Abstract
Mechanisms of aging predispose to cardiovascular disease (CVD), as well as to aggregate
health challenges. For older adults, CVD is likely to exist in combination with comorbid
conditions, disability, polypharmacy, falling risks, and body composition changes.
These other dimensions of health result in cumulative weakening with greater clinical
complexity that confound basic precepts of CVD presentation, prognosis, and treatments.
A convenient operational tool is needed to gauge this age-related vulnerability such
that it can be integrated in the evaluation and treatment of CVD. Frailty is a concept
that is neither disease- nor age-specific, but is used to characterize the reserve
that a person has available to tolerate stresses associated with aging, disease, and
even therapy. Frailty arises from specific biological mechanisms in association with
cumulative physiological decrements, psychosocial stresses, and physical impairments.
Performance-based and survey tools have been developed and tested to measure frailty.
Although different frailty tools vary in practicality, measured domains, and precise
applications, all are useful in identifying risks that commonly accrue with age. Although
comparisons between frailty tools are ongoing and sometimes even controversial, the
rationale to integrate routine use of frailty screening as part of routine care is
relatively straightforward and easy to envision. Frailty assessment applied as a vital
sign (for standard maintenance and evaluation of new symptoms) enhances perspectives
of risk, decision-making, and opportunities for tailored CVD management.
Résumé
Les mécanismes du vieillissement prédisposent aux maladies cardiovasculaires (MCV)
ainsi qu’à l’ensemble des problèmes de santé. Chez les personnes âgées, il est probable
que les MCV existent en association avec des états comorbides, une incapacité, une
polypharmacie, des risques de chute et des changements dans la constitution corporelle.
Ces autres dimensions de la santé entraînent une diminution cumulative d’une complexité
clinique accrue qui va à l’encontre des préceptes fondamentaux du tableau clinique,
du pronostic et des traitements des MCV. Un outil efficace pratique est nécessaire
pour mesurer cette vulnérabilité liée à l’âge de manière à ce qu’il puisse être intégré
à l’évaluation et au traitement des MCV. La fragilité est un concept qui n’est ni
lié à la maladie ni lié à l’âge, mais il est utilisé pour définir la réserve disponible
de la personne pour tolérer les stress associés au vieillissement, à la maladie, voire
au traitement. La fragilité résulte de mécanismes biologiques précis en association
avec la diminution cumulative des réserves physiologiques, le stress psychosocial
et la détérioration physique. Des outils axés sur la performance et des outils d’enquête
ont été élaborés et testés pour mesurer la fragilité. Bien que les différents outils
de mesure de la fragilité varient dans la pratique, les domaines mesurés et les applications
précises, tous sont utiles pour déterminer les risques qui augmentent fréquemment
avec l’âge. Bien que des comparaisons entre les outils de mesure de la fragilité soient
en cours, même s’ils suscitent parfois la controverse, les raisons d’intégrer l’utilisation
systématique du dépistage de la fragilité dans le cadre des soins courants sont relativement
simples et faciles à concevoir. L’évaluation de la fragilité utilisée comme signe
vital (pour le maintien normal et l’évaluation des nouveaux symptômes) améliore les
perspectives du risque, la prise de décision et les possibilités d’adaptation de la
prise en charge des MCV.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Geriatric cardiology: an emerging discipline.Can J Cardiol. 2016; 32: 1056-1064
Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in teh United States. 2014. Available at: https://www.census.gov/prod/2014pubs/p25-1140.pdf. Accessed July 18, 2016.
- Role of frailty in patients with cardiovascular disease.Am J Cardiol. 2009; 103: 1616-1621
- Cardiovascular risk profile and frailty in a population-based study of older British men.Heart. 2015; 101: 616-622
- Putting the value framework to work.N Engl J Med. 2010; 363: 2481-2483
- Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study.Arch Intern Med. 2002; 162: 2333-2341
- The role of genome instability in frailty: mitochondria versus nucleus.Nestle Nutr Inst Workshop Ser. 2015; 83: 19-27
- Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults.J Am Geriatr Soc. 2006; 54: 991-1001
- Antecedents of frailty over three decades in an older cohort.J Gerontol B Psychol Sci Soc Sci. 1998; 53: S9-S16
- Allostatic load and frailty in older adults.J Am Geriatr Soc. 2009; 57: 1525-1531
- Inflammation, atherosclerosis, and coronary artery disease.N Engl J Med. 2005; 352: 1685-1695
- The biology of aging and frailty.Clin Geriatr Med. 2011; 27: 27-37
- Frailty amplifies the effects of aging on protein metabolism: role of protein intake.Am J Clin Nutr. 2003; 78: 422-429
- Amino acids: metabolism, functions, and nutrition.Amino Acids. 2009; 37: 1-17
- Frailty: an emerging geriatric syndrome.Am J Med. 2007; 120: 748-753
- Inflammatory markers and physical performance in older persons: the Inchianti study.J Gerontol A Biol Sci Med Sci. 2004; 59: 242-248
- A physiologic index of comorbidity: relationship to mortality and disability.J Gerontol A Biol Sci Med Sci. 2008; 63: 603-609
- Time for a change–a new approach to ICD replacement.N Engl J Med. 2012; 366: 291-293
- Frailty and outcomes after implantation of left ventricular assist device as destination therapy.J Heart Lung Transplant. 2014; 33: 359-365
- Risk scores for predicting outcomes in valvular heart disease: how useful?.Curr Cardiol Rep. 2011; 13: 107-112
- How accurate is the eyeball test? A comparison of physician’s subjective assessment versus statistical methods in estimating mortality risk after cardiac surgery.Circ Cardiovasc Qual Outcomes. 2014; 7: 151-156
- Working toward a frailty index in transcatheter aortic valve replacement: a major move away from the “eyeball test”.JACC Cardiovasc Interv. 2012; 5: 982-983
- Usefulness of clinical data and biomarkers for the identification of frailty after acute coronary syndromes.Can J Cardiol. 2015; 31: 1462-1468
- Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction.J Am Coll Cardiol. 2013; 61: 1964-1972
- Identifying frailty in hospitalized older adults with significant coronary artery disease.J Am Geriatr Soc. 2006; 54: 1674-1681
- Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization.Circ Cardiovasc Qual Outcomes. 2011; 4: 496-502
- Gait speed and operative mortality following cardiac surgery: a report from the Society of Thoracic Surgeons adult cardiac surgery database.STS Gait. JAMA Cardiol. 2016; 1: 314-321
- Gait speed predicts 30-day mortality after transcatheter aortic valve replacement: results from the Society of Thoracic Surgeons/American College of Cardiology transcatheter valve therapy registry.Circulation. 2016; 133: 1351-1359
- Geriatric conditions in patients undergoing defibrillator implantation for prevention of sudden cardiac death: prevalence and impact on mortality.Circ Cardiovasc Qual Outcomes. 2016; 9: 23-30
- Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure.Rev Esp Cardiol. 2008; 61: 835-842
- Frailty and risk for heart failure in older adults: the Health, Aging, and Body Composition study.Am Heart J. 2013; 166: 887-894
- The effect of bleeding risk and frailty status on anticoagulation patterns in octogenarians with atrial fibrillation: the FRAIL-AF study.Can J Cardiol. 2016; 32: 169-176
- Older adults' recognition of trade-offs in health care decision-making.J Am Geriatr Soc. 2015; 63: 1658-1662
- Frailty markers and treatment decisions in patients seen in oncogeriatric clinics: results from the ASRO pilot study.PLoS One. 2016; 11: e0149732
- Searching for an operational definition of frailty: a delphi method-based consensus statement: the frailty operative definition-consensus conference project.J Gerontol A Biol Sci Med Sci. 2013; 68: 62-67
- Prognostic significance of potential frailty criteria.J Am Geriatr Soc. 2008; 56: 2211-2216
- Depression, frailty, and all-cause mortality: a cohort study of men older than 75 years.J Am Med Dir Assoc. 2015; 16: 296-300
- Frailty in relation to the accumulation of deficits.J Gerontol A Biol Sci Med Sci. 2007; 62: 722-727
- Aging as a process of deficit accumulation: its utility and origin.Interdiscip Top Gerontol. 2015; 40: 85-98
- Accumulation of deficits as a proxy measure of aging.ScientificWorldJournal. 2001; 1: 323-336
- Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation.J Am Geriatr Soc. 2010; 58: 681-687
- Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care.J Gerontol A Biol Sci Med Sci. 2004; 59: 255-263
- Frailty thy name is… Phrailty?.J Gerontol A Biol Sci Med Sci. 2007; 62: 728-730
- Frailty trajectories in an elderly population-based cohort.J Am Geriatr Soc. 2016; 64: 285-292
- The timed “up & go”: a test of basic functional mobility for frail elderly persons.J Am Geriatr Soc. 1991; 39: 142-148
- A 30-s chair-stand test as a measure of lower body strength in community-residing older adults.Res Q Exerc Sport. 1999; 70: 113-119
- Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism.J Am Geriatr Soc. 2003; 51: 636-641
- Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery.J Am Coll Cardiol. 2010; 56: 1668-1676
- Frailty and cardiovascular disease: potential role of gait speed in surgical risk stratification in older adults.J Geriatr Cardiol. 2015; 12: 44-56
- The frailty phenotype and the frailty index: different instruments for different purposes.Age Ageing. 2014; 43: 10-12
- Gait speed and survival in older adults.JAMA. 2011; 305: 50-58
- A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.J Gerontol. 1994; 49: M85-M94
- 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 64 ([erratum in 2014;64:2713-4]): e139-e228
- GFR estimation: from physiology to public health.Am J Kidney Dis. 2014; 63: 820-834
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Frailty: toward a clinical definition.J Am Med Dir Assoc. 2008; 9: 71-72
- The Patient Health Questionnaire-2: validity of a two-item depression screener.Med Care. 2003; 41: 1284-1292
- Transitions between frailty states among community-living older persons.Arch Intern Med. 2006; 166: 418-423
- Pre-frailty and risk of cardiovascular disease in elderly men and women: the pro.V.A. Study.J Am Coll Cardiol. 2015; 65: 976-983
- Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality.J Am Geriatr Soc. 2013; 61: 1537-1551
- Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies.J Am Med Dir Assoc. 2015; 16: 301-308
- A comparison of four frailty models.J Am Geriatr Soc. 2014; 62: 721-726
- Six screening instruments for frailty in older patients qualified for emergency abdominal surgery.Arch Gerontol Geriatr. 2015; 61: 437-442
- Emergency general surgery in the elderly: too old or too frail?.J Am Coll Surg. 2016; 222: 805-813
- The I.A.N.A Task Force on frailty assessment of older people in clinical practice.J Nutr Health Aging. 2008; 12: 29-37
- Protocol for the PREHAB study-Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial.BMJ Open. 2015; 5: e00725
- Cardiac rehabilitation in older adults.Can J Cardiol. 2016; 32: 1088-1096
- A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke.Stroke. 1998; 29: 2055-2060
- Home-based walking exercise in peripheral artery disease: 12-month follow-up of the goals randomized trial.J Am Heart Assoc. 2014; 3: e000711
- Therapeutic interventions for frail elderly patients: part I. Published randomized trials.Prog Cardiovasc Dis. 2014; 57: 134-143
- The metabolic regulation of aging.Nat Med. 2015; 21: 1416-1423
- Interventions to slow aging in humans: Are we ready?.Aging Cell. 2015; 14: 497-510
Article info
Publication history
Published online: June 02, 2016
Accepted:
May 27,
2016
Received:
April 11,
2016
Footnotes
See page 1086 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
