Frailty Dramatically Increases Mortality Risk at any Age
Frailty syndrome is known to be associated with risk of death. It is a collection of signs of an advanced stage of damage and consequent dysfunction in the body, to the point at which loss of strength prevents most activities and the immune system can barely defend against pathogens. Researchers here add to the body of evidence demonstrating that frailty is linked to mortality; frail individuals at any age are in a worse position than their less frail age-matched peers. For all of the obvious reasons, the banishment of frailty from the human condition is one of the more important near term goals for the rejuvenation research community. It may be possible to achieve this to a fair degree through a narrow focus on the comprehensive control over chronic inflammation, as many of the components of frailty appear to be greatly influenced by the growing inflammation and incapacity of the immune system with age.
The concept of frailty is well established. Many clinicians diagnose it and know that it may negatively impact on a patient's clinical condition. However, it is often diagnosed in a subjective 'end of the bed' test rather than by using specific diagnostic criteria, despite being recognised as a factor influencing outcomes in geriatric research for many years. Frailty is a state in which a vulnerable individual, has a diminished physiological capacity to respond to external stress such as infection or trauma.
There are many instruments used to measure frailty, with variation in their composition. Development of these tools, and frailty research generally, have historically focused on older populations, but the recent publication finding the existence of frailty and its' negative impact on outcomes in younger adults (aged over 40 years) admitted as a surgical emergency suggests that frailty is not a diagnosis exclusive to older adults. The exact prevalence of frailty is currently unknown, recent studies have reported this between 8% and as high as 37%, but any estimate is a combination of heterogeneous subgroups and shows variation depending on the tool used to detect frailty.
This study aimed to evaluate the prevalence of frailty its associated risk of mortality, readmission rate and length of hospital stay in all adults, regardless of age, admitted as a surgical emergency. To evaluate the impact of frailty across the full range of the frailty spectrum the 7-point Clinical Frailty Scale was used and the outcome measures assessed for each incremental point increase. The cohort included 2,279 patients (median age 54 years; 56% female). Frailty was documented in patients of all ages: 1% in the under 40s to 45% of those aged 80+. We found that each incremental step of worsening frailty was associated with an 80% increase in mortality at Day 90, supporting a linear dose-response relationship. In addition, the most frail patients were increasingly likely to stay in hospital longer, be readmitted within 30 days, and die within 30 days.