1
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Multidisciplinary Outlook on the
Frailty Process: Theoretical Issues,
Individual Trajectories, and
Consequences for Daily Life
Edith Guilley 1 & Paolo Ghisletta
1,2
Center for Interdisciplinary Gerontology
Faculty of Psychology and Educational Sciences
1
2
University of Geneva, Switzerland
57th Annual Scientific Meeting - GSA, Washington, Nov. 2004
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Theoretical Framework for an
Interdisciplinary Concept of Frailty
Paolo Ghisletta
1,2,
Anik de Ribaupierre
1,2,3,
& Jean-Pierre Michel 1,4
Center for Interdisciplinary Gerontology
2 Faculty of Psychology and Educational Sciences
3 Center for Life Course and Life Style Studies
4 Department of Rehabilitation and Geriatrics
1
University of Geneva, Switzerland
57th Annual Scientific Meeting - GSA, Washington, Nov. 2004
3
Outline
1. Popularity of Frailty
2. Definitions of Frailty
3. Operationalizations of Frailty
4. Some psychological and social aspects
of Frailty
5. Similarities between physiological
reserves and psychological resources
6. Possible future directions
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1. Popularity of Frailty
“Frailty” Citations by Domain
5
100
90
80
Medline
Source: Ovid (v. rel9.1.0),
keyword “frailty”
70
60
50
40
30
PsychInfo
20
Sociological
Abstracts
10
0
1970
1980
1990
2000
2005
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2. Definitions of Frailty
Markle-Reid & Browne (2003)
Synonyms
•
•
•
•
•
•
•
•
•
•
•
Functional dependency
Functional disability
Chronic illness and disability
Biologically old
Failure to thrive
Wasting syndrome common in people of advanced age
Chronically dependent in a variety of ways
Decreased ability to respond to stressful situations
Fragile, delicate, brittle, tender, easily disturbed
Functionally vulnerable
Feebleness and general vulnerability
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Markle-Reid & Browne (2003)
Antonyms
•
•
•
•
•
•
•
Independence vs. autonomy
Vigorous vs. frail
Robustness vs. general vulnerability
Chronologically old vs. biologically old
Vitality vs. frailty
Well elderly vs. frail elderly
Hardy vs. frail
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Markle-Reid & Browne (2003)
Definitions
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Aging
Disability
Reduced physiological reserves
Decreased muscle strength, mobility and balance
Decreased strength, flexibility, cardiovascular endurance and body composition
Compromised homeostatic mechanisms
Feebleness, delicately constituted, vulnerable or lack of resilience
Inactivity combined with weight loss
Functional impairment and dependence in activities of daily living
Chronic and disabling illness
Acute illnesses such as confusion, falls, immobility, incontinence, and pressure sores
Poor mental health functioning, such as cognitive impairment and depression
Need for formal or informal assistance with personal care or household tasks, and
long-term (nursing home) care
Mathematical modeling of morbidity and mortality to denote a latent variable
associated with extent of risk
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Definitions of Frailty: In Sum
• “Frailty is a syndrome in desperate need
of description and analysis” (Gillick,2001)
• “Frailty does not have a precise
scientific meaning… it remains more a
constellation of many conditions than a
discrete clinical entity” (Hamerman, 1999)
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3. Operationalizations of Frailty
Operationalization
12
(1/5)
• Strawbridge et al. (1998) – 4 dimensions
– Physical deficiencies (balance, weakness, etc.)
d
– Nutritive deficiencies (appetite,
weight
loss)
n
a
e
t
l
a
a
i
– Cognitive deficiencies
(attention,
memory)
n
r
o
a
i
iv ens
t
l
– Sensory deficiencies
Mu tidim(vision and hearing)
l
u
M
Operationalization
13
(2/5)
• Rockwood et al. (1999) – 2 dimensions
– Walk without help
d
n
a
e
l
a
iatbladder
– Continent of bowelarand
n
o
i
v
s
i
n
t
l
e
u
– Cognitive functioning
M tidim
l
u
– Diagnosis ofMdementia
– Basic ADL
Operationalization
•
14
(3/5)
Brown et al. (2000) – 1 dimension
–
Physical Performance Test (9 functional
items)
1. Book lift
e
t
a
i
r
a
v
i
Pick up a pennylt
u
M
Chair rise
2. Put on and take off a coat
3.
4.
5. Turn 360°
6. 50-foot walk
7. One flight of stairs
8. Four flights of stairs
9. Progressive Romberg test
Operationalization
15
(4/5)
• Fried et al. (2001) - ~ 1 dimension
– Shrinking (unintentional weight loss)
t
a
t
– Strength (grip, adjusted for m
gender
and BMI)
p
e
t
t
A (self-reported
y
– Poor endurance and energy
t
i
d
l
n
a
a
n
o
i
exhaustion) iate
s
n
r
e
a
m
ifeet, adj. for gender and
iv(walkt15
d
t
– Slowness
i
l
Mu Mul
height)
– Low physical activity level (self report)
Operationalization
16
(5/5)
• Lalive d’Epinay et al.:
– Swiss Interdisciplinary Longitudinal Study on
the Oldest Old (next presentation
by Guilley et
d
n
a
e
al.)
al
iat
n
r
o
a
i
iv ens
t
l
Mu tidim
l
u
M
Operationalization, in Sum
• “There is more to physical frailty than
physical variables alone” (Brown, 2000, p. M354)
• There are multiple expressions of frailty
(Katz, 2004)
Æ
at least consider
moderating and/or mediating
psychological and social factors
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4. Some Psychological and Social
Aspects of Frailty
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Frailty Process
time
ROBUSTNESS
« A transitional state »
FRAILTY
Age,
Age, Gender,
Gender, Lifestyle,
Lifestyle,
Socio-economic
Socio-economic status,
status,
Co-morbidities,
Co-morbidities,
Affective,
Affective, Cognitive
Cognitive and
and
Sensory
Sensory Impairments
Impairments (…)
(…)
ADL
DEPENDENCE
Four Major Etiologies of Frailty
Bortz (2002)
1. Genetic disorders
2. Diseases and injuries
3. Lifestyle (nutrition and sedentariness):
“I feel that quantitatively the greatest
contributor to frailty is lifestyle”
4. Aging
(p. M285)
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Frailty: The Importance of
Psychological and Social Aspects
1. Identify at-risk individuals
2. Prevent ADL dependence
3. Implement effective treatment
1. Exercise
o
t
e
l
b
a
r
e
2. Dietary
and medicines
l vuln
Alsupplements
l
a
i
c
o
s
d
n
a
l
a
c
i
g
o
l
o
h
3. Change
psycin lifestyle s
effect
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5. Similarities between
Physiological Reserves and
Psychological Resources
Function Threshold
Bortz (1996)
Frailty?
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Physiological Reserves and Age:
The Medical Perspective
decrease
in total
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available
increase in
allocated
Young adults
Robine & Michel (2001)
allocated
Old adults
Relative Allocation of Resources:
The Life Span Psychology Perspective
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Baltes & Graf (1992)
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Some Tenets of Life Span Psychology
Baltes, P. B. & Baltes, M. M. (1990)
• Lifelong dynamics of gains and losses
• Successful development: maximization of
gains and minimization of losses
• The application of SOC may be favorable
– Selection: choosing directionality of
development and goals, narrowing possibilities
– Optimization: enhance existing and develop
new goals directed means
– Compensation: acquisition of new goal-directed
internal and external means
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6. Possible Future Directions
Where should We be Heading?
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• Abandon
l
a
c
i
g
o
l
o
h
c
y
– [dependence = frailty]
s
p
l
e
a
z
c
i
i
n
g
g
o
• Adopt
better
analytical
tools
reflecting
s
l
o
e
o
c
i
i
t
e
c
l
i
o
R
a
s
r
dynamics of
process
and ns of f
o
i
s
s
e
• Acknowledge
subjective experience of
r
p
ex
– [chronological aging = frailty]
(Rockwood, 1994;
Mitnitski, 2002)
(Strawbridge, 1998; Fried, 2001)
(Lipsitz, 2002; Rockwood, 2002;
Vaupel, 1979)
older adults (we call frail)
& Browne, 2003; Whitbourne, 2002)
(Becker, 1994; Markle-Reid
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Thank You
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