Frailty generally occurs later in life and results in physiological decline. It is estimated that more than 20% of Australians will become frail as they age,¹ with declines in multiple domains, including physical function (eg weakness, slow walking speed, unintentional weight loss), cognition and nutritional status (eg appetite loss).² Older people who are frail are vulnerable to adverse health outcomes, including procedural complications, falls, institutionalisation, disability and death.^3,4 Frailty is on a spectrum, with older people with mild frailty (becoming ‘slow’ and losing muscle strength) at increased risk of becoming severely frail (resulting in loss of independence, and need for care in residential aged care home).

Frailty can also occur in younger adults, particularly vulnerable people with disability or onset of illness;⁵ however, more research is needed in this area.⁶

Risk factors for frailty

There are a number of factors associated with increased risk of frailty. These include:⁴

• older age
• current smoker
• lower educational level
• current use of postmenopausal therapy
• not being married
• depression
• intellectual disability
• being of Aboriginal and Torres Strait Islander descent
• sedentary lifestyle
• undernutrition
• chronic disease
• multimorbidity
• polypharmacy
• obesity.

Screening for frailty

A provides a good opportunity for GPs to case-find people who are frail or pre-frail.

Screening for frailty helps to identify functional decline. Commonly used frailty scoring tools include the following.⁴ 

• – ask about and score:
  • unintentional weight loss (≥4 kg in the past year)
  • self-reported exhaustion
  • weakness (reduced grip strength)
  • slow gait speed
  • low physical activity.

Frailty = ≥3 of the above; pre-frailty = 1–2 of the above; not frail = none of the above.⁷

• – based on the accumulation of illnesses, functional deficits, cognitive decline and social circumstances, it involves answering >20 medical and functional questions.⁸
• – helpful scale that takes very little time.
• – scale that rates frailty from 0 to 17.⁹
• – scale that assesses fatigue, resistance, ambulation, illness, and loss of weight.
• Other useful simple tests with variable specificity and sensitivity:¹⁰
  • slow walking speed (>5 seconds to walk 4 metres)
  • (>10 seconds to stand from a chair, walk 3 metres, turn around, walk back to the chair and sit down again).

The screening tool may include a number of components, such as assessing:^2,4

• slow gait speed
• unintentional weight loss
• mood
• accumulation of illnesses
• social circumstances
• cognitive difficulties
• polypharmacy
• weakness
• exhaustion.

Pathophysiology of frailty

For information on the pathophysiology of frailty, including further detail about the immune, endocrine, stress and energy response systems changes that contribute to the development of frailty, please refer to the ‘Frailty’ chapter in the RACGP aged care clinical guide (Silver Book) – Part A.

There are no additional recommendations for Aboriginal and Torres Strait Islander people.

Further information about frailty in an aged care setting:
Frailty | RACGP aged care clinical guide (Silver book) – Part A | RACGP