Frailty is a progressive age-related decline in physiological systems that results in decreased reserves, which confers vulnerability to stressors and increases the risk of adverse health outcomes such as disability or death. Frailty overlaps with but is distinct from multimorbidity and disability.
Frailty becomes more prevalent with increasing age and is very common in hip fracture patients. The scope and detail of assessment needed and the choice of assessment tool should be tailored to the population being assessed and the purpose of the assessment. Many of the functional tests such as walking speed and the Timed Up and Go test are not feasible in patients with acute hip fractures. Simpler tools are more commonly used, such as the Clinical Frailty Scale or the Edmonton Frail Scale.
Sarcopenia is defined as a loss of muscle function with ageing and is a major component of frailty. Low muscle mass and function are associated with poor outcomes from acute illness such as fragility fractures. Prevalence increases with age. In older (65+) hip fracture patients sarcopenia is found in 17–74%. It is recommended that diagnosis, treatment and prevention of sarcopenia become part of routine clinical practice with older patients.
Gait speed and grip strength are simple screening tests, but not feasible in acute hip fracture patients. Measurement of muscle mass can be done with a CT scan or, less accurately, with impedance techniques or anthropometry. The Sarc-F tool, a brief questionnaire about muscle function, can indicate pre-fracture severe sarcopenia.
There are close links epidemiologically, biologically and clinically between frailty, sarcopenia, osteoporosis and falls. Older people who have had a fall and/or a fracture should be assessed for frailty and sarcopenia to better develop a care plan that includes nutrition and exercise interventions.
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