Fragility in Older Adults

Abstract

The term fragility has evolved over time, as a “risk” of dying, losing functions or getting sick, associated with weakness, falls, and malnutrition. Different definitions have included physical, cognitive and psychosocial issues. The discussion of the definition focuses on whether or not psychosocial factors should be included. Most agree that it is a condition associated with aging and that despite the clearness of the concept, the biggest challenge is to find causal factors. Linda Fried defined fragility as the presence of 3 of the following 5 criteria: self-reported chronic fatigue, weakness, inactivity, decreased walking speed and weight loss. This model was replicated and was used as the basis to build the modern model with identification of causal factors such as physiological activation of inflammation, and altered immune, endocrine, and musculoskeletal systems. Other comorbidities included as causal factors are diastolic hypertension, stroke, cancer and COPD; associated to sociodemographic factors such as female gender and low socio-educative level. Finally, fragility was associated to disability with an emphasis on the overlap of the concepts disability/fragility, making it clear that they are not synonyms and not completely exclusive. We conclude that fragility is a multifactorial syndrome and detection of risk groups is the challenge for future research