Frailty - Literature - Gobbens et al (2010)

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• Gobbens, R. J., van Assen, M. A., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. (2010). Determinants of frailty. Journal of the American Medical Directors Association, 11(5), 356-364.

[andkov]

from Gobbens (2010):

[andkov]

from Gobbens (2010)

Criteria for a successful definitions of FRAILTY:

• 1. multidimentionla nature: physical, psychological, and social
• 2. dynamic, relative state that can change over time
• 3. predictive value (of adverse outcomes: hospital, nursing home, death)
• 4. frailty =/= disability =/= comorbidity
• 5. usable in practice

None of the existing definitions (2010) meets all these criteria

[andkov]

from Gobbens (2010)

Expert opinion

20 experts in US, Canada, and the Netherlands were asked the question:

Which existing conceptual definition of frailty places most emphasis on the integral functioning of older people?

Gobbens (2010) definition of FRAILTY

Frailty is a dynamic state affecting an individual who experiences losses in one or more domains of human functioning (physical, psychological, social), which is caused by the influence of a range of variables and which increases the risk of adverse outcomes

[andkov]

from Gobbens (2010)

Same experts were asked the identify components in the integral operational definition of FRAILTY

Phenotype of FRAILTY (Fried et al, 2004)

• strength
• nutrition
• endurance
• mobility
• physical activity

To these the experts consulted by Gobbens (2010) add

Physical

• balance
• sensory functioning (hearing, vision)

Psychological

• cognition (especially multitasking)
• emotions (depression, anxiety)
• coping (mastery, self-efficacy, self-esteem)

Social

• social relationships
• social support . The first

[andkov]

Integral models of FRAILTY

1. Bergman et al (2004)

Includes the 5 phenotypes of frialty (Fried et al, 2004) + cognitive decline and depressive symptoms. Based on life-course approach. Draws a distinction between frailty, disability and comorbidity.

However, this model:

• mostly focuses on physical domain
• no specific life course determinants that influence frailty and adverse outcomes

Based on this model and the results of the expert meetings and literature search, a slightly modified integral conceptual model of frailty was developed by Gobbens (2010)

• specifies life course determinants of frailty, and relationship of frailty to adverse outcomes
• diet, smoking, alcohol
• biological (genetic) factors
• education, income
• age, sex, ethnicity, civil status
• disease (heart failure, anaemia, diabetes mellitus)