A Conceptual Framework of Frailty: A Review

This article presents an overview of the increasingly common condition of frailty, which by and large lacks clarity of definition. A variety of sources provide this statement regarding definition, incidence, causation, rate, and time of appearance. Utilizing the newly elaborated process of symmorphosis, which explains the coadaptation of struc-ture and function secondary to altered energy loads, I propose that frailty is a body-wide set of linked deteriora-tions including, but not confined to, musculoskeletal, cardiovascular, metabolic, and immunologic systems. The common final pathway that leads to this constellation of findings is usually keyed to a decline in physical activity either as a result of habit or disease inputs. As such, the state of frailty is largely separable from the process of ag-ing and should thereby be susceptible to active intervention and reversal. HE emergence of frailty as an increasingly common physical state prompts inquiry into what it is. Is it a dis-ease? Many persons are frail, yet lack a specific diagnosis. Is it aging? Some young people are frail, and some old peo-ple aren’t. Is it inevitable? Its occasional reversibility ne-gates this suggestion. Is it functional or structural? Is it sin-gle- or multi-system in its nature? A recent review article states “frailty does not have a pre-cise scientific meaning ” (1). Gillick observed “frailty is a syndrome in desperate need of description and analysis ” (2). Elsewhere, Fried and colleagues observed that a standard-ized definition has not been established (3). “In fact, identi-fication of the criteria for frailty has been found to be a highly complex and demanding task ” (4). This article intro-duces a recently elaborated process, symmorphosis, which provides an organizing framework for understanding frailty into which numerous seemingly separate aspects can be in-corporated (5). Further, insights provided by this formula-tion lead directly to the understanding of pathogenetic mechanisms and thereby preventive and therapeutic ap-proaches