However, our discussion of the epidemiology of frailty in this chapter focuses on the phenotypic definition of Fried`s frailty for a number of reasons. First, there is a growing consensus that frailty is a definable clinical condition with multiple signs and symptoms. Second, the clinical manifestations of frailty can theoretically be organized into a self-sustaining cycle of naturally progressive events (Figure 1) (2, 7) consistent with clinical observations. Third, converging lines of evidence suggest that these manifestations have associations (8-13) consistent with syndromic presentation(1). Fourth, all this provides an a priori theoretical framework that facilitates the study of the mechanisms underlying the development of fragility (14). Finally, we would say that the 5-component phenotype is more attractive for use in a clinical setting than the IF, which typically contains 30 to 70 elements. Frailty syndrome in the elderly is characterized by a gradual decline in physiological reserve, increased susceptibility to stressors, and poor clinical outcomes, including recurrent falls and injuries, progressive hospitalization or disability.1 Although definitions vary, several surgical definitions of frailty have largely prevailed in population studies in older adults. and validated.2,3 The frailty phenotype2 described by Fried and colleagues characterizes frailty as an energy alteration syndrome with five basic clinical characteristics: (1) low grip strength, (2) slow walking speed, (3) low physical activity, (4) self-reported fatigue, and (5) unintentional weight loss. A fragile condition is when three or more of these clinical characteristics are met, and a fragile condition is when one or two criteria are met. The Frailty Index (FI) developed by Mitnitsky and colleagues3 is another commonly used tool to assess frailty and conceptualizes frailty as a state of risk characterized by the accumulation of age-related deficits. The FI calculates the risks of frailty in older adults by taking into account deficits in a number of health conditions, including signs and symptoms, daily activities (ADLs) and instrumental ADLs (LDAI), disability, illness, physical and psychosocial risk factors, and geriatric syndromes identified by routine comprehensive geriatric assessment (ACE).4,5 In both definitions, the concept that multisystemic accumulation of age-related physiological decline underlies frailty and that the sum of these deficits contributes to the development of adverse clinical outcomes. Transitions in states of frailty in older adults living in the community and their associated factors. J Am Med Dir Assoc.
2014;15(4):281-286. Geriatric frailty syndrome is thought to reflect deficiencies in the regulation of several physiological systems, which embodies a lack of resilience to physiological challenges and therefore an increased risk of a number of harmful parameters. In general, empirical assessment of geriatric frailty in individuals attempts to capture these or related traits, although different approaches to such an assessment have been developed in the literature (see de Vries et al., 2011 for a full review).  The questionnaire covers five key indicators of frailty: cognitive impairment, which is assessed by the Trail Creation Test; affective disorders identified using the geriatric depression scale developed by Yesavaggio et al.; maintain equilibrium for less than 10 seconds in the tandem equilibrium test; a BMI 30 kg/m2; and living alone.58–61 A positive result for three or more outcomes is indicative of MSDS.58–59 Individualization appears to be essential in the care of patients with CI and FS. This means that health professionals should focus their interventions on the three areas of human functioning – physical, psychological and social. The focus should be on characteristics such as poor physical health, lack of social relationships, lack of social support, depression and inability to cope with problems, as these problems – as well as the components of frailty and CI – have the greatest impact on the quality of life of older people.74 Lanziotti Azevedo da Silva S, Campos Cavalcanti Maciel Á, de Sousa Máximo Pereira L, Domingues Dias JM, Guimarães de Assis M, Corrêa Dias R. Transition patterns of frailty syndrome in community-dwelling older individuals: a longitudinal study. J Aging of fragility.
2015;4(2):50–55. Handforth C, Clegg A, Young C, et al. The prevalence and outcomes of frailty in elderly cancer patients: a systematic review. Ann Oncol 2015;26(6):1091–1101. Pollack LR, Litwack-Harrison S, Cawthon PM, et al. Models and predictors of frailty transitions in older men: examining osteoporotic fractures in men. J Am Geriatr Soc. 2017;65(11):2473–2479. Frailty is a common geriatric syndrome that carries an increased risk of catastrophic deterioration in health and function in the elderly. Frailty is a condition associated with aging, and it has been recognized for centuries. It is also a marker of a more common frailty syndrome, with associated weakness, slowing down, decreased energy, lower activity and, if severe, unintentional weight loss.
Frailty has been identified as a risk factor for developing dementia. The first paper on the problem of “frail elderly patients” was published in 1953, and frailty syndrome (SF) was first described in the 1990s.1,2 Although it has long been recognized and diagnosed, no consensus definition of this clinical syndrome has been established. The second international working meeting on frailty and ageing in 2006 concluded that FS implies an increased susceptibility to external and internal stressors due to deficiencies in several interconnected physiological systems.3,4 Conclusion With the significant growth of people over 80 years of age and the increase in average life expectancy, clinicians will undoubtedly experience an increase in the prevalence of frailty syndrome. Many of the predisposing factors to frailty occur as a result of the aging process. Most clinicians usually superficially identify frail seniors through the “you know it when you see it” test. Aging is associated with a gradual decline in the musculoskeletal system, resulting in decreased physical and functional capacity due to loss of muscle mass, strength and function, and in conjunction with a deterioration in bone density and structure (Harridge and Lazarus, 2017). Frailty is a syndrome prevalent in the elderly, which can be defined as a state of decomposition and vulnerability at the end of life, characterized by weakness and decreased physiological reserve (Topinková, 2008). Sarcopenia (loss of muscle mass and strength), osteopenia/osteoporosis, slow walking speed, poor balance, decreased physical activity are among the important features of frailty syndrome (Fried et al., 2001; Rockwood and Mitnitsky, 2007). Increased susceptibility in this population contributes to adverse outcomes, including procedural complications, falls, institutionalization, poor psychosocial well-being, decreased quality of life, disability, and death (Fried et al., 2001; Landi et al., 2012; Yu et al., 2014). Frailty syndrome describes a clinical condition of increased vulnerability identified by progressive multisystemic decline, decreased physiological reserve and ability to cope with acute stress, and increased adverse health outcomes.1 Adverse clinical events such as recurrent falls and injuries, frequent hospitalizations, or progressive disability often provide clinicians with evidence that a patient is affected by frailty.2 Unlike these late manifestations, frailty at its earliest stage is often not clinically evident.