Paliatívna medicína a liečba bolesti 2/2011

Frailty syndrome – characteristic

Frailty is a state of vulnerability that carries an increased risk of poor outcomes in older adults. Frailty syndrome includes common signs and symptoms as fatigue, weith loss, muscle weakness, and progressive decline in function. Geriatricians have long been aware of this syndrome of multiple coexisting conditions, weakness, immobility, and poor tolerance to physiologic or psychologic stressors. People so affected are often characterized as „frail“ and are known to be more vulnerable to poor health outcomes, including disability, social isolation, and institutionalization. Although frailty is more prevalent in older people and in those with multiple medical conditions, it can exist independently of age, disability, or disease, and may be an independent patophysiologic process involving multiple systems. Frail older adults are among the most challenging for medical management. However, awareness of this syndrome and its risks can help us care for these patients more confidently and decrease their risk for adverse outcomes. Frail older adults are less able to tolerate the stress of medical illness, hospitalization, and immobility. They are less able to tolerate the pain. The care of frail older patients experiencing pain involves a comprehensive assessment, which includes evaluation for conditions that may exacerbate or be exacerbated by pain, affecting its expression, such as emotional and spiritual distress, disability, and comorbid conditions. Pain in frail older patients should be managed in an interdisciplinary environment using pharmacologic and nonpharmacologic interventions including opioids whose main goals are decreasing suffering and improving quality of life.

Keywords: Frailty syndrome, multisystem decline, disability, suffering, pain relief and management, quality of life.