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Frailty and Sarcopenia in Cirrhosis pp 233–246Cite as

Should Frailty Include Multidimensional and Dynamic Factors?

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Abstract

The models and measures for frailty are multiple, and their relationships are complex. A dichotomous view frames frailty models as a heightened state of vulnerability (i.e., deficit accumulation) or as a physiologic syndrome (i.e., frailty phenotype). However, these two models are insufficient to explain many aspects of frailty. Other constructs for frailty capture the multidimensional, functional, and dynamic aspects of frailty. Geriatric syndromes have these features and may be a more authentic phenotype. An integrated view of frailty that resists unnecessary reduction in definition invites researchers and clinicians to employ a family of frailty measures in a coordinated way.

Frailty measures can be grouped into the frailty phenotype, biological markers, the frailty index, judgment-based measures, self-report measures, performance-based measures, and multidimensional measures. Selection of measures for a context could be based on test characteristics (diagnostic test accuracy, reliability, content and criterion validity, and sensitivity to change), intended use (risk modelling, outcome measure, research or opportunistic clinical use, policy), practical considerations (need for special equipment, administration time, need for prior training, need for a previously prepopulated database), interpretability (ability to grade severity, define dimensions, or detect dynamic changes), and operator training.

Implementation efforts should focus on the needs of citizens, policy-makers, clinicians, and researchers within their own contexts. If this is true, then frailty must include multidimensional and dynamic factors.

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  1. Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Darryl B. Rolfson

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  1. Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada

    Puneeta Tandon

  2. Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada

    Aldo J. Montano-Loza

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Rolfson, D.B. (2020). Should Frailty Include Multidimensional and Dynamic Factors?. In: Tandon, P., Montano-Loza, A. (eds) Frailty and Sarcopenia in Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-030-26226-6_16

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