Friability

Introduction

Friability is a physiological state characterized by increased vulnerability to stressors caused by decreased physiologic reserves.
It is an endpoint of multiple disease processes

Aetiology

Multifactorial

  • Lack of physical exercise and undernutrition play major roles

Clinical features

Symptoms

  • Anorexia
  • Fatigue
  • Inactivity
  • Weakness
  • Weight loss

Signs

  • Abnormalities of gait and balance
  • Deconditioning (loss of physical functioning)
  • Osteopenia
  • Sarcopenia (decreased skeletal muscle mass, strength and exercise tolerance, thermoregulation, energy expenditure, etc.)
  • Slow gait speed (Timed Up and Go test ≥ 15 seconds)
  • Undernutrition

Fried’s phenotypic criteria for diagnosis of frailty

  • Reduced physical activity
  • Self-reported exhaustion/poor endurance
  • Slow gait
  • Weakness
  • Weight loss

Each of the above is scored 1 if present
Total scores are interpreted as follow:

  • Robust = 0
  • Pre-frail=1-2
  • Frail 3-5

Complications

  • Acute illnesses
  • Dependency
  • Disability
  • Falls
  • Hospitalizations
  • Injuries
  • Institutionalization
  • Mortality

Investigations

  • Full blood count
  • Electrolytes, urea and creatinine
  • Liver function tests
  • Thyroid function tests
  • Serum calcium and albumin
  • Urinalysis

Treatment objectives

  • Return patient to baseline status

Non-drug treatment

This should be tailored to address clinical presentation

Drug treatment

Should be tailored to address clinical presentation

Prevention

Multi-dimensional approaches:

  • Identify patients who are pre-frail and intervene to return to robustness
  • Exercise (endurance and muscle strengthening; stretching and balance exercises)
  • Nutrition (healthy food; supplements as indicated)
  • Reduce chronic disease prevalence
  • Treat sarcopenia
  • Promote healthy aging