Comprehensive review highlights urgent need for frailty-focused clinical care in older adults

A review appeared in New England Journal of Medicine highlights the critical importance of treating frailty in older adults. The comprehensive article, entitled “Frailty in Older Adults,” provides an in-depth analysis of the biological basis of frailty, the need for early detection and intervention, and outlines promising future directions for healthcare professionals.

Authored by Dae Hyun Kim MD, ScD, MPH, founder of the Frailty Research Program at the Marcus Institute for Aging Research at Hebrew SeniorLife, and Kenneth Rockwood, MD, MPA, FRCPC, professor in the Division of Geriatrics, Department of Medicine, Dalhousie University, Halifax, NS, Canada, the study addresses frailty as a condition characterized by diminished physiological reserves and increased vulnerability, which significantly compromise the effectiveness and safety of health interventions. Current treatment strategies are becoming increasingly individualized, addressing the unique needs of older adults based on an assessment of their frailty and its causes.

“Frailty should be central to health care planning for older people and should be considered in both preventive and therapeutic decisions,” said Dr. Kim.

The Centers for Medicare and Medicaid Services (CMS), a federal agency that insures over 160 million people, “recently approved the addition of age-appropriate hospital measurement domains to the Inpatient Hospital Quality Reporting program. One of the five domains is frailty screening and intervention, which makes our review article very timely because it essentially covers the latest evidence on how to do frailty screening and interventions,” Dr. Kim added.

Understanding frailty and the urgency of screening and management

Frailty is characterized by a decline in physiological reserves and increased vulnerability to stressors and leads to a higher risk of negative health outcomes. The prevalence of frailty increases with age and is an important predictor of future disability and mortality.

The main biological factors contributing to frailty include chronic inflammation, the production of inflammatory molecules by aged cells (“cellular senescence”), reduced energy production in cells (“mitochondrial dysfunction”), impaired cellular nutrient sensing, and hormonal imbalances. All of these factors contribute to fatigue, lack of endurance, muscle loss and weakness, and a slowing of walking speed.

The study highlights the importance of frailty screening and implementing tailored interventions to effectively manage frailty. Interventions such as nutritional support, physical exercise programs and comprehensive geriatric assessments have been shown to benefit patient outcomes.

In addition, assessing frailty prior to stressful treatments such as surgery or chemotherapy can help identify appropriate candidates and optimize health status to improve treatment outcomes. The authors advocate for integrating frailty assessments into routine clinical practice to enable healthcare providers to personalize treatment plans and allocate resources more effectively.

Innovative interventions and future directions

Dr. Kim and Dr. Rockwood summarize the latest evidence on various interventions to manage frailty, including exercise programs to improve strength and mobility, nutritional strategies to increase muscle mass and function, and medication review and optimization.

They also discuss the need for further research to investigate the potential of big data-based approaches to improve frailty screening and collaborative care models, such as in geriatric cardiology, geriatric oncology and geriatric surgery, to improve safety and health outcomes in hospitalized patients.

Finally, the authors call for a multidisciplinary approach to frailty care that includes collaboration between geriatricians, general practitioners, physiotherapists and dieticians. By promoting an environment of proactive health management, the health system can better meet the needs of an ageing population.

Dr. Kim emphasizes the importance of this research, stating, “Our goal is to provide an important resource to help health professionals, caregivers, and policy makers better understand and manage frailty, ultimately improving outcomes for older adults. As the older population continues to grow, the results of this research are expected to shape the future of health policy and practice for older adults.”

Provided by Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research