Abstract
The metaphor of a frail older person as a car running out of petrol seems to have
resonance in the lay media. Though it may be an over simplistic representation of
a complex and dynamic process, it does facilitate discussion with patients and their
relatives about the appropriateness of interventions, such as whether or not there
is enough fuel (physiological reserves) to get up a really steep hill (undergo a coronary
bypass graft). It can also be used as a way to emphasise what can be done to help.
For example, in some longitudinal studies, 5% of older patients are less frail after
5 years follow up, suggesting there are things that can still be done to “fill up
the tank”. This review will consider whether drug therapies can fulfil this role.
Frail older people are often prescribed long lists of medications but it is debatable
whether current treatments actually address the causes or consequences of frailty
itself. Here, we explore the associations between frailty and co-morbidity and evaluate
whether the management of chronic disease may impact frailty development or progression.
We consider how the management of hypertension may have an important role in the prevention
of frailty, mediated by reduction of cerebrovascular disease, but why aggressive management
of hypertension may have negative consequences for those who are already frail. We
also summarise the evidence linking immunosenescence, inflammation and endocrine changes
to frailty and investigate whether targeted drug therapy has the potential to influence
frailty pathophysiology.
Keywords
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Article info
Publication history
Published online: November 02, 2012
Accepted:
October 17,
2012
Received:
October 15,
2012
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
