Anna Giulia Cattaneo, Department of Biotechnologies and Molecular
Sciences, DBSM, University of Insubria, Via J-H Dunant, 3,
The aging process is frequently considered and experienced
as a progression from a fit and healthy youth to a frail condition
charged of comorbidity. This event is so common that the occurrence
of a considerable degree of fitness late in life is generally
considered a lucky exception to a severe rule.
However, the importance for a standard assessment of the
aging-associated frailty is still partially understood, especially
in the daily clinical practice, and it is the recent subject
of epidemiological studies aimed to define it.
In 2001 Fried & co-workers proposed five criteria derived
from data collected from a cohort study, the Cardiovascular
Health Study and associated to the "frail phenotype":
the minimal requirement for frailty was meeting at least 3
criteria. Seven percent of all the observed population (i.e.
372 out of 5317 persons) was considered frail.
Further studies have substantially confirmed this data, but
failed to found any association between frailty scores and
morbidity or mortality rates. Frailty seemed to be predictive
for higher need for assistance only.
A better predictive ability characterizes scoring methods
based on a more complete assessment of the geriatric status,
which include the Activity of Daily Living (also Instrumental)
disability, comorbidity and geriatric syndromes, cognitive
Recent studies are focused in finding a frailty index predictive
for morbidity/mortality, and especially linked to aging.
A combination of these tools is greatly informative of the
need for assistance, and predictive of progression of the
disability and frailty degree, or even of morbidity and mortality.
These or similar assessments could be very useful not only
for the future management of resources for geriatric care,
but even in the daily practice. The decisional process to
initiate the therapy of major diseases, potentially charged
of intolerable risk for potentially lethal side-effects in
the presence of an high frailty degree, can be speeded up
and more safely preformed. Clinical trials especially aimed
to the geriatric care could consider the assessment score
as an inclusion criteria for the more difficult cases, like
the need and feasibility of antineoplastic therapy. Several
papers testing different age-related changes are reported
at the end of this Editorial. Among them one can select those
more useful to describe and predict the aging process. The
criteria for the choice could be the feasibility of the protocol
on a large scale of individuals, the predictability of the
resulting panel and the acceptance degree for both the old
subjects and/or their care-givers.
It seems to be highly desirable that a panel of test aimed
to assess the geriatric status and the associated frailty
should enter the everyday practice, in the same way as the
collection of anamnesis or the physical examination at the
admission to the geriatric care facilities. A well planned
follow-up could in a near future help a personalized care,
and even a theragnostic approach to the old person. In addition,
data can be collected to permit a better understanding of
the aging process in perspective.
SUMMARY OF PROPOSED ASSESSING CRITERIA AND SCORE SYSTEMS
AND RELATED BIBLIOGRAPHY:
1. Fried et al, 2001. J Gerontol A Biol Sci Med Sci. 56: M146-157
2. Lucicesare A et al. 2010. J Nutr Health Aging. 14(4):278-81.
3. Searle SD et al. 2008. BMC Geriatr. 8:24.
4. Kiely DK et al. 2009. J Am Geriatr Soc. 57(9):1532-9.
ADLs: bathing, dressing, toileting, transferring,
continence, feeding (without help).
IADLs: use telephone, handle finances, take medications, cooking,
shopping, housekeeping, laundry, use of transport.
1. Cigolle CT et al. 2007. Ann Intern Med. 147(3): 156-64.
2. Searle SD et al. 2008. BMC Geriatr. 8:24.
GERIATRIC ASSESSMENT: delirium, dementia,
depression, osteoporosis, incontinence, falls, neglect and
abuse, failure to thrive
3. Cigolle et al. 2007. Ann Intern Med. 147(3): 156-64.
4. Rockwood et al. 2004. J Gerontol A Biol Sci Med Sci. 59:
NUTRITION: Malnutrition Universal Screening
Tools, Short Nutritional Assessment Questionnaire, Mini Nutritional
Assessment, Nutritional Risk Score
COMORBIDITY (Age-adjusted Charlson Comorbidity
Score): weighted score for different illnesses.
1. Avila-Funes et al. 2008. J Gerontol A Biol Sci Med Sci.
2. Bandeen-Roche et al. 2006. J Gerontol A Biol Sci Med Sci.
3. Kopple TM et al. 2008. Cancer 112: 2384-2392
4. Pal SK et al. 2010. CA Cancer J Clin 60: 120-132
5. Deshpande N, Metter EJ, Ferrucci L. 2010. Arch Phys Med
BIOLOGICAL MARKERS OF AGING: IL-6, C-reactive
protein, D-dimer and coagulation markers, insulin-like growth
factor 1, Prostate Specific Antigen, Carcino Embryonic Antigen.
5. Bandeen-Roche K et al. 2009. Rejuvenation Res. 12(6):403-10.
6. Le Couteur DG et al. 2010. J Gerontol A Biol Sci Med Sci.
7. Travison TG et al. 2010. J Clin Endocrinol Metab. 95(6):2746-54.
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