Frailty in the clinical scenario

The aim of health care has changed substantially—after centuries of trying to live longer, the time for living better has come. This change in focus has two main drivers—societies' life expectancies are approaching natural lifespans, 1 Joint Report prepared by the European Commission (DG ECFIN) and the Economic Policy Committee (AWG)The 2012 Ageing Report. Economic and budgetary projections for the 27 EU Member States (2010–2060). European Commission. Directorate-General for Economic and Financial Affairs, 2012http://ec.europa.eu/economy_finance/publications/european_economy/2012/pdf/ee-2012-2_en.pdf Google Scholar and the gains in life-years have been accompanied by an increase in the rates of disability and a consequent absence of independence in many parts of the world. In the past two decades, a large proportion of the burden of disease has shifted globally owing to morbidity from non-communicable diseases and resulting disability than rather premature death. 2 Murray CJL Lopez AD Measuring the global burden of disease. N Engl J Med. 2013; 369: 448-457 Crossref PubMed Scopus (1248) Google Scholar Disability is the main result of three concurrent factors in older people (older than 60 years): the ageing process, unhealthy lifestyles, and health disorders. Disability is often preceded by a state characterised by reduced capacity to respond to stressors, caused by a decline in functional reserves. This condition—frailty—might precede by several years the development of disability 3 Fried LP Tangen CM Walston J et al. Frailty in older adults: evidence for a phenotype of frailty. J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156 Crossref PubMed Google Scholar and other clinical outcomes, and is a major risk factor for non-catastrophic disability. 3 Fried LP Tangen CM Walston J et al. Frailty in older adults: evidence for a phenotype of frailty. J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156 Crossref PubMed Google Scholar , 4 Xue QL Walston JD Fried LP Beamer BA Prediction of risk of falling, physical disability, and frailty by rate of decline in grip strength: the Women's Health and Aging Study. Arch Intern Med. 2011; 171: 1119-1121 Crossref PubMed Scopus (93) Google Scholar Multimorbidity—older adults need health care that can count past oneThe health-care needs of older people with multimorbidity, and the extent to which these needs are met, are sharp exemplars of the challenges faced by health-care systems across the world in the 21st century. The increase in longevity in developed and developing countries alike is a testament to the success of 20th-century medicine and economic and social development. Research, policy, and action have transformed our ability to prevent infant mortality, to prevent and treat infectious diseases, and to prevent and treat the great killers in midlife such as heart disease and cancer. Full-Text PDF