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Frailty—and Its Dangerous Effects—Might Be Preventable

Jennifer Fisher Wilson
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Potential Financial Conflicts of Interest: None disclosed.

Ann Intern Med. 2004;141(6):489-492. doi:10.7326/0003-4819-141-6-200409210-00035
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The differences between a 70-year-old who is robust and one who is frail are easily detectible. Frail older patients are visibly more vulnerable, withdrawn, unsteady, and weak, and they tend to have more complications as they age and a higher rate of hospitalization. In short, doctors know frailty when they see it. But until recently, diagnosing frailty was mostly subjective, and physicians seldom thought of specific treatment. Now medicine has an objective method for diagnosis, and this new method is opening the door for potential treatments. Specialists in the field are moving away from the common view of frailty as an inevitable part of old age toward a new view of frailty as an avoidable condition.



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Frailty Might be Delayed, but not Prevented
Posted on October 5, 2004
Joanne Lynn
Conflict of Interest: None Declared

The "Current Clinical Issues" on frailty (Wilson JF, Annals Int Med 141:489-492, Sept 21, 2004) claimed that "its dangerous effects" might be preventable. The claim seems to evade certain important aspects of the situation. Delaying onset can be important, but nothing now on the horizon is likely to prevent frailty as part of the last phase of life for those who survive into old age.

What is it that the author would envision as the usual life course without frailty - should we come to advanced old age and simply stop? Should we only die of other specific illnesses? Which ones? Preventing frailty would have to amount to having long lives without general decline at the end.

Most people strongly favor "squaring the curve" of disability over the lifetime when possible and delaying both frailty and death, in general. However, claiming that we can and should PREVENT frailty completely has dubious merit. Frailty (without dementia) is actually a rather desirable way to let go of life and die - certainly better than dementia, emphysema, Parkinson's, and many strokes. Since frailty occurs at a later date than the usual dying with cancer and heart disease, it actually might count as the most generally desirable way to die.

People would still want that dwindling of functional capacity and physiological reserves to be as late as possible, but we might not actually want it to be as short as possible. In general, we are not eager to be dead, even if living with disabilities and coming close to the end of life. Furthermore, it is actually rather kind of fate and comfortable for families if the dying person has a little time to wrap things up and be prepared for the end of life.

So, It seems likely that the article really has to reflect a research agenda that aims to delay onset and maybe shorten the course, but not to prevent, frailty. Since frailty is one of the better tracks toward dying, it might be acceptable as part of the necessary end of life. Indeed, frailty may come closest to using up all one can of life, since other more specific illnesses seem to cut short a life that otherwise could have gone on for a while. In a sense, frailty is what a person gets to die from if he or she avoids other lethal conditions earlier in life. Avoiding it completely may not be possible and, if possible, might not enhance our experience of life in its last phase.

Conflict of Interest:

None declared

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