Frailty and Ageing

Frailty is a common condition affecting older adults, but is not an inevitable part of the ageing process. Frailty is a method of describing the observed heterogeneity in function, disability and health among older people. Importantly what frailty identification allows is the prediction of risk of adverse events such as mortality or disability. Frailty is defined as a syndrome with multiple causes and contributors that is characterised by diminished strength, endurance and reduced physiological function that increases an individual’s vulnerability for developing increased dependency and/or death. Frailty is important clinically as older people with frailty present to healthcare services atypically with frailty syndromes such as falls and delirium. Frail older adults may benefit from assessment by specialist geriatricians and a wider multi-disciplinary team.
Frailty is associated with changes to the immune system, importantly the presence of a pro-inflammatory environment and changes to both the innate and adaptive immune system. Some of these changes have been demonstrated to be present before the clinical features of frailty are apparent suggesting the presence of potentially modifiable mechanistic pathways. To date, exercise programme interventions have shown promise in the reversal of frailty and related physical characteristics, but there is no current evidence for successful pharmacological intervention in frailty. Multicomponent interventions such as those based on Comprehensive Geriatric Assessment have also demonstrated some reversal of frailty.
There are numerous knowledge gaps within the literature. A clearer understanding of the fundamental science underpinning frailty is vital to allow for the development of successful interventions.