Frail Elderly

by

William Satariano, Marlon Maus

• LAST REVIEWED: 25 June 2013
• LAST MODIFIED: 25 June 2013
• DOI: 10.1093/obo/9780199756797-0078

Introduction

The frail elderly are the subject of a growing number of conferences, consensus panels, review articles, book chapters, editorials, and special issues in scientific journals. In addition to addressing the needs of older adults at significantly high risk for ill health and disability, research on frailty is driven by a concern with the rising costs for health and social services for this population. Although there is general agreement that frailty represents generalized, age-related vulnerability, there is less agreement about the specific components of frailty and the operational criteria by which it should be measured. Several definitions and models have been proposed to better conceptualize frailty as a multidimensional geriatric syndrome. There is a growing consensus that the “phenotype” of frailty includes a core set of physical items (weakness, fatigue, poor walking speed, unexpected weight loss, and low levels of physical activity). Specific measurement criteria are in place to measure each of these items, providing the means by which the severity and progression of frailty can be assessed. The frailty phenotype also has served to direct research into the physiology of frailty, which is characterized by inflammation and sarcopenia (age-related loss of muscle mass) as well as impairment of separate organ systems and disruptions in the communication and coordination among those systems. The elements included in the characterization of the frailty syndrome are evolving, and several researchers feel that depression and cognitive dysfunction in addition to obesity should also be included. It is has also been proposed that the definition of frailty be expanded to include social and environmental factors. In addition to these components, there are competing formulations that consider overall decrements in seventy items, including symptoms, functional status, history of specific health conditions, and falls. The crux of the debate regarding the concept and measurement of frailty has to do with distinctions between components of frailty and which factors are predictors or outcomes of frailty. Most of the interventions intended to postpone or reduce the severity of frailty have focused on promotion of physical activity and good nutrition. In conclusion, frailty, a geriatric syndrome, is central for consideration of the biology, epidemiology, and economics of aging. Future research is needed to resolve the controversial issues and to advance the research, practices, and policies necessary to address the needs of expanding and increasingly diverse aging populations.

Introductory Works

Dychtwald 1999, an edited book, includes several chapters that introduce important general concepts in geriatrics, but also several focusing on the special needs of the frail elderly. Olson 2003 introduces the issues involved in caring for the frail elderly in long-term care establishments in the United States. It makes an extremely compelling case for the need for reform in view of the fact that there is no real system of long-term care in this country. Various alternatives to institutionalization have been proposed as a way of providing needed care for the frail elderly, especially after hospitalization. One such program is a foster care program for the frail elderly created by the Johns Hopkins Hospital and funded by the Robert Wood Johnson Foundation, described in Oktay 1988. Cox 1993 presents several options regarding policies, community responses, housing, caregiving, and familial and ethnic considerations in different models intended to decrease the need for institutionalization of the frail elderly. The main premise of the book is that the frail continue to desire and seek as much independence as possible. Many innovative approaches that communities and state agencies are developing are described.

• Cox, C., ed. 1993. The frail elderly: Problems, needs, and community responses. Westport, CT: Auburn House.

  The author argues for consistency, comprehensiveness, and coordination in developing a nonmedical model of care for the frail, with greater attention to home care services because they are both more economical and dignified than institutionalization.

• Dychtwald, K., ed. 1999. Healthy aging: Challenges and solutions. Gaithersburg, MD: Aspen.

  This textbook has several chapters that present general concepts of healthy and successful aging, and introduces models for the care of frail elderly patients. Although somewhat dated, it also covers several economic issues for the provision of care to the elderly.

• Oktay, J. S., ed. 1988. Community care for the frail elderly: The Johns Hopkins Hospital Program. New York: Human Sciences.

  The authors present an alternative to institutionalization of frail elders discharged from hospital settings. Foster care programs, in particular the one developed by the Social Works Department of the Johns Hopkins Hospital, are described.

• Olson, L. K. 2003. The not-so-golden years: Caregiving, the frail elderly, and the long-term care establishment. Lanham, MD: Rowman & Littlefield.

  The book focuses on long-term care establishments for the frail elderly. It makes a case for the need for reform in view of the complete lack of a long-term health system in the United States and the lack of a sound approach to caring for people who require ongoing help with basic activities of daily living.