Frailty: Konzept und Diagnose

Frailty führt bei älteren Erwachsenen zu einer erhöhten Vulnerabilität für negative Gesundheitsereignisse. Bislang existiert kein Goldstandard zur Diagnose einer Frailty. Dieser Beitrag bietet einen Überblick über die wichtigsten Instrumente zur Frailty-Diagnostik und ihre Anwendungsbereiche.

Abstract

Frailty increases the older adult’s vulnerability to suffer adverse health outcomes. To date, no gold standard for the diagnosis of frailty exists. This article provides an overview of the most relevant frailty instruments and their scope of application.

Kernaussagen

• Mit dem geriatrischen Syndrom der Frailty liegt ein Konzept vor, das die Heterogenität und unterschiedliche Vulnerabilität älterer Patienten abbildet.

• Eine Frailty-Diagnostik kann sowohl in konservativen als auch operativen klinischen Disziplinen die Prognoseabschätzung und Planung von diagnostischen und therapeutischen Maßnahmen verbessern.

• Es stehen mehrere Frailty-Instrumente zur Verfügung, deren Auswahl an das jeweilige Setting und die Fragestellung angepasst werden sollte.

Schlüsselwörter

Frailty - Pre-Frailty - ältere Erwachsene - geriatrisches Assessment - Screening

Keywords

frailty - pre-frailty - older adults - geriatric assessment - screening

Publication History

Article published online:
29 December 2023

• Literatur

• 1 Morley JE, Vellas B, van Kan GA. et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392-397 DOI: 10.1016/j.jamda.2013.03.022. (PMID: 23764209)
• 2 Dent E, Morley JE, Cruz-Jentoft AJ. et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging 2019; 23: 771-787 DOI: 10.1007/s12603-019-1273-z. (PMID: 31641726)
• 3 Ni Lochlainn M, Cox NJ, Wilson T. et al. Nutrition and frailty: Opportunities for prevention and treatment. Nutrients 2021; 13: 2349 DOI: 10.3390/nu13072349.
• 4 Benzinger P, Eidam A, Bauer JM. Clinical importance of the detection of frailty. Z Gerontol Geriatr 2021; 54: 285-296 DOI: 10.1007/s00391-021-01873-z. (PMID: 33782735)
• 5 Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62: 722-727 DOI: 10.1093/gerona/62.7.722. (PMID: 17634318)
• 6 Searle SD, Mitnitski A, Gahbauer EA. et al. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8: 24 DOI: 10.1186/1471-2318-8-24. (PMID: 18826625)
• 7 Rockwood K, Mitnitski A. Limits to deficit accumulation in elderly people. Mech Ageing Dev 2006; 127: 494-496 DOI: 10.1016/j.mad.2006.01.002. (PMID: 16487992)
• 8 Fried LP, Tangen CM, Walston J. et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-156 DOI: 10.1093/gerona/56.3.m146. (PMID: 11253156)
• 9 Rockwood K, Song X, MacKnight C. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495 DOI: 10.1503/cmaj.050051. (PMID: 16129869)
• 10 Rockwood K, Theou O. Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources. Can Geriatr J 2020; 23: 210-215 DOI: 10.5770/cgj.23.463. (PMID: 32904824)
• 11 Deutsche Gesellschaft für Geriatrie e.V. Clinical Frailty Scale (CFS). 2020 Accessed September 26, 2023 at: https://www.dggeriatrie.de/images/Bilder/PosterDownload/200331_DGG_Plakat_A4_Clinical_Frailty_Scale_CFS.pdf
• 12 Theou O, Perez-Zepeda MU, van der Valk AM. et al. A classification tree to assist with routine scoring of the Clinical Frailty Scale. Age Ageing 2021; 50: 1406-1411 DOI: 10.1093/ageing/afab006.
• 13 Dalhousie University – Geriatric Medicine Research. CFS Classification Tree. Accessed September 26, 2023 at: https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale/cfs-classification-tree.html
• 14 Acute Frailty Network. Clinical Frailty Scale. Januar 2021. Accessed September 26, 2023 at: https://www.acutefrailtynetwork.org.uk/Clinical-Frailty-Scale
• 15 Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16: 601-608 DOI: 10.1007/s12603-012-0084-2. (PMID: 22836700)
• 16 Braun T, Gruneberg C, Thiel C. German translation, cross-cultural adaptation and diagnostic test accuracy of three frailty screening tools: PRISMA-7, FRAIL scale and Groningen Frailty Indicator. Z Gerontol Geriatr 2018; 51: 282-292 DOI: 10.1007/s00391-017-1295-2. (PMID: 28795247)
• 17 Guralnik JM, Simonsick EM, Ferrucci L. et al. 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: M85-94 DOI: 10.1093/geronj/49.2.m85.
• 18 Western MJ, Malkowski OS. Associations of the Short Physical Performance Battery (SPPB) with adverse health outcomes in older adults: A 14-year follow-up from the English Longitudinal Study of Ageing (ELSA). Int J Environ Res Public Health 2022; 19: 16319 DOI: 10.3390/ijerph192316319. (PMID: 36498395)
• 19 European Medicines Agency. Reflection paper on physical frailty: instruments for baseline characterisation of older populations in clinical trials. Januar 2018. Accessed September 26, 2023 at: https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-physical-frailty-instruments-baseline-characterisation-older-populations-clinical_en.pdf
• 20 Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing 2015; 44: 148-152 DOI: 10.1093/ageing/afu157. (PMID: 25355618)
• 21 Boreskie KF, Hay JL, Boreskie PE. et al. Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr 2022; 22: 13 DOI: 10.1186/s12877-021-02722-9. (PMID: 34979966)
• 22 Daly RM, Iuliano S, Fyfe JJ. et al. Screening, diagnosis and management of sarcopenia and frailty in hospitalized older adults: Recommendations from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Expert Working Group. J Nutr Health Aging 2022; 26: 637-651 DOI: 10.1007/s12603-022-1801-0.
• 23 van Walree IC, Scheepers E, van Huis-Tanja L. et al. A systematic review on the association of the G8 with geriatric assessment, prognosis and course of treatment in older patients with cancer. J Geriatr Oncol 2019; 10: 847-858 DOI: 10.1016/j.jgo.2019.04.016.
• 24 Clegg A, Young J, Iliffe S. et al. Frailty in elderly people. Lancet 2013; 381: 752-762 DOI: 10.1016/S0140-6736(12)62167-9. (PMID: 23395245)
• 25 Zhang X, Dou Q, Zhang W. et al. Frailty as a predictor of all-cause mortality among older nursing home residents: a systematic review and meta-analysis. J Am Med Dir Assoc 2019; 20: 657-663 e654 DOI: 10.1016/j.jamda.2018.11.018.
• 26 Kaehr E, Visvanathan R, Malmstrom TK. et al. Frailty in nursing homes: the FRAIL-NH Scale. J Am Med Dir Assoc 2015; 16: 87-89 DOI: 10.1016/j.jamda.2014.12.002. (PMID: 25556303)