September 2019

An Excerpt: Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management 

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Frailty is prevalent in all countries and is a leading contributor to functional decline and early mortality in older adults. The condition is defined as “a clinical state in which there is an increase in an individual’s vulnerability for developing an increased dependency and/or mortality when exposed to a stressor.” Frailty can begin before 65 years of age, but the onset escalates in those aged 70 years and over. Nonetheless, frailty is not an obligatory part of the ageing process, and many adults reach advanced ages without developing frailty. Accordingly, various long-term risk factors of frailty, like overweight/obesity, physical inactivity, cardiovascular risk, self-rated health, and alcohol use have been identified.

The current estimate of physical frailty prevalence is around 15% for adults aged 65 years and over, based on a recent meta-analysis of community-dwelling older Europeans. In adults aged over 85 years, prevalence increases to over 25%. Frailty prevalence is also elevated in persons with lower education, low socioeconomic position, or from ethnic minority groups. In addition, women tend to have a higher prevalence of frailty than men, although they may be more resistant to decline in frailty status over time.

The number of older adults with frailty is increasing, likely due to increased survival of older adults with co-morbidities, more exposure to sedentary lifestyles, and smaller social support networks. There is much potential for frailty to be reversed, particularly in its early stages. For that reason, early identification and management of frailty is an important priority for both healthcare providers and healthcare policy makers.

The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. The recommendations (see Table, above) focus on the clinical and practical aspects of care for older people with frailty and promote person-centered care.

Where sufficient evidence was available from systematic reviews/meta-analyses, recommendations were ranked according to the GRADE approach (1). Where evidence was limited in systematic reviews/meta-analyses or for topics beyond the scope of systematic reviews, Consensus Based Recommendations (CBR) were formulated by the International Conference of Frailty and Sarcopenia Research (ICFSR) task force on frailty; † ‘No data’ indicates no data identified by systematic reviews.

 

In general, the task force strongly recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context. Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). For management, a comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multicomponent physical activity program with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

Source: This excerpt is from Dent E, Morley JE, Cruz-Jentoft AJ, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23:771. https://doi.org/10.1007/s12603-019-1273-z. References have been removed for brevity. Use is per the Creative Commons Distribution 4.0 International License. To read the full article, go to https://link.springer.com/article/10.1007/s12603-019-1273-z#citeas.

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