FRAILTY AND THE OLDER MAN - 07/09/11

Doi : 10.1016/S0025-7125(05)70157-7

Jeremy Walston, MD ^a,^b, Linda P. Fried, MD, MPH ^a,^c

^a Department of Medicine (JW, LPF)

^b The Johns Hopkins Geriatrics Center (JW)

^c Johns Hopkins Center on Aging and Health (LPF), The Johns Hopkins Medical Institutions, Baltimore, Maryland

Resumen

Frailty has been defined by some as a wasting syndrome common in people of advanced age that is often considered by clinicians as conferring risk for morbidity and mortality. Although no standard clinical or diagnostic criteria have been firmly established, many authors who have written on the topic include weight loss, loss of lean body mass (sarcopenia), fatigue, and loss of strength or endurance as part of the syndrome.^{26 Evans W. Functional and metabolic consequences of sarcopenia J Nutr 1997 ; 127 (suppl 5) : 998S-1003S

Haga clic aquí para ir a la sección de Referencias, 30 Fried L.P., Grossman L., Margolick J.B. , y al. Conference on the physiologic basis of frailty Aging Clin Exp Res 1992 ; 4 : 251-265

Haga clic aquí para ir a la sección de Referencias, 70 Palmer R.M. “Failure to thrive” in the elderly: Diagnosis and management Geriatrics 1990 ; 45 : 47-55

Haga clic aquí para ir a la sección de Referencias, 102 Wallace J.L., Schwartz R.S., LaCroix A.Z. , y al. Involuntary weight loss in older outpatients: Incidence and clinical significance J Am Geriatr Soc 1995 ; 43 : 329-337

Haga clic aquí para ir a la sección de Referencias} A wide range of biologic, physiologic, social, and environmental bases for this disorder has been postulated, including both processes resulting from specific diseases and age-related physiologic changes that are not due to disease.^{51 Lipsitz L.A., Goldberger A.L. Loss of ‘complexity’ and aging: Potential applications of fractals and chaos theory to senescence JAMA 1992 ; 267 : 1806-1809

Haga clic aquí para ir a la sección de Referencias, 63 Morley J.E., Kaiser F.E., Sih R. , y al. Testosterone and frailty Clin Geriatr Med 1997 ; 13 : 685-695

Haga clic aquí para ir a la sección de Referencias} Many of these models and definitions have considered gender differences in the presentation or the cause of frailty, perhaps because of the daunting complexity of clearly defining this age-related condition in either gender. This article summarizes definitions, research, and potential causes of the syndrome and considers the evidence for the gender differences in epidemiology and causes of frailty, including the gender-specific physiologic basis that may influence the development of the syndrome of frailty in men.

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Esquema

DEFINITION OF THE GERIATRIC SYNDROME OF FRAILTY

DEVELOPMENT AND VALIDATION OF FRAILTY PHENOTYPE

Gender-Specific Differences

POTENTIAL PROTECTION FROM FRAILTY AS A RESULT OF GENDER DIFFERENCES IN ALL-CAUSE MORBIDITY AND MORTALITY

SPECIFIC FACTORS THAT MAY AFFECT THE DEVELOPMENT OF FRAILTY IN MEN

Gender Differences in Body Composition May Provide Protection Against Frailty for Men

Specific Neuroendocrine Factors May Play a Role in the Development of Frailty in Men

Immune System and Sex Steroid Interactions May Decrease the Risk of Frailty in Men

Behavioral or Environmental Factors May Protect Men From the Development of Frailty

SUMMARY

Address reprint requests to Jeremy Walston, MD, The Johns Hopkins Geriatrics Center, 5505 Bayview Circle, Baltimore, MD 21224, e-mail: [email protected]