Frailty

Frailty is a common clinical syndrome (= group of symptoms that characterise a specific condition) in the elderly population. In its simplest form, it is a state of vulnerability to adverse occurrences. As a consequence, small disruptions may turn into important health problems. Frailty hence increases the risk for disability after an incident, accidental falls or hospitalisation. The identification of people at high risk seems to be the best way to prevent and treat frailty efficiently. 

What is frailty?

Frailty refers to a state of increased vulnerability in the elderly. It could be seen as a condition of reduced “reserve capacity” in humans, as a result of which small disruptions may trigger important health problems more easily. 
Frailty is a multiple dimension concept that involves social, physical, psychological and environmental factors and destabilises the physiological balance of a person. The aged body does not regenerate properly and the deterioration mechanism specifically targets muscles, bones, circulation of body fluids, as well as hormone and immune systems. Frailty is also clinically defined as an independent geriatric syndrome characterised by anorexia, sarcopenia (loss of muscle mass), osteoporosis, fatigue, risk of falling and poor physical health. 

Why is it important to measure frailty?

Worldwide the proportion of people aged 60 years and older will increase rapidly during the coming decades. This is mainly the result of four factors: low fertility, longer life span, entry of the third generation of the baby-boom and migration. Since frailty specifically targets the ageing population, data on the prevalence (occurrence), screening, monitoring and surveillance of frailty will become increasingly important.

How is frailty identified?

In the last two decades, two main approaches have been used to identify frailty: the Frailty index and the Frailty phenotype. 
The Frailty index is based on the accumulation of deficits. It is defined as the ratio of deficits present in an individual to the total number of age-related health variables on a predefined list. The latter includes at least 30 variables encompassing different elements, such as symptoms, signs, diseases, disabilities and laboratory abnormalities. No attention is given to the nature of the health problems. The frailty index results in a score ranging between 0 and 1. It 

The Frailty phenotype assesses the vulnerability of older adults through five dimensions: weight loss, weakness, fatigue, slowness in walking and low levels of physical activity. These domains characterise different disease stages and medical conditions. Based on the frailty score people are classified in three categories: robust, pre-frail and frail.

Sciensano conducts regular Health Interview Surveys. Sciensano is also involved in an EU Joint Action that aims to develop successful prevention of frailty in older people.

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