To Packed House, Henderson Award-Winner Linda Fried, MD,
Delivers State-of-Art Lecture on Frailty

Henderson Lecture attendees listen to Dr. Fried's frailty lecture.

Growing evidence suggests that frailty is a distinct clinical syndrome resulting from diminished function across multiple physiologic systems that heightens vulnerability to stressors and, ultimately, risks of morbidity and mortality, Linda Fried, MD, told the crowd of healthcare professionals who gathered for AGS' annual Henderson State-of-the-Art Lecture in May. The lecture was among the highlights of the Society's 2008 Annual Scientific Meeting.

The Dean of Columbia University's Mailman School of Public Health and one of the world's leading experts on frailty, Dr. Fried is the Society's 2008 Henderson State-of-the-Art Award recipient. Named for the late Dr. Edward Henderson, who was instrumental in establishing the field of geriatrics, the award recognizes an individual whose research helps healthcare providers better understand and respond to problems inherent in caring for older people.

Frailty appears to be a definable clinical syndrome, associated with increased risks of falls, delayed recovery from illness, disability, hospitalization, and mortality, and is prevalent among older adults, particularly those older than 75.

"Frailty has been considered the core, even the raison d'etre, of geriatric medicine," Dr. Fried noted during her lecture.

Several different approaches have been developed to characterize frailty. But a growing body of research suggests that frailty is a distinct physiologic state of diminished function across multiple physiologic systems, she explained. A range of studies have linked frailty to systems dysfunctions, as manifested by diminished heart rate variability and immune function, low testosterone and IGF-1 levels, and elevated cortisol, insulin and glucose levels, among other things. Older adults with signs of such dysregulation run an increased risk of frailty. Multi-system dysregulation, Dr. Fried said, may be associated with the diminished energy availability, complexity of function, and, finally, the ability to maintain homeostasis in the face of stressors such as illness and injury.

"Physiologic vulnerability may precede the onset of frailty," she added.

Linda Fried, MD was named the American Geriatrics Society's 2008 Henderson State-of-the-Art Awardee at the Annual Scientific Meeting in Washington, DC.

Certain core characteristics -- including sarcopenia, lessened strength and exercise tolerance, slowed motor speed, diminished physical activity, and inadequate nutrient intake and weight loss -- are widely considered hallmarks or manifestations of frailty. Research suggests that, like other syndromes, frailty follows a fairly predictable progression. This typically begins with a decline in walking speed or strength, followed by other manifestations of frailty, including declines in activity and loss of energy. Weight loss is usually a late-stage characteristic, Dr. Fried noted.

A number of studies, including the Cardiovascular Health Study -- for which she is principal investigator -- have found that older adults with three or more of these core characteristics of frailty run increased risks of falls, worsening disability, hospitalization and death. Other findings also suggest that higher numbers of these criteria of frailty are associated with worse outcomes.

"It's likely that the early stage of frailty, where you have one, two, or possibly three manifestations, would be most responsive to intervention," Dr. Fried noted. In light of this, screening older adults who are older than 75 or at increased risk of frailty for these core characteristics of the syndrome -- particularly strength, exercise tolerance, and adequate nutrient intake -- may be warranted. For adults at risk or with early manifestations of frailty, interventions targeting sarcopenia and undernutrition would also be warranted.

"We know that in the frail elderly, resistance exercise is very highly effective in increasing muscle mass and strength, and we see greater effect with both exercise and nutritional supplementation," she added. Research into other potential interventions, including possible pharmaceutical approaches, is needed. Studies investigating the underlying causes of the multisystem dysfunctions that appear to set the stage for frailty are already underway.