Frailty

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John E. Morley, MB, B.Ch,  St. Louis University, Division Of Geriatric Medicine, St. Louis, MO and St. Louis VA Medical Center, GRECC, St. Louis, MO, USA

Frailty is a major problem in older men. Frailty is a precursor of functional deterioration, which leads to recurrent hospitalisation, institutionalisation and death. The causes of frailty are multifactorial. These include genetic factors (e.g. apolipoprotein E4), hormone (e.g. testosterone, growth hormone, DHEA), anorexia including increased leptin and cholecystokinin, inactivity, pain, depression, cytokines, atherosclerosis and cognitive impairment. Free radical damage to muscles (sarcopenia) and brain are an important component of this syndrome. Treatment of frailty, at present, focuses on the treatment of sarcopenia (resistant exercise), hormonal treatments (testosterone), treatment of anorexia (e.g. megestrol) and modification of atherosclerosis. The role of decreasing cytokines is uncertain. Pain and depression can accelerate the frailty syndrome. Prevention and treatment of frailty represents a major evolving area for maintaining the quality of life in older persons.