Frailty

What it is

Frailty is a state of reduced physiological reserve across multiple systems, leaving the individual unable to withstand minor stressors (infection, surgery, medication change) without disproportionate loss of function. Two main operationalisations:

• Fried physical-frailty phenotype (5 criteria; see Frailty index).
• Rockwood deficit-accumulation index (counts age-related deficits).

Why it matters

• Independent predictor of mortality, hospitalisation, ICU outcomes, post-operative complications.
• Surgical-outcome literature increasingly stratifies by frailty rather than age alone.
• Pre-frail and frail states are reversible with intervention.

Drivers

• Sarcopenia and physical inactivity.
• Chronic disease burden, polypharmacy.
• Malnutrition.
• Depression, social isolation.
• Sensory loss (hearing, vision).
• Chronic inflammation.

What works

• Resistance + balance + aerobic training (LIFE study, multiple RCTs).
• Adequate protein plus exercise (synergistic).
• Polypharmacy review with structured deprescribing.
• Hearing aids (independent functional and cognitive benefit).
• Social engagement.

Related entries

Frailty index, Sarcopenia, Exercise.