperative evaluation in geriatric surgery: comorbidity, functional status and pharmacological history. Minerva Anestesiol 2011, 77:637-646.
81. Aaldriks AA, Maartense E, le Cessie S, Giltay EJ, Verlaan HA, van der Geest LG, Kloosterman-Boele WM, Peters-Dijkshoorn MT, Blansjaar BA, van Schaick HW, Nortier JW. Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Crit Rev Oncol Hematol 2011, 79:205-212. 10.1016/j.critrevonc.2010.05.009, 20709565.