The ultimate goal of frailty research is to support healthy aging for all older adults. For clinical practice, this means improving risk assessment for those undergoing medical or surgical treatments and finding new ways to reduce the risk of complications and adverse health outcomes related to frailty. Validated tools have been developed to measure frailty and to determine risk assessment in populations of older adults. These include the Physical Frailty Phenotype, the Deficit Accumulation Index, and several shorter tools that have been proposed as screening methods to find those older adults at higher risk of adverse health outcomes, such as the FRAIL Scale, the Clinical Frailty Scale, and the Edmonton Frail Scale. Although there are many tools now available to identify frail, at-risk older adults, there are many fewer studies and case reports on how best to manage frail, older adults once they are identified in clinical settings.
This section reviews information available from primary care providers, subspecialty health care providers, and researchers who seek to implement frailty assessment in their practice and who seek guides to help their clinical decision-making processes for their older patients.
Frailty in Primary Care and Geriatric Medicine
Screening for frailty in primary care or geriatric medicine settings can provide important information on patients regarding their risk for a wide-range of adverse health outcomes, including falls, cognitive and functional decline, procedural complications, and early mortality. Current expert consensus recommends that all adults age ≥70 or any older adult experiencing weight loss >5% over a year should be screened for frailty (Morley et al., 2013). The UK presently recommends that those older adults identified as frail by any of the common screening methods should undergo a Comprehensive Geriatric Assessment (Turner et al., 2014), which can help to identify more specific medical, social, psychological, or functional/cognitive issues to target. In addition, increased activity levels and exercise have been broadly accepted as an intervention that can improve health and quality of life in frail, older adults.
Frailty for Subspecialists
Subspecialists in medical and surgical fields are increasingly interested in the identification of older adults who are at high risk for surgical procedures and medical treatments such as chemotherapy. Understanding the impact of frailty on each particular patient population and on procedures is key to the design of safer and more effective treatment and care plans. Many studies have been performed by subspecialists that identify a significantly higher risk profile in those who are frail compared to those who are more robust. However, fewer guidelines that aim at better management recommendations for those about to undergo treatments or procedures have been studied and published. As knowledge evolves, it will be increasingly important to provide well-studied guidelines and care plans on how best to manage frail, older adults in subspecialty practices, especially those facing risky medical or surgical treatments or procedures.
The links listed below provide a more detailed look at risk related to frailty and in some cases recommendations on how best to manage frailty in these clinical populations.
Going forward, we will provide state of the art overviews of relevant information on the management of frail, older adults in each of these disciplines.
- Infectious Diseases
- Pulmonary Medicine
- Transplant Surgery
- Other medical specialties