Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K

Lancet 2013;381:752-62

Publication date: March 2, 2013


The healthcare systems of today are characterized primarily by single-system illnesses, despite the fact that many elderly people have multi-organ problems that often result naturally from aging. Frailty in particular is a prevalent, unifying aspect of aging that warrants attention away from organ-specific treatment but towards a more holistic study of the body and existing diseases.

Clegg et al. discuss a variety of the roles and manifestations of several aspects of declining bodily function that occur as we age, such as an increasingly frail brain, endocrine system, and immune system, as well as skeletal muscle loss (sarcopenia). They also elaborate on two models of frailty: the phenotype model and the cumulative deficit model. The phenotype model involves the presence of a panel of 5 underlying age-related factors that are predictors of frailty: unintentional weight loss, self-reported exhaustion, low energy expenditure, slow gait speed, and weak grip strength. The cumulative deficit model encompasses the premise that frailty is based on the cumulative effect of a number of individual symptoms, signs and abnormal laboratory values, disease states, and disabilities (collectively referred to as deficits). This review also discusses several other aspects of aging and frailty, including pathophysiology, prevalence, outcomes, epidemiology, instrumentation and interventions.


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