Background: Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use. Methods: In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators. Results: Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments. Conclusions: Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.

/pdf/measures-of-frailty-in-population-based-studies-an-overview-4s348cgo27.pdf

Measures of frailty in population-based studies: an overview

Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were "frailty", "frail", "frail elderly", "depressive", "depressive disorder", and "depression". Participants of included studies were ≥ 55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al's criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥ 55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral interventions for frailty and depressive symptomatology that prevent adverse sequelae such as falls, disability, and premature mortality.

/pdf/depression-and-frailty-in-later-life-a-systematic-review-59jrtz2ad8.pdf

Depression and frailty in later life: a systematic review.

Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: Results from the Women's Health and Aging Study (WHAS) II

Osteoporosis and osteoporotic fractures remain significant public health challenges worldwide. Recently the concept of frailty in relation to osteoporosis in the elderly has been increasingly accepted, with emerging studies measuring frailty as a predictor of osteoporotic fractures. In this overview, we reviewed the relationship between frailty and osteoporosis, described the approaches to measuring the grades of frailty, and presented current studies and future research directions investigating osteoporosis and frailty in the elderly. It is concluded that measuring the grades of frailty in the elderly could assist in the assessment, management and decision-making for osteoporosis and osteoporotic fractures at a clinical research level and at a health care policy level.

/pdf/an-overview-of-osteoporosis-and-frailty-in-the-elderly-2r9g4msw10.pdf

An overview of osteoporosis and frailty in the elderly

The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.

The frailty syndrome: a comprehensive review.

Le patient âge fragile est un sujet a haut risque de fracture de hanche. Toutefois, il accede peu a l’organisation aux mesures prevenant la chute et rarement a l’approche diagnostique et therapeutique de l’osteoporose. Cette revue de la litterature porte sur les liens entre le syndrome de fragilite et le risque de fracture de hanche. Elle fut discutee lors d’une reunion d’un groupe de geriatres, d’endocronologues, de rhumatologues et de gynecologistes. Le concept de fragilite permet d’envisager une approche differente du risque de fracture de hanche des sujets âges. Des perspectives de prevention, d’organisation des soins specifiques semblent pertinentes au sein de cette population. Le modele classique, voulant que l’on traite individuellement chaque pathologie, se prete mal a la prise en charge du sujet fragile. L’approche diagnostique de l’osteoporose axee sur la majoration de la densite minerale osseuse (DMO) est necessaire mais probablement insuffisante dans cette population. L’objectif therapeutique ne peut pas se limiter a l’augmentation de la DMO. La prevention de la chute en ameliorant les facteurs determinant du syndrome de fragilite (force, statut nutritionnel, activite physique, cognition) sont des approches therapeutiques qui devraient limiter l’incidence des fractures. Des etudes supplementaires, orientees vers le sujet fragile, permettraient de mieux comprendre les effets de la prise en charge de la fragilite sur la fracture. En parallele, la prise en charge plus systematique de l’osteoporose devrait limiter le risque d’une personne âgee robuste de devenir fragile et d’une personne fragile de devenir dependante.

Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques

Objective: The aim of this review of the literature is to report the factors which both contribute to the frailty syndrome and increase hip fracture risk in the elderly. This work is the fruit of common reflection by geriatricians, endocrinologists, gynecologists and rheumatologists, and seeks to stress the importance of detection and management of the various components of frailty in elderly subjects who are followed and treated for osteoporosis. It also sets out to heighten awareness of the need for management of osteoporosis in the frail elderly.Design: The current literature on frailty and its links with hip fracture was reviewed and discussed by the group.Results: The factors and mechanisms which are common to both osteoporosis and frailty (falls, weight loss, sarcopenia, low physical activity, cognitive decline, depression, hormones such as testosterone, estrogens, insulin-like growth factor-I (IGF-I), growth hormone (GH), vitamin D and pro-inflammatory cytokines) were identified. The obstacles to access to diagnosis and treatment of osteoporosis in the frail elderly population and common therapeutic pathways for osteoporosis and frailty were discussed.Conclusion: Future research including frail subjects would improve our understanding of how management of frailty can can contribute to lower the incidence of fractures. In parallel, more systematic management of osteoporosis should reduce the risk of becoming frail in the elderly population.

/pdf/frailty-osteoporosis-and-hip-fracture-causes-consequences-3lf40yi830.pdf

Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives.

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Fragilité, ostéoporose et fracture du col du fémur: causes, conséquences et perspectives thérapeutiques

Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives.