Friday, January 14, 2011
So, if frailty is so important, you would think all Gerontologists would have the same definition on the tip of their tongue. But frailty is surprisingly hard to define. And then is not general agreement on any one definition. The definition remains a matter of debate in the field.
It is certainly a challenge teaching Geriatrics when you can't give a coherent definition for such a central concept. There are many who argue that the Justice Oliver Wendell Holmes definition, "I know it when I see it" is actually the best approach. This is not unreasonable---after all, this accounts for the inordinate amount of stuff that happens with aging that collectively causes frailty. Perhaps clinical judgment is better than any diagnostic algorithm. On the other hand, when a Geriatrician is trying to teach a medical student, who does not "know it when they see it", this can be a totally unhelpful approach.
Others have worked to define frailty as a specific clinical syndrome marked by easily definable characteristics. A very popular definition was established by Dr. Linda Fried, which defines fraily as the presence of 3 of the following 5 phenomena: involuntary weight loss, weakness, slow walking speed, exhaustion, low physical activity. The definition has the significant advantage of being reproducible. If we use this definition, we are all talking about the same thing when we talk about frailty. On the other hand, proponents of the Justice Holmes approach might argue that this definition does not account for the vast milieu of problems that can cause frailty.