Frailty Syndrome.

Frailty syndrome is a clinical state of increased vulnerability in older adults caused by decline in reserve across multiple body systems. Hallmark features are unintentional weight loss, weakness, slow walking, exhaustion, and reduced physical activity. Frail older adults face higher risk of falls, hospitalisation, and death.

No. Frailty describes a clinical state of vulnerability, not simply chronological age. Many older adults remain robust into their 80s and 90s, while some adults in their 60s become frail because of disease, inactivity, or poor nutrition. Frailty assessment captures this individual variation.

Common signs include unintended weight loss of 4.5 kg or more in a year, exhaustion, weak grip strength, slow walking speed (under 0.8 m/s), low physical activity, and difficulty with daily tasks like shopping, cooking, and bathing. Three or more of these features confirm frailty.

Clinicians use brief screening tools (FRAIL questionnaire, Clinical Frailty Scale, 4-metre gait speed) followed by comprehensive geriatric assessment in confirmed cases. Blood tests rule out reversible contributors such as anaemia, vitamin deficiencies, and thyroid disease.

Yes, especially in pre-frailty and mild frailty. Around 30-50% of pre-frail older adults regain robust status with multicomponent exercise and improved nutrition over 3-6 months. Even severe frailty can be stabilised and complications reduced with comprehensive geriatric care.

Multicomponent exercise programmes combining resistance training (2-3 sessions weekly), aerobic activity (150 minutes weekly), balance work (tai chi, Otago), and flexibility are the strongest evidence-based intervention. Programmes should be progressive and supervised when frailty is moderate or severe.

Aim for 1.0-1.2 g/kg/day of protein (1.2-1.5 g/kg/day during illness) distributed across meals, alongside a Mediterranean-style diet rich in vegetables, fruits, olive oil, and oily fish. Vitamin D 800-1,000 IU/day is recommended in older adults with low or unmeasured levels.

The Clinical Frailty Scale is a 9-point visual judgement scale developed by Kenneth Rockwood. It runs from 1 (very fit) through 3-4 (managing well, very mild frailty) to 7-8 (severe and very severe frailty) and 9 (terminally ill). It is widely used in hospitals, GP practices, and surgical preoperative pathways.

Yes. Frail older adults face 2-3 times higher 30-day complications and mortality after major surgery compared with robust peers. Routine frailty screening before elective surgery and prehabilitation (4-6 weeks of structured exercise and nutrition) reduce complications by 30-50%.

Frailty itself is not directly inherited, but genetic factors influence muscle mass, bone density, and disease risk. Twin studies suggest 30-45% heritability of the frailty phenotype. Lifestyle and environmental factors carry more weight at the individual level.

Sarcopenia is the age-related loss of muscle mass and strength. Frailty is a broader clinical syndrome that includes sarcopenia plus weight loss, exhaustion, slow gait, and low activity across multiple body systems. Sarcopenia is the main biological driver of physical frailty.

Yes. Long-acting benzodiazepines, anticholinergics, sedating antihistamines, opioids, and many antipsychotics increase falls, cognitive impairment, and functional decline. Annual medication review using STOPP/START criteria identifies high-risk drugs for safe deprescribing.

Comprehensive geriatric assessment is a structured multidisciplinary evaluation of older adults covering medical, functional, mental, and social health. It identifies and treats reversible contributors to frailty, reduces hospital functional decline by 20%, and lowers nursing-home admissions by 18%.

Yes, partly. Regular physical activity (especially resistance training), adequate protein intake, control of chronic diseases, treatment of vision and hearing impairment, social engagement, and avoidance of high-risk medications all reduce the incidence of frailty in older adults.

Consider geriatric medicine review for moderate to severe frailty, frequent falls, multiple unplanned hospital admissions, complex medication regimens, before major elective surgery, or when cognitive concerns coexist with physical decline. Many GPs and primary care teams provide geriatric assessment.

Not necessarily. Many frail older adults maintain independent living with proactive management. Multicomponent exercise, nutrition support, medication review, home modifications, and falls prevention reduce functional decline and delay or avoid the need for residential care.

No. Most frail older adults live for years with appropriate care. Very severe frailty (Clinical Frailty Scale 8-9) is associated with limited life expectancy and often warrants palliative care planning. Even at this stage, comfort, dignity, and quality of life can be supported actively.

Vitamin D supports muscle function and bone health. Supplementation 800-1,000 IU/day reduces falls by 20-30% in deficient older adults and supports the benefit of resistance training. Single very high doses above 100,000 IU should be avoided as they have been linked to higher fall risk.

Cognitive frailty is the combination of physical frailty and mild cognitive impairment without dementia. It carries a doubled risk of progression to dementia, disability, and death. Multicomponent exercise, cognitive stimulation, and management of depression slow progression.

Yes. Frail older adults have 1.5-2 times higher risk of falls due to reduced muscle strength, slower gait, postural instability, and polypharmacy. Many falls occur during routine activities. Multifactorial fall prevention programmes (exercise, vision, footwear, home safety) reduce falls by 20-30%.

Encourage and support regular exercise and balanced nutrition, accompany the relative to GP and geriatric appointments, help with medication management, address home hazards (loose rugs, poor lighting), keep them socially engaged, and seek advice on respite care and advance planning when needed.