A person who is frail is said to be “physically weak and delicate (fragile)”. Frailty is defined as “infirmity - the state of being weak in health and body (especially in old age)”.
It is understood to be an increased vulnerability to loss of function whereas disability is actual loss of function. It is a loss of resilience and the loss of ability to withstand physical and psychological stressors.
Frailty is a combination of factors and can occur in younger persons (but in these cases usually a disease process such as cancer or a condition such as Anorexia Nervosa is present).
Dr Linda Fried produced the Fried Framework of Frailty and the definition suggested that for anyone to be considered frail, the person should have 3 or more of the following 5 factors:
- Unintentional weight loss (10 pounds or more in a year).
- General feeling of exhaustion (as self- reported).
- Weakness (as measured by grip strength).
- Slow walking speed.
- Low levels of physical activity.
Frailty occurs on a background of natural ageing and can be precipitated by a factor such as anaemia, joint pain or loss of muscle mass (sarcopenia).
The domains whose functions are usually affected in frailty are: -
- Musculo-skeletal - such as reduced muscle mass [known as sarcopenia], joint pain as in arthritis (leading to reduction in activity, and immobility), polymyalgia rheumatica (painful hip and shoulder muscles with weakness).
- Cardio- respiratory - such as chronic obstructive pulmonary disease, heart failure, anaemia, atherosclerosis and peripheral vascular disease.
- Cognitive - such as cognitive impairment, slower reaction times, depression, [leading to feelings of fatigue, and slower thought processes, reduced activity and motivation, and anorexia].
- Balance and Gait (impaired balance can lead to an increased risk of falling, loss of confidence, and reduced mobility).
- Nutritional Status Anorexia - can often occur as part of the ageing process and also as a consequence of certain diseases such as COPD where eating becomes difficult due to lack of breath. The consequence is chronic under- nourishment, vitamin deficiency and a decline in health.
It is recognised that other factors play a part, and these can include:
- Diabetes mellitus.
- Chronic diseases (such as congestive cardiac failure, COPD).
- Endocrine disorders (such as hyper and hypothyroidism, adrenal gland dysfunction and low testosterone levels (testosterone builds up muscle tissue).
- Pain (leading to restriction of movement and depression).