Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 387

Frailty syndrome is a multifactorial impairment in health status predictive of adverse living events, such as loss of independence, falls, hospitalization, adverse drug events, decompensation of chronic diseases, admission to nursing settings, or death.^1,13 According to Fried’s model, unintentional weight loss of ≥10 pounds (about 4.5 kg) or ≥5% of body weight in the prior year is one of the five criteria of the frailty phenotype.

The English Longitudinal Study of Aging (ELSA) showed that in subjects older than 65, contribution of weight loss to the frailty phenotype was the lowest among all criteria.¹⁴ Weight loss was also the least prevalent frailty criterion (23.8%) among centenarians, with at least 95% of them having one frailty criterion.¹⁵ Only 20% of the oldest‐old frail subjects (mean age 88) presented with unintentional weight loss compared to a much higher proportion of subjects with low gait speed (97%), low muscle strength (84%), low physical activity (92%), or exhaustion (66%).¹⁶ This later study evidenced two different frailty profiles (two dimensions) with multicomponent analysis. Weight loss and exhaustion were linked in the first dimension and the three other criteria in the second dimension. Note that the first dimension is similar to ‘impaired general condition’ syndrome. Indeed, in frail subjects, anorexia was associated with weight loss, exhaustion, and low gait speed but not decreased physical activity or muscle strength.¹⁷

Two different prefrailty profiles were suggested in the TILDA study including subjects older than 50: the first (PF1) associated weight loss and/or exhaustion, and the second (PF2) associated one or two of the physical criteria (low gait speed, decreased physical activity, or muscle strength).¹⁸ PF1 participants were more likely to be women, younger, with lower BMI, functionally independent, and with fewer comorbid conditions (diabetes, hypertension, arthritis) but a higher incidence of osteoporosis. After a 10‐year follow‐up, mortality rate and disability progression were much lower in the PF1 group than PF2, even after adjusting for confounders.

However, these prefrailty profiles may have different trajectories in older people, particularly those older than 85. Weight loss–associated frailty or prefrailty syndrome may also benefit from different preventive management than others. This field in frailty management deserves specific studies.

The WHO Guidelines on Integrated Care for Older People (ICOPE)¹⁹ propose screening and management strategies for older subjects at risk for unhealthy ageing. Weight loss and anorexia are grouped into the malnutrition item, calling for integrative management of nutritional risk. The impact of this program is not known at this time.