Introduction
Friability is a physiological state characterized by increased vulnerability to stressors caused by decreased physiologic reserves.
It is an endpoint of multiple disease processes
Aetiology
Multifactorial
- Lack of physical exercise and undernutrition play major roles
Clinical features
Symptoms
- Anorexia
- Fatigue
- Inactivity
- Weakness
- Weight loss
Signs
- Abnormalities of gait and balance
- Deconditioning (loss of physical functioning)
- Osteopenia
- Sarcopenia (decreased skeletal muscle mass, strength and exercise tolerance, thermoregulation, energy expenditure, etc.)
- Slow gait speed (Timed Up and Go test ≥ 15 seconds)
- Undernutrition
Fried’s phenotypic criteria for diagnosis of frailty
- Reduced physical activity
- Self-reported exhaustion/poor endurance
- Slow gait
- Weakness
- Weight loss
Each of the above is scored 1 if present
Total scores are interpreted as follow:
- Robust = 0
- Pre-frail= 1 to 2
- Frail = 3 to 5
Complications
- Acute illnesses
- Dependency
- Disability
- Falls
- Hospitalizations
- Injuries
- Institutionalization
- Mortality
Investigations
- Full blood count
- Electrolytes, urea and creatinine
- Liver function tests
- Thyroid function tests
- Serum calcium and albumin
- Urinalysis
Treatment objectives
- Return patient to baseline status
Non-drug treatment
This should be tailored to address clinical presentation
Drug treatment
Should be tailored to address clinical presentation
Prevention
Multi-dimensional approaches:
- Identify patients who are pre-frail and intervene to return to robustness
- Exercise (endurance and muscle strengthening; stretching and balance exercises)
- Nutrition (healthy food; supplements as indicated)
- Reduce chronic disease prevalence
- Treat sarcopenia
- Promote healthy aging.