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Dimensions of Frailty: Concepts and Practice Guidelines
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Dimensions of Frailty: Concepts and Practice Guidelines

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Aging".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 7351

Special Issue Editors

Dr. Katarzyna Broczek

E-Mail Website
Guest Editor
Polish Society of Gerontology, Branch in Warsaw, 61-245 Poznan, Poland
Interests: internal medicine; geriatrics; psychogeriatrics; medical rehabilitation
Dr. Pietro Gareri

E-Mail Website
Guest Editor
Geriatrician Center for Cognitive Disorders and Dementia, Catanzaro Lido - ASP Catanzaro, 88100 Catanzaro, Italy
Interests: internal medicine; geriatrics; psychogeriatrics; geriatric pharmacology; neuropsychopharmacology

Special Issue Information

Dear Colleagues,

Frailty is one of the fundamental concepts in geriatrics and in recent decades has become a recognized public health problem. Numerous studies have addressed the cellular and molecular bases of frailty, and experiments on muscle proteins conducted in space may in the near future help astronauts exposed to microgravity, as well as potentially preventing age-related sarcopenia on Earth. In addition to the physical frailty phenotype, other types of frailty were described including cognitive, psychological or social frailty and osteosarcopenia.

In practice, frailty is often underdiagnosed or perceived as an inevitable effect of the aging process, while prevention guidelines rely on general rules of a high-protein diet and exercise. It is, therefore, crucial to facilitate and promote simple measures for frailty screening in older adults, early detection of risk factors and more personalized treatment approaches. Practice guidelines should be easily accessible for different levels of care and supported by public health programs similarly to solutions in cardiovascular diseases.

The aim of the present topic is to provide a comprehensive overview of the theoretical bases of frailty and new findings, clues for clinical practice and healthcare systems and the application of novel technologies. We welcome reviews, meta-analyses, research papers, case reports and guidelines for practice. We look forward to a lively discussion between science and pragmatic views with the ultimate goal to promote a proactive approach to frailty.

Dr. Katarzyna Broczek
Dr. Pietro Gareri
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • frailty
  • physical frailty
  • cognitive frailty
  • psychological frailty
  • social frailty
  • aging
  • inflammaging
  • vulnerability
  • sarcopenia
  • osteosarcopenia
  • rehabilitation
  • nutrition
  • exercise
  • novel technologies

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Published Papers (3 papers)

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Research

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18 pages, 1744 KiB  
Article
Frailty Syndrome as a Transition from Compensation to Decompensation: Application to the Biomechanical Regulation of Gait
by Lesli Álvarez-Millán, Daniel Castillo-Castillo, Rosa Quispe-Siccha, Argelia Pérez-Pacheco, Maia Angelova, Jesús Rivera-Sánchez and Ruben Fossion
Int. J. Environ. Res. Public Health 2023, 20(11), 5995; https://doi.org/10.3390/ijerph20115995 - 30 May 2023
Viewed by 1865
Abstract
Most gait parameters decrease with age and are even more importantly reduced with frailty. However, other gait parameters exhibit different or even opposite trends for aging and frailty, and the underlying reason is unclear. Literature focuses either on aging, or on frailty, and [...] Read more.
Most gait parameters decrease with age and are even more importantly reduced with frailty. However, other gait parameters exhibit different or even opposite trends for aging and frailty, and the underlying reason is unclear. Literature focuses either on aging, or on frailty, and a comprehensive understanding of how biomechanical gait regulation evolves with aging and with frailty seems to be lacking. We monitored gait dynamics in young adults (19–29 years, n = 27, 59% women), middle-aged adults (30–59 years, n = 16, 62% women), and non-frail (>60 years, n = 15, 33% women) and frail older adults (>60 years, n = 31, 71% women) during a 160 m walking test using the triaxial accelerometer of the Zephyr Bioharness 3.0 device (Zephyr Technology, Annapolis, MD, USA). Frailty was evaluated using the Frail Scale (FS) and the Clinical Frailty Scale (CFS). We found that in non-frail older adults, certain gait parameters, such as cadence, were increased, whereas other parameters, such as step length, were decreased, and gait speed is maintained. Conversely, in frail older adults, all gait parameters, including gait speed, were decreased. Our interpretation is that non-frail older adults compensate for a decreased step length with an increased cadence to maintain a functional gait speed, whereas frail older adults decompensate and consequently walk with a characteristic decreased gait speed. We quantified compensation and decompensation on a continuous scale using ratios of the compensated parameter with respect to the corresponding compensating parameter. Compensation and decompensation are general medical concepts that can be applied and quantified for many, if not all, biomechanical and physiological regulatory mechanisms of the human body. This may allow for a new research strategy to quantify both aging and frailty in a systemic and dynamic way. Full article
(This article belongs to the Special Issue Dimensions of Frailty: Concepts and Practice Guidelines)
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7 pages, 313 KiB  
Article
Multidimensional Frailty Predicts Mortality Better than Physical Frailty in Community-Dwelling Older People: A Five-Year Longitudinal Cohort Study
by Alberto Cella, Nicola Veronese, Monica Pomata, Katerin Leslie Quispe Guerrero, Clarissa Musacchio, Barbara Senesi, Camilla Prete, Erica Tavella, Ekaterini Zigoura, Giacomo Siri and Alberto Pilotto
Int. J. Environ. Res. Public Health 2021, 18(23), 12435; https://doi.org/10.3390/ijerph182312435 - 26 Nov 2021
Cited by 11 | Viewed by 1947
Abstract
Frailty is a common syndrome in older people that carries an increased risk of mortality. Two main models describe frailty, either as a loss of physical functions or as an accumulation of multiple deficits. The aim of our study was to compare the [...] Read more.
Frailty is a common syndrome in older people that carries an increased risk of mortality. Two main models describe frailty, either as a loss of physical functions or as an accumulation of multiple deficits. The aim of our study was to compare the physical frailty index developed in the Cardiovascular Health Study (CHS) with a multidimensional frailty tool, the Multidimensional Prognostic Index (MPI), in predicting death in community-dwelling older subjects. Four hundred and seven community-dwelling older subjects were enrolled. Each subject underwent a comprehensive geriatric assessment (CGA) with calculation of the MPI and CHS index. Mortality was recorded over the following 5 years. In the overall sample (mean age of 77.9 ± 4.5 years; 51.6% female), 53 subjects (13%) died during the 5-year follow-up period. Both the MPI and CHS index were able to predict mortality; however, the MPI was significantly more accurate than the CHS index in predicting mortality (C-index = 0.69 and 0.59, respectively; p < 0.001), with a statistically significant difference of 10%. In conclusion, multidimensional frailty, assessed by the MPI, predicts five-year mortality in community-dwelling older people better than physical frailty, as assessed by the CHS index. These findings suggest the usefulness of assessing frailty by means of CGA-based tools to predict relevant health-negative outcomes in older people. Full article
(This article belongs to the Special Issue Dimensions of Frailty: Concepts and Practice Guidelines)

Review

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14 pages, 1962 KiB  
Review
Pulse Wave Velocity and Sarcopenia in Older Persons—A Systematic Review and Meta-Analysis
by Karolina Piotrowicz, Alicja Klich-Rączka, Anna Skalska, Barbara Gryglewska, Tomasz Grodzicki and Jerzy Gąsowski
Int. J. Environ. Res. Public Health 2022, 19(11), 6477; https://doi.org/10.3390/ijerph19116477 - 26 May 2022
Cited by 8 | Viewed by 2526
Abstract
Sarcopenia and cardiovascular disease share some of the pathophysiologic mechanisms. Sarcopenia is likewise an important feature of frailty and the one potentially related to cardiovascular pathology. Previously, the relationship between arterial stiffness and frailty has been established. In this study, we conducted a [...] Read more.
Sarcopenia and cardiovascular disease share some of the pathophysiologic mechanisms. Sarcopenia is likewise an important feature of frailty and the one potentially related to cardiovascular pathology. Previously, the relationship between arterial stiffness and frailty has been established. In this study, we conducted a systematic review and a meta-analysis of studies where the relationship between pulse wave velocity (PWV) and sarcopenia has been addressed. We included six cross-sectional studies that enrolled 5476 participants. Using the WebPlotDigitizer, RevMan5, and SAS 9.4, we extracted or calculated the summary statistics. We then calculated standardized mean differences (SMD) of PWV in the sarcopenic and non-sarcopenic participants. The pooled SMD was 0.73 (95% CI 0.39–1.08, p < 0.0001, I2 = 90%) indicating higher value in the sarcopenic subjects. The three studies that presented odds ratios for sarcopenia as a function of PWV homogenously indicated a greater probability of concomitant sarcopenia with higher values of PWV. Greater stiffness of the aorta is associated with sarcopenia. It is impossible to establish the causation. However, the plausible explanation is that increased stiffness may translate into or be an intermediary phenotype of common vascular and muscle damage. On the other hand, sarcopenia, which shares some of the inflammatory mechanisms with cardiovascular disease, may wind up the age-related large arterial remodeling. Full article
(This article belongs to the Special Issue Dimensions of Frailty: Concepts and Practice Guidelines)
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