Core Features

There is agreement that frailty is a syndrome encountered in older individuals that is marked by increased vulnerability to a number of adverse outcomes. Other hallmarks are the presence of multisystem impairment (see preceding section) and the concept of a gradient. Although vulnerability is present to a degree in all of us, frailty is marked by a greater than normal susceptibility. In studies we will likely continue to treat frailty as either a dichotomous value (frail/ not frail) or categorize it on a short ordinal frailty scale (e.g., not present, mild, moderate, and severe frailty) in order to make the data easier to manage and understand. There is likely a diverse mix of predisposing, precipitating, enabling, and reinforcing factors (see Table 50.1). It is hoped that a characteristic clustering of characteristics will allow for its accurate identification (see Table 50.2). The consequences of frailty in a given individual will depend on their particular balance of assets and deficits (see Table 50.3). The physical and social environment of the older person coupled with how they cope with their limitations will be modifiers of outcomes. As can be seen, there is some overlap between Tables 50.1 and 50.2 as well as between Tables 50.2 and 50.3. This arises because of our current uncertainty about the patho-genesis, manifestations, and consequences of frailty. Ultimately there should be a clear distinction between the three.

Figure 50.1 Life course model for frailty. 622

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