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Geriatric Medicine

Geriatric Syndromes and the Syndrome of Frailty

Falls, immobility, incontinence, sarcopenia, osteopenia, delirium, dizziness, mild cognitive impairment, and syncope are examples of geriatric syndromes. Though diverse, these syndromes share common features. They can result from a variety of causes, and each is associated with a constellation of poor outcomes in quality of life, disability, and morbidity (Inouye et al., 2007). Geriatric Syndromes can also share common risk factors, such as older age, functional impairments, decreased mobility, burden of comorbidities, polypharmacy, and poor nutrition.

Physical frailty has been called “the overarching geriatric syndrome” due to the hypothesis that it usually coexists with, and may influence the development of, other geriatric syndromes and their common risk factors (Inouye et al., 2007). For example, frailty predicted future falls in community-dwelling older adults in a meta-analysis, despite that contributing studies used varying frailty assessments (Kojima, 2015). Decreased strength and physical impairments may play a common role in this association, as well as with associations of frailty with incontinence. Conversely, incident incontinence is associated with risk for functional impairment, and thus may be an early marker of frailty onset (Wagg et al., 2015). The physical frailty phenotype is also associated with the development of postoperative delirium (Leung, 2011).

The underlying biology that drives the link between these syndromes is not well known, but chronic inflammation and dysregulation in stress response systems likely play a role. Inflammatory pathways are known to contribute to frailty and to delirium, for example. Given these biological commonalities, the early detection of subclinical changes or deficits at the molecular, cellular, and/or physiologic level could be key to preventing or delaying the development of frailty and related geriatric syndromes.