Abstract:Frailty is a clinical state characterized by increased vulnerability due to the decline of multiple organ functions. It is clinically manifested as slow movement, reduced activity, low energy level and involuntary weight loss. Frailty heightens the risk of disability, long-term hospitalization and mortality in the elderly when they face stressful events. Early assessment of frailty and personalized interventions can prevent and delay its progression, thereby reducing the occurrence of adverse events. This article reviews the literature on frailty published both domestically and internationally from January 2015 to January 2024. It provides an overview of the tools for assessing frailty in the elderly, such as the Clinical Frailty Scale, Frailty Index, Fried Frailty Phenotype, FRAIL Scale, and biological markers, and the management of frailty, including exercise, nutritional interventions, oral health management, and medication management, so as to provide the evidence for early assessment and intervention of frailty.
[1] CLEGG A,YOUNG J,ILIFFE S,et al.Frailty in elderly people[J].Lancet,2013,381(9868):752-762. [2] AFILALO J,ALEXANDER K P,MACK M J,et al.Frailty assessment in the cardiovascular care of older adults[J].J Am Coll Cardiol,2014,63(8):747-762. [3] 田鹏,杨宁,郝秋奎,等.中国老年衰弱患病率的系统评价[J].中国循证医学杂志,2019,19(6):656-664. TIAN P,YANG N,HAO Q K,et al.Epidemiological characteristics of frailty in Chinese elderly population:a systematic review[J].Chin J Evid-Based Med,2019,19(6):656-664.(in Chinese) [4] CESARI M,PRINCE M,THIYAGARAJAN J A,et al.Frailty:an emerging public health priority[J].J Am Med Dir Assoc,2016,17(3):188-192. [5] ROCKWOOD K,SONG X W,MACKNIGHT C,et al.A global clinical measure of fitness and frailty in elderly people[J].CMAJ,2005,173(5):489-495. [6] ROCKWOOD K,THEOU O.Using the Clinical Frailty Scale in allocating scarce health care resources[J].Can Geriatr J,2020,23(3):210-215. [7] 符琳琳,王青,张少景,等.四种衰弱评估工具对老年住院患者出院后全因死亡预测效果比较[J].中华老年多器官疾病杂志,2020,19(9):651-655. FU L L,WANG Q,ZHANG S J,et al.Comparison of four frailty assessment methods for predicting all-cause deaths in discharged elderly inpatients[J].Chin J Mult Organ Dis Elderly,2020,19(9):651-655.(in Chinese) [8] MITNITSKI A B,MOGILNER A J,ROCKWOOD K.Accumulation of deficits as a proxy measure of aging[J].Sci World J,2001,1:323-336. [9] SEARLE S D,MITNITSKI A,GAHBAUER E A,et al.A standard procedure for creating a frailty index[J].BMC Geriatr,2008,8:1-10. [10] FAN J N,YU C Q,GUO Y,et al.Frailty index and all-cause and cause-specific mortality in Chinese adults:a prospective cohort study[J].Lancet Public Health,2020,5(12):650-660. [11] FRIED L P,TANGEN C M,WALSTON J,et al.Frailty in older adults:evidence for a phenotype[J].J Gerontol A Biol Sci Med Sci,2001,56(3):146-156. [12] 郝秋奎,李峻,董碧蓉,等.老年患者衰弱评估与干预中国专家共识[J].中华老年医学杂志,2017,36(3):251-256. HAO Q K,LI J,DONG B R,et al.Chinese experts consensus on assessment and intervention for elderly patients with frailty[J].Chin J Geriatr,2017,36(3):251-256.(in Chinese) [13] XUE Q L,BANDEEN-ROCHE K,VARADHAN R,et al.Initial manifestations of frailty criteria and the development of frailty phenotype in the Women's Health and Aging Study Ⅱ[J].J Gerontol A Biol Sci Med Sci,2008,63(9):984-990. [14] 卫尹,曹艳佩,杨晓莉,等.老年住院患者衰弱综合征现状及影响因素[J].复旦学报(医学版),2018,45(4):496-502. WEI Y,CAO Y P,YANG X L,et al.Frailty syndrome in hospitalized geriatrie patients and its risk factors[J].Fudan Univ J Med Sci,2018,45(4):496-502.(in Chinese) [15] GONÇALVES R S D S A,MACIELÁC C,ROLLAND Y,et al.Frailty biomarkers under the perspective of geroscience:a narrative review[J/OL].Ageing Res Rev,2022[2025-01-27].https://pubmed.ncbi.nlm.nih.gov/36162706.DOI:10.1016/j.arr.2022.101737. [16] BYRNE T,COOKE J,BAMBRICK P,et al.Circulating inflammatory biomarker responses in intervention trials in frail and sarcopenic older adults:a systematic review and meta-analysis[J/OL].Exp Gerontol,2023[2025-01-27].https://pubmed.ncbi.nlm.nih.gov/37156445.DOI:10.1016/j.exger.2023.112199. [17] NAVARRO-MARTíNEZ R,SERRANO-CARRASCOSA M,BUIGUES C,et al.Frailty syndrome is associated with changes in peripheral inflammatory markers in prostate cancer patients undergoing androgen deprivation therapy[J].Urol Oncol,2019,37(12):976-987. [18] 吴粉毅,李维辛,陈菲,等.老年衰弱的生物标记物研究进展[J].实用老年医学,2020,34(8):844-847. WU F Y,LI W X,CHEN F,et al.Advances in research on biomarkers of frailty in the elderly[J].Pract Geriatr,2020,34(8):844-847.(in Chinese) [19] SOYSAL P,ISIK A T,CARVALHO A F,et al.Oxidative stress and frailty:a systematic review and synthesis of the best evidence[J].Maturitas,2017,99:66-72. [20] PINTO M,MORAES C T.Mechanisms linking mtDNA damage and aging[J].Free Radic Biol Med,2015,85:250-258. [21] PILLATT A P,SILVA B D,FRANZ L B B,et al.Muscle,endocrine,and immunological markers of frailty in older people[J].Exp Gerontol,2021,151:1-6. [22] KALANTARIAN H,ALSHURAFA N,LE T,et al.Monitoring eating habits using a piezoelectric sensor-based necklace[J].Comput Biol Med,2015,58:46-55. [23] PRADEEP KUMAR D,TOOSIZADEH N,MOHLER J,et al.Sensor-based characterization of daily walking:a new paradigm in pre-frailty/frailty assessment[J].BMC Geriatr,2020,20(1):1-11. [24] GIANARIA E,GRANGETTO M,ROPPOLO M,et al.Kinect-based gait analysis for automatic frailty syndrome assessment[C].Arizona:2016 IEEE International Conference on Image Processing(ICIP),2016. [25] LOPEZ P,PINTO R S,RADAELLI R,et al.Benefits of resistance training in physically frail elderly:a systematic review[J].Aging Clin Exp Res,2018,30(8):889-899. [26] FUJITA E,TAAFFE D R,YOSHITAKE Y,et al.Repeated sit-to-stand exercise enhances muscle strength and reduces lower body muscular demands in physically frail elders[J].Exp Gerontol,2019,116:86-92. [27] AAS S N,TØMMERBAKKE D,GODAGER S,et al.Effects of acute and chronic strength training on skeletal muscle autophagy in frail elderly men and women[J].Exp Gerontol,2020,142:1-13. [28] MENG X F,LI G C,ZHANG G W,et al.Effects of dance intervention on frailty among older adults[J].Arch Gerontol Geriatr,2020,88:1-7. [29] HUANG C Y,MAYER P K,WU M Y,et al.The effect of Tai Chi in elderly individuals with sarcopenia and frailty:a systematic review and meta-analysis of randomized controlled trials[J/OL]. Ageing Res Rev,2022[2025-01-27].https://pubmed.ncbi.nlm.nih.gov/36223875.DOI:10.1016/j.arr.2022.101747. [30] NEGM A M,KENNEDY C C,THABANE L,et al.Management of frailty:a systematic review and network meta-analysis of randomized controlled trials[J].J Am Med Dir Assoc,2019,20(10):1190-1198. [31] PENG L N,CHENG Y C,YU P C,et al.Oral nutritional supplement with β-hydroxy-β-methylbutyrate(HMB)improves nutrition,physical performance and ameliorates intramuscular adiposity in pre-frail older adults:a randomized controlled trial[J].J Nutr Health Aging,2021,25(6):767-773. [32] KANG L,GAO Y,LIU X H,et al.Effects of whey protein nutritional supplement on muscle function among community-dwelling frail older people:a multicenter study in China[J].Arch GerontolGeriatr,2019,83:7-12. [33] OKTAVIANA J,ZANKER J,VOGRIN S,et al.The effect of protein supplements on functional frailty in older persons:a systematic review and meta-analysis[J].Arch Gerontol Geriatr,2020,86:1-9. [34] WATANABE Y,OKADA K,KONDO M,et al.Oral health for achieving longevity[J].Geriatr Gerontol Int,2020,20(6):526-538. [35] SHIROBE M,WATANABE Y,TANKA T,et al.Effect of an oral frailty measures program on community-dwelling elderly people:a cluster-randomized controlled trial[J].Gerontology,2022,68(4):377-386. [36] KOSSIONI A E,HAJTO-BRYK J,JANSSENS B,et al.Practical guidelines for physicians in promoting oral health in frail older adults[J].J Am Med Dir Assoc,2018,19(12):1039-1046. [37] VAN DER HEIJDEN L T,MIAN P,HIAS J,et al.Highly variable paracetamol pharmacokinetics after multiple oral dosing in frail older people:a population pharmacokinetic analysis[J].Drugs Aging,2022,39(1):83-95. [38] LIAU S J,LALIC S,SLUGGETT J K,et al.Medication management in frail older people:consensus principles for clinical practice,research,and education[J].J Am Med Dir Assoc,2021,22(1):43-49. [39] TOSI F C,LIN S M,GOMES G C,et al.A multidimensional program including standing exercises,health education,and telephone support to reduce sedentary behavior in frail older adults:randomized clinical trial[J/OL].Exp Gerontol,2021[2025-01-27].https://pubmed.ncbi.nlm.nih.gov/34271135.DOI:10.1016/j.exger.2021.111472. [40] KIM C O,JEONG Y H,PARK Y J,et al.Reinforcement effects of social network intervention during nutritional supplementation in frail older adults[J].Gerontology,2021,67(5):620-632. [41] GENÉ HUGUET L,NAVARRO GONZÁLEZ M,KOSTOV B,et al.Pre frail 80:multifactorial intervention to prevent progression of pre-frailty to frailty in the elderly[J].J Nutr Health Aging,2018,22(10):1266-1274. [42] ROLLER-WIRNSBERGER R,LINDNER S,LIEW A,et al.European Collaborative and Interprofessional Capability Framework for prevention and management of frailty-a consensus process supported by the Joint Action for Frailty Prevention(ADVANTAGE)and the European Geriatric Medicine Society(EuGMS)[J].Aging Clin Exp Res,2020,32(4):561-570. [43] SATAKE S,KINOSHITA K,ARAI H.More active participation in voluntary exercise of older users of information and communicative technology even during the COVID-19 pandemic,independent of frailty status[J].J Nutr Health Aging,2021,25(4):516-519.