Factors contributing to frailty: literature review.

AIM This paper presents a review of theoretical and research literature in order to identify the factors contributing to frailty. BACKGROUND Frailty is a multifaceted gerontological concept that lacks a clear definition, but may result from an identifiable homogeneous cluster of bio-psycho-social-spiritual factors. METHOD A total of 134 articles were identified through a search of the MEDLINE (1966 to July 2004), CINAHL (1982 to July 2004), PsychInfo (1985 to July 2004) and Ageline (1995 to July 2004) databases. Each article was reviewed to determine its fit with inclusion/exclusion criteria. Seven research and 11 theoretical articles were retained and further reviewed for methodological quality using a validity tool. FINDINGS Seventeen different definitions of frailty were identified. Regardless of the differing definitions, common contributing factors could be identified. Physical, cognitive/psychological, nutritional and social factors, as well as ageing and disease, were evident in both the theoretical and research literature. CONCLUSIONS Although there is strong agreement that a relationship exists between a cluster of factors and frailty, designation of the factors as contributors or outcomes of frailty differs. Without a clear explanatory theory of the path from contributors to frailty to outcomes, research will continue to produce confusing results. A theoretical framework that includes bio-psycho-social-spiritual factors as contributors to frailty is recommended as the most useful framework for gerontological nursing.

[1]  Douglas K. Miller,et al.  Editorial: Something about frailty. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[2]  W. Bortz,et al.  The physics of frailty. , 1993, Journal of the American Geriatrics Society.

[3]  M. Brown,et al.  Physical and performance measures for the identification of mild to moderate frailty. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[4]  W. Strawbridge,et al.  Antecedents of frailty over three decades in an older cohort. , 1998, The journals of gerontology. Series B, Psychological sciences and social sciences.

[5]  Matthew M. Gushta,et al.  Individual determinants of research utilization: a systematic review. , 2003, Journal of advanced nursing.

[6]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  S. Moore,et al.  Balance and muscle strength as predictors of frailty among older adults. , 1998, Journal of gerontological nursing.

[8]  C. Ritchie,et al.  Sarcopenia, weight loss, and nutritional frailty in the elderly. , 2002, Annual review of nutrition.

[9]  I. Burnside,et al.  Methodological considerations in the study of frail elderly people. , 1993, Journal of advanced nursing.

[10]  I. Brown,et al.  Frailty: constructing a common meaning, definition, and conceptual framework , 1995, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[11]  H. Wynne,et al.  Who are the frail elderly? , 1988, The Quarterly journal of medicine.

[12]  J. Meisenhelder.  Gender differences in religiosity and functional health in the elderly. , 2003, Geriatric nursing.

[13]  D Kromhout,et al.  How to select a frail elderly population? A comparison of three working definitions. , 1999, Journal of clinical epidemiology.

[14]  E. Wagner,et al.  Preventing frail health. , 1992, Clinics in geriatric medicine.

[15]  Kathleen Koenig,et al.  Serum Interleukin‐6 and Hemoglobin as Physiological Correlates in the Geriatric Syndrome of Frailty: A Pilot Study , 2002, Journal of the American Geriatrics Society.

[16]  L. Lipsitz.  Dynamics of stability: the physiologic basis of functional health and frailty. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[17]  D Hamerman,et al.  Toward an Understanding of Frailty , 1999, Annals of Internal Medicine.

[18]  D. Raphael,et al.  Frailty: a public health perspective. , 1995, Canadian journal of public health = Revue canadienne de sante publique.

[19]  M A Province,et al.  Frailty and Injuries in Later Life: The FICSIT Trials , 1993, Journal of the American Geriatrics Society.

[20]  N. Krause.  Church-based social support and health in old age: exploring variations by race. , 2002, The journals of gerontology. Series B, Psychological sciences and social sciences.

[21]  B. L. Beattie,et al.  Frailty in elderly people: an evolving concept. , 1994, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[22]  D M Buchner,et al.  Unstable disability and the fluctuations of frailty. , 1997, Age and ageing.

[23]  B. Vellas,et al.  Instrumental activities of daily living as a potential marker of frailty: a study of 7364 community-dwelling elderly women (the EPIDOS study). , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[24]  W. Bortz,et al.  A conceptual framework of frailty: a review. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.