The Frail Aged

Developing a precise definition of frailty or an understanding of why it occurs remain areas of debate. Frailty is often defined by Fried’s criteria as unintentional weight loss, self-reported exhaustion, slow gait, weakness and low physical activity. A diagnosis of frailty requires three or more criteria to be present. [1] Some descriptions of frailty also include changes in mood, cognition, disability and the presence of multiple co-morbid illnesses. [2]

Frailty implies increased vulnerability to stressors, risk of multiple adverse health outcomes and decline in function. It is not clear whether this is accelerated ageing or due to a specific disease process. [3] Research has found increased risks associated with developing frailty. [4] These include:

  • Falls
  • Fractures
  • Osteoporosis
  • Disability
  • Shortened life expectancy
  • Multiple co-morbid illnesses.

The last year of life is characterised by a steady decline in overall function, rather than a sudden decline in any one domain. [5] Frail older people may or may not have dementia. Frailty and dementia together predicts a more rapid decline and shorter life expectancy. Frailty is usually associated with being underweight. There is some evidence [6] that being overweight, particularly having increased abdominal fat, is associated with the same risks and disability as being frail.

Care considerations

Frail residents are seldom included in medication trials, but are vulnerable to over medication. It is important that medications are reviewed regularly and dosages individualised. [7]

Residents often have a slow decline in the months before death and sometimes lack a specific diagnosis. This means that caregivers and health professionals may not recognise that death is approaching and palliative care needs should be assessed.

  1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56.
  2. Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med. 2010 May;26(2):275-86.
  3. Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, et al. Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):731-7.
  4. Ensrud  KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):744-51.
  5. Covinsky KE, Eng C, Lui LY, Sands LP, Yaffe K. The last 2 years of life: functional trajectories of frail older people. J Am Geriatr Soc. 2003 Apr;51(4):492-8.
  6. Hubbard RE, Lang IA, Llewellyn DJ, Rockwood K. Frailty, body mass index, and abdominal obesity in older people. J Gerontol A Biol Sci Med Sci. 2010 Apr;65(4):377-81. Epub 2009 Nov 25.
  7. Schmader K, Baron R,  Haanpää ML, Mayer J, O'Connor AB, Rice ASC, et al. Treatment considerations for elderly and frail patients with neuropathic pain. Mayo Clin Proc. 2010 Mar;85(3 Suppl):S26-32.
  • Champion A. Anorexia of Aging. Ann Long Term Care. 2011 Oct;19(10):18-24.
  • Therapeutic Guidelines
    This website has guidelines based on independent information relating to medications for the frail aged
  • Falls Prevention
    This Australian Commission on Safety and Quality in Health Care (ACSQHC) page has links to guidelines and resources.

Clinical Practice 

Last updated 30 January 2017