Biomedical Engineering Reference
In-Depth Information
with various models. The “physical phenotype” defines frailty as a biological syndrome
of decreased physiological reserves resulting in a cumulative decline in all physiologi-
cal systems and vulnerability to adverse outcomes and provides an operational definition
by means of measurable items (exhaustion, weight loss, low energy expenditure, weak
grip strength, and slow walking speed) that allow the classification of older people in
“no frailty,” “intermediate,” and “frail” groups (Fried et al. 2001). This model supports the
distinction among frailty, comorbidity, and disability. The physiological changes associ-
ated with aging can be considered as being the factors that contribute to frailty. Frailty can
cause a risk of disability, but the fundamental concept is that although frailty, disability,
and comorbidity are often associated, one is not synonymous with the other: Comorbidity
represents an etiological factor of frailty and disability is an outcome of frailty (Fried et al.
2001, 2004). Disability can arise from a dysfunction in a single system or in many systems,
but frailty always implies a multisystem dysfunction. Disability does not need to be asso-
ciated with instability, whereas frailty always is (Rockwood et al. 2000). Frailty is a pre-
dictor of falls, hospitalization, disability, and death (Fried et al. 2001). The “multidomain
phenotype” includes multidomain models resulting from regression models that consider
cognitive, functional, and social aspects (Abellan van Kan et al. 2010). Frailty measures
depending on the deficit identify frailty by means of comprehensive geriatric assessment.
Rockwood and colleagues (1999) compiled a frailty index considering cognitive status,
mood, motivation, communication, mobility balance, bowel and bladder functions, activi-
ties of daily living, nutrition, and social resources as well as several comorbidities. This
index was highly predictive of death or institutionalization. More recently, a standard pro-
cedure for constructing a frailty index was proposed (Searle et al. 2008). On the basis of the
idea that having more health deficits corresponds to a major probability of becoming frag-
ile, the frailty index counts deficits in health (symptoms, signs, diseases, and disabilities or
laboratory, radiographic, or electrocardiographic abnormalities). At the same time, in this
theoretical framework, disability and dementia are components of the frailty index and
are evaluated as poor clinical outcomes in the theoretical framework. The social domain
receives particular attention because social isolation could have a strong impact on the
development of dementia or disability (Abellan van Kan et al. 2010).
Now it appears clearer why Hazzard defines the geriatrician as an expert in subtlety
and complexity. The explanation of these three main concepts highlights how complex
this particular population is and the effective need of an expert physician. In fact, the care
of older people differs from that of younger people for different reasons related to life
expectancy, disease prevalence and comorbidity, social resources, goals of treatment, and
preferences for care (Reuben et al. 2003).
13.3 Geriatric Assessment
The Geriatric Medicine Section of the European Union of Medical Specialists (UEMS)
defines geriatric medicine as “a specialty of medicine concerned with physical, mental,
functional and social conditions in acute, chronic, rehabilitative, preventive, and end of life
care in older patients” with the aim to “optimise the functional status of the older person
and improve the quality of life and autonomy” (2008, p. 1). Older patients are described as a
group that requires a holistic approach and difficulties in the diagnostic process, response
to treatment, and the need for social support are emphasized.
 
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