What Is Frailty? And How Do You Measure It?

Supreme Court Justice Potter Stewart is oft remembered for his quote that while obscenity may be hard to define, "I know it when I see it."  In that fashion, I feel similarly about frailty.  After all, we've all seen or known frail elderly.  But just what is it that makes them frail?  It can't be disability because many people w/disabilities are not frail.  What about comorbidities?  Same issue: many people w/multiple comorbidities aren't frail either.  Of course, there are those w/disabilities and/or multiple comorbidities who are patently frail upon first inspection.  But how do you describe/define a frail person who's not standing or sitting in front of you?

While this may appear to be an academic question that is moot, in fact, it's very important to clarify definitions so that we're talking about the same thing w/our colleagues.  We can't study something unless we know what we're studying so that we're all studying the same thing.  In fact, within the rapidly expanding research field of frailty, there is no working gold-standard definition: there are at least 27 scales or indices attempting to define frailty without using a picture.  In a review article published last month in BMC Geriatrics, the authors noted that the Phenotype of Frailty is the most commonly used and validated scale to measure frailty in the elderly.

It turns out that the original Phenotype of Frailty was published in the Journal of Gerontology: MEDICAL SCIENCES.  The authors developed their index based upon self-reported exhaustion, unintentional weight loss (greater than 10 pounds in a year), weakness (as measured by grip strength), slow walking speed, and low physical activity.  To qualify for any of the last 3 criteria, you had to be in the lowest 20% by gender, body mass index, and/or height.  Phenotype of Frailty was defined as 3 or more of the criteria while just 1 or 2 criteria was considered intermediate or pre-frailty.

I guess if you put it that way, it's not so difficult.  Exhaustion.  Weight loss.  Weakness.  Slow walking.  Low physical activity.  Regardless of disability or comorbidity (although either or both could certainly complicate the issue).  So now you know it, even if you don't see/have the person in front of you.  And if you think about, frailty can be addressed by nutrition & exercise as well as reviewing medications.  Get out there and start looking!

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