Frailty In Adulthood

The complexity of frailty is dynamic conditions leading to vulnerabilities, and it has significantly impacted on the multi-dimensions of health in older adults. Notably, evidence shows that physical decline and disability are the vital key component in developing frailty1,2,8,26,32,33. Considering for antecedents and risk factors of frailty, it can simply classify as intrinsic factors and extrinsic factors which have impacted on developing frailty equally.
For intrinsic factors, the personal characteristics and individual behavior play a significant role in developing frailty. Personal characteristics including biology and physiology were discovered to be reliable predictors of functional limitations in elderly, who consequently develop frailty21,22,26,32,34.
Furthermore, evidence has revealed that system dysregulation like metabolic dysregulation, hemato-coagulation, endocrine, and inflammation pathways, are significant factors which associated with frailty in elderly1,7,23,30,34,39. The chronic inflammation (serum levels of C-reactive protein: CRP, and interleukin 6: IL-6) is a key related to aged-declination, such as neuro-cardiovascular alteration, sarcopenia, and cognitive alteration26,34. These inflammation markers are related to age-related inflammation in older adults with severe progression of OA40,41. Ongoing imbalance of homeostasis of neurological, endocrine, and immunological due to frailty results in progressive sarcopenia (skeletal-muscle mass loss and strength and power decrease) 22. Many studies also demonstrated that age-related testosterone and Insulin-like growth factor-1 (IGF-1) declines were associated with sarcopenia42,43. Additionally, it was clear that comorbidities–diabetes mellitus (DM), stroke, and history of heart disease (CHD), osteoporosis, and arthritis–were associated with
Psycho-social factors including poverty economic status, loneliness, psycho-social depression, social isolation, less interpersonal support, and traumatic stress events were found to be associated with increased vulnerabilities which caused frailty in older adults51-54. Moreover, geriatric malnutrition syndrome integrating with cognitive impairment was essential risk factors of decreasing food intake. Accumulation of these problems induced severe malnutrition (cachexic)55,56, vitamin deficiency57, loss of muscle strength (sarcopenia), which is an excellent marker of frailty in older adults22,42,58,59. Also, cognitive impairment or cognitive dysfunction was associated with reducing appetite and lessening food intake in older adults60. Moreover, the preoperative nutrition status, malnutrition and overly-nutrition, intensified the risk of declined mobility, postoperative delirium, institutionalization, and death in older adults undergoing orthopedic surgery61-63. Overwhelming, immobility, pain related physical limitation, and imbalanced nutrition affected aging’s health which increased the risk of morbidity, complications, and mortality in this particular