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Study of an old Man's Profile - Galleria degli Uffizi - Firenze
Assessing the Frailty in Aging Torna agli editoriali

di
Anna Giulia Cattaneo, Department of Biotechnologies and Molecular Sciences, DBSM, University of Insubria, Via J-H Dunant, 3, 21000 Varese.

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 and physical.
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:

FRAILTY INDEXES:
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: 1310-1317

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. 63: 1089-1096
2. Bandeen-Roche et al. 2006. J Gerontol A Biol Sci Med Sci. 61: 262-266
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 Rehabil. 91(2):226-32

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. 65(7):712-7.
7. Travison TG et al. 2010. J Clin Endocrinol Metab. 95(6):2746-54.

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