Skip to main content

Advertisement

Frailty as a Nexus Between the Biology of Aging, Environmental Conditions and Clinical Geriatrics

Article metrics

  • 522 Accesses

  • 14 Citations

Abstract

Chronic diseases often determine pathologic phenotypes similar to those traditionally attributed to aging, such as accelerated decline of muscle mass and increments of basic metabolic rate, suggesting that the true nature of aging is progressively increasing entropy in the face of failing homeostatic mechanisms. Aging in different animal species and in humans suggest that increasing entropy causes major problems in four domains; body composition, energetic imbalance between availability and demand, homeostatic dysregulation, and neurodegeneration. In humans, loss of integrity and function in these domains causes manifestations similar to frailty, especially if the damage is severe and/or involves multiple domains, and has catastrophic consequences, such as physical and cognitive disability. Characterizing these phenotypes, and understanding the mechanisms by which they emerge with increasing entropy is a necessary step to find interventions that can prevent, delay or moderate the effects of aging. Pharmacological and non-pharmacological interventions that may effectively modulate the aging phenotypes are actively studied and will certainly be ready in the near future. Until then, creating a “senior friendly society”, that allows maximal independence but also promotes an active and healthy lifestyle may be the most cost-effective intervention to improve the quality of life in the population.

References

  1. 1.

    Louria DB. Extraordinary longevity: Individual and societal issues. J Am Geriatr Soc. 2005;53:S317–9.

  2. 2.

    Anderson GF, Hussey PS. Population aging: A comparison among industrialized countries. Health Aff (Millwood). 2000;19:191–203.

  3. 3.

    Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: Toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54:991–1001.

  4. 4.

    Glass D, Roubenoff R. Recent advances in the biology and therapy of muscle wasting. Ann N Y Acad Sci. 2010;1211:25–36.

  5. 5.

    Ruggiero C, Metter EJ, Melenovsky V, Cherubini A, Najjar SS, Ble A, et al. High basal metabolic rate is a risk factor for mortality: The Baltimore Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci. 2008;63:698–706.

  6. 6.

    Kipling D, Davis T, Ostler EL, Faragher RG. What can progeroid syndromes tell us about human aging? Science. 2004;305:1426–31.

  7. 7.

    Ershler WB, Ferrucci L, Longo DL. Hutchinson-Gilford progeria syndrome. N Engl J Med. 2008;358:2409–10.

  8. 8.

    Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C. Frailty: An emerging research and clinical paradigm—issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62:731–7.

  9. 9.

    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.

  10. 10.

    Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, et al. Nonlinear multisystem physiological dysregulation associated with frailty in older women: Implications for etiology and treatment. J Gerontol A Biol Sci Med Sci. 2009;64:1049–57.

  11. 11.

    Fried LP, Hadley EC, Walston JD, Newman AB, Guralnik JM, Studenski S, et al. From bedside to bench: Research agenda for frailty. Sci Aging Knowledge Environ. 2005;2005(31):pe24.

  12. 12.

    Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, et al. Phenotype of frailty: Characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci. 2006;61:262–6.

  13. 13.

    Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011;27:17–26.

  14. 14.

    Rockwood K, Hubbard R. Frailty and the geriatrician. Age Ageing. 2004;33:429–30.

  15. 15.

    Ferrucci L, Bandinelli S, Cavazzini C, Lauretani F, Corsi A, Bartali B, et al. Neurological examination findings to predict limitations in mobility and falls in older persons without a history of neurological disease. Am J Med. 2004;116:807–15.

  16. 16.

    JW Rowe and RL Kahn. Human aging: Usual and successful. Science 1987;237:143–149.

  17. 17.

    Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780–91.

  18. 18.

    Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995;273:1348–53.

  19. 19.

    Young J, Inouye SK. Delirium in older people. BMJ. 2007;334:842–6.

  20. 20.

    Gems D, Partridge L. Stress-response hormesis and aging: “That which does not kill us makes us stronger”. Cell Metab. 2008;7:200–3.

  21. 21.

    Ferrucci L, Guralnik JM, Woodman RC, Bandinelli S, Lauretani F, Corsi AM, et al. Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med. 2005;118:1288.

  22. 22.

    Bongaarts J. Human population growth and the demographic transition. Philos Trans R Soc Lond B Biol Sci. 2009;364:2985–90.

  23. 23.

    Crimmins EM, Beltrán-Sánchez H. Mortality and morbidity trends: Is there compression of morbidity? J Gerontol B Psychol Sci Soc Sci. 2011;66:75–86.

Download references

Author information

Correspondence to Luigi Ferrucci MD, PhD.

Additional information

Recommended Citation: Ferrucci L, Hesdorffer C, Bandinelli S, Simonsick EM. Frailty as a Nexus Between the Biology of Aging, Environmental Conditions and Clinical Geriatrics. Public Health Reviews. 2010;32:475–88.

Rights and permissions

Reprints and Permissions

About this article

Key words

  • Frailty
  • aging
  • older adults