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Open Access Peer-Reviewed
Editorial

Perspectives for research and clinical practice on frailty

Perspectivas para a pesquisa e prática clínica em fragilidade

Patrick Alexander Wachholz

DOI: 10.5327/Z2447-21152019v13n3ED

The significant increase in scientific research on frailty has led to important advances in understanding pathophysiological mecha-nisms and their impact on human aging. Associated with a variety of conceptual frameworks, diagnostic tools for detecting frailty have rapidly multiplied, many investigating risk prior to medical or surgical interventions, others considering long-term complex care planning.1

Despite these advances, frailty assessment is still quite incipient in geriatric clinical practice and even more insufficient in primary health care.2 In this issue of Geriatrics, Gerontology and Aging (GGA), readers will find an interesting exploratory analysis of the association between frailty, anthropometric variables and functional capacity in older adults living in the com-munity and in nursing homes.3

Although certain barriers might explain our low national rate of routine fragility assessment,1,4 this problem has not yet been sufficiently investigated. Moreover, major international regulatory agencies (the US Food and Drug Administration and the European Medicines Agency) do not yet recognize frailty as an outcome or indication for pharmacological or non-pharmacological interventions, which means that frailty is not eligible for reimbursement by health systems, and some regulatory bodies are still reluctant to approve clinical trials that consider frailty as a result.5

The discovery of experimental animal models of frailty has renewed hopes that the syndrome may be recognized as an outcome measure in preclinical studies. Interleukin (IL)-10 knockout mice and Cu/Zn superoxide dismutase enzyme (Sod1KO) have recently been added to rat and mouse fragility models that mimic the two most frequently used diagnostic criteria (fragility phenotype and fragility index).6 Biomarker studies are still restricted to cross-sectional analyses and observational series; more robust and better delineated longitudinal investigations are needed to confirm their use as fragility markers. Promising biomarkers include fibrinogen, albumin, dimer D, leukocyte count, IL-6, c-reactive protein (CRP), and tumor necrosis factor alpha (TNF-α).7

If we are to arrive at a solid understanding of which intervention strategies can be effective and viable for managing and preventing frailty, it is crucial for study design to progress, transitioning from observational studies (which basically analyze the association between variables) to longitudinal and experimental studies on the action of interventions and the effects of exposure.3 This issue features a rel-evant example of this type of study: a longitudinal analysis of predictors of functional dependence in people aged 50 years and older.8

It is also important to perceive frailty as a dynamic state that is potentially reversible and responsive to preventive interven-tions. Comprehensive care strategies should include variation in the frailty continuum, focusing particularly on maintaining functional capacity through person-centered care.4,9 This issue of GGA includes an interesting review article on the potential of respiratory muscle training in sarcopenia management.10

Identifying frailty in older adults without proposing or discussing the advantages of proven interventions seems, in a crude analogy, as stigmatizing as disregarding a surgical intervention based solely on an individual’s biological age. Incidentally, the use of stigmatizing language in academic discourse has been widely debated and reviewed, such that international journals and scientific events are rejecting studies whose language is considered pejorative, as discussed in an opinion article in this issue of GGA.11

In conclusion, we invite readers to share GGA with their peers and institutions and consider publishing in it. The editorial board has been collaborating with the Brazilian Society of Geriatrics and Gerontology so that the journal can soon appear in new indexes and find a growing audience for its content.

Good reading!

 

REFERENCES

1. Walston J, Bandeen-Roche K, Buta B, Bergman H, Gill TM, Morley JE, et al. Moving Frailty Toward Clinical Practice: NIA Intramural Frailty Science Symposium Summary. J Am Geriatr Soc. 2019;67(8):1559-64. http://doi.org/10.1111/jgs.15928

2. Satake S, Arai H. Implications of frailty screening in clinical practice. Curr Opin Clin Nutr Metab Care. 2017;20(1):4-10. https://doi.org/10.1097/MCO.0000000000000341

3. Cunha VA, Baião VM, Santos GA, Ribeiro HS, Correa HL, Melo WM, et al. Frailty syndrome in older adults from the community and long-term care institutions: an exploratory analysis. Geriatr Gerontol Aging. 2019;13(3):141-8. http://doi.org/10.5327/Z2447-211520191900033

4. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376-86. https://doi.org/10.1016/S0140-6736(19)31785-4

5. Trendelenburg AU, Scheuren AC, Potter P, Müller R, Bellantuono I. Geroprotectors: A role in the treatment of frailty. Mech Ageing Dev. 2019;180:11-20. https://doi.org/10.1016/j.mad.2019.03.002

6. Banga S, Heinze-Milne SD, Howlett SE. Rodent models of frailty and their application in preclinical research. Mech Ageing Dev. 2019;179:1-10. https://doi.org/10.1016fj.mad.2019.01.008

7. Kane AE, Sinclair DA. Frailty biomarkers in humans and rodents: Current approaches and future advances. Mech Ageing Dev. 2019;180:117-28. https://doi.org/10.1016lj.mad.2019.03.007

8. Vieira MCU, Dias DF, Bortoletto MSS, Silva AMR, Cabrera MAS. Preditores de dependência funcional em pessoas de 50 anos ou mais: estudo de seguimento de 4 anos. Geriatr Gerontol Aging. 2019;13(3):157-66. http://doi.org/10.5327/Z2447-211520191900060

9. World Health Organization. Course L. WHO | WHO Guidelines on Integrated Care for Older People (ICOPE). Genebra: WHO; 2017.

10. Vilaça AF, Pedrosa BCS, França ERT, Amaral TCN, Andrade MA, Castro CMMb, et al. Treinamento muscular respiratório em idosos: estudo de revisão. Geriatr Gerontol Aging. 2019;13(3):167-72. http://doi.org/10.5327/Z2447-211520191900065

11. Oliveira D. A linguagem acadêmica e o estigma na longevidade. Geriatr Gerontol Aging. 2019;13(3):177-9. http://doi.org/10.5327/Z2447-211520191900061


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