8. Conclusions
It is widely recognized that the assessment of diseases status performed according to the traditional dichotomy “no disease vs. disease” is insufficient to understand the complexity of problems that influence health and well being in older persons. This concept was recognized long ago by geriatricians and implemented in the paradigm of “Comprehensive Geriatric Assessment”. Accordingly, many researchers and clinicians have proposed that the direct assessment of physical and cognitive function provides the essential information that is needed to design effective interventions in frail older persons. However, this approach has never been completely translated into clinical practice and many geriatricians claim that the administration of any available medical treatment is still conditioned to a previous diagnosis of specific diseases and hypotheses about specific pathophysiological pathways. Furthermore, significant changes in health status may occur and be amenable to effective treatment long before any clear effect on physical and cognitive function is detected.
We propose that the concept of frailty — a condition that involves impairment in multiple physiological systems and is characterized by exhaustion of functional reserve, massive use of compensatory strategies and high risk of homeostatic breakdown — can be used by clinicians to gain a better understanding of the global burden of disease and reduced physical function in older persons and their interaction with the “pure” effect of aging. Unfortunately, there is still no agreement on the criteria that should be used in order to identify frail older persons. However, there is general consensus that comorbidity, disease susceptibility and risk of developing multiple health outcomes are commonly associated with the detection of abnormal circulating levels of several biomarkers and changes in body composition. Thus, composite measures of mobility, body composition, strength, circulating hormones and biomarkers of inflammation may help clinicians understand the severity of health status deterioration in their patients over and beyond the information provided by the simple diagnosis of diseases. Aggregate measures of these outcomes should be developed in future studies and are likely to replace the current criteria for the definition of frailty, both in research projects and in clinical practice.
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Abbatecola, A., Gwen Windham, B., Bandinelli, S., Lauretani, F., Paolisso, G., Ferrucci, L. (2005). Clinical and Biochemical Evaluation Changes Over Aging. In: Balducci, L., Extermann, M. (eds) Biological Basis of Geriatric Oncology. Cancer Treatment and Research, vol 124. Springer, Boston, MA. https://doi.org/10.1007/0-387-23962-6_7
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