see also:

• geriatrics
• exercise for health

• frailty is the accumulation of deficits with ageing resulting in mobility issues, loss of independence
• the level of frailty is an important factor in:
  • falls risk
  • depression due to mobility issues, loss of independence
  • need for emergency department attendance - 20-40% of ED attendances are said to be for those who are frail
  • impaired ability to return to prior baseline levels after an acute illness or even following ED processes - each episode likely to further increase long term frailty
  • mortality risk

• there appear to be genetic risk factors
  • a 2025 study suggested there were many genes that affect how our immune system, brain and metabolism work which contribute to risk of frailty ¹⁾
• ageing
• cognitive deterioration
• psychological deterioration
  • falls result in increased risk of falls partly due to loss of confidence, possibly depression leading to inattention
• physical deterioration
  • musculoskeletal
    • chronic pain / disabiity
    • sarcopenia / generalised muscle wasting
      • reduced protein intake
      • alcohol
      • smoking
      • exercise
      • hormonal
      • pathologic
      • genetic factors account for ~50-60% of sarcopenia variability - see sarcopenia / generalised muscle wasting
  • neurologic disabilities
  • impaired vision/hearing may lead to increased risk of falls, social isolation, depression, etc

• 1. “very fit”
• 2. “well” - no active disease symptoms, occasionally very active or exercise
• 3. “managing well” - well controlled medical symptoms but are regularly active beyond regular walking
• 4. “vulnerable” - symptoms limit activities, “slowed up” or “tired during day” but not dependent upon others
• 5. “mildly frail” - more evident slowing and may need help with higher level IADLs (usually unable to walk outside alone or go shopping)
• 6. “moderately frail” - need help with all outdoor activities and with keeping house. Have problems with stairs and bathing.
• 7. “severely frail” - completely dependent for personal care
• 8. “very severely frail” - approaching end of life - may not recover from a minor illness.
• 9. “terminally ill” - end of life with life expectancy < 6 months even if not otherwise evidence of frailty

• Fatigue - are you fatigued?
• Resistance - cannot walk up 1 flight of stairs?
• Aerobic - cannot walk 1 block
• Illnesses - more than 5 illnesses
• Loss of weight - > 5kg LOW in past 6 months

score: 0 = robust; 1-2 = prefail; 3-5 = frail

• score 0-2 on 11 domains:
  • cognition
  • hospital admissions past year
  • self-reported general health status
  • functional independence - number of activities need help with
  • social support availability
  • 5 or more medications
  • do you forget to take medications
  • nutrition - weight loss
  • mood - sad or depressed?
  • continence
  • functional performance - how long to get out of chair, walk 3m and get back to sitting in chair (0 = <10sec, 1 = 10-20sec, 2 = >20secs or unable)
• score 0-5 not frail
• score 6-7 = vulnerable
• score 8-9 = mildly frail
• score 10-11 = moderate frailty
• score 12-17 = severe frailty

• mobilising as soon as possible
• high protein meals
• glasses of water
• encourage families to visit
• encourage self washing, dressing, etc
• enure night rest
• early discharge planning

• regular aerobic and muscle bulk maintenance exercises
• risk mitigation to prevent trauma and its associated long term disabilities which lead to frailty
  • risk assess activities and manage appropriately even when young adults
    • don't be stupid
    • take extra care in high risk situations
  • falls risk prevention
• maintenance of social networks
• healthy lifestyle to reduce cardiovascular, stroke, obesity, diabetes and osteoporosis risks in particular
• no smoking
• adequate protein in diet - the body does not store protein except in muscles - you don't want these wasting away