Essentials of health evaluation in the elderly with special reference to frailty and sarcopenia

Abstract

 Nowadays, the goal of health evaluation in the elderly has been focused on frailty under the screening name of FRAIL that looked specifically for Fatigue, Resistance (inability to walk up a flight of stairs), Ambulation (inability to walk a short distance), Illness (>five comorbid conditions), and Loss of body mass (>5% of total body weight). In this introductive remark of frailty and sarcopenia, we will first demonstrate the current concept of frailty with special regards to its clinical phenotype introduced by Freid and others in 2001 that included 5 items including loss of body weight, sarcopenia, reduced hand grip, fatigability and slow walking. Then conceptually, a transitional state in a dynamic process of frailty proposed by Lang and others (2013) with special regards to impairment of homeostasis was introduced to understand its lability and stabilization. Since clinical frailty scale proposed by Rockwood and others (2005) is a quite usable idea for evaluation of the severity of frailty, this is a recommendable tool for the cohort study and general clinical practices. Concerning sarcopenia, its fundamental concepts, details of definitions and evaluation in research and clinical practices have already been described by European Working Group on Sarcopenia in Older People (EWGSOP). Sarcopenia itself is one of the most important items in frailty definition and its evaluation has to be done both in its mass and force. In clinical basis, manual evaluations must be the most practical and desirable method as semi-quantitative evaluation. Lastly, sarcopenic obesity is an another important health problem, of which prevalence has been increasing. This is thought to be an infiltration of fat cells into the muscle mass, of which quality might be greatly changed and deteriorated. Fat tissue itself is an active endocrine organ which releases inflammatory cytokines and hormones. Treatment strategies consist of dietary regimens and exercise program associated with vaccinations for herpes zoster, influenza and pneumococcal pneumonia. Other co-morbidities associated with frailty should be treated appropriately.