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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Frailty is the quality of being frail&#44; which is defined in the Spanish dictionary as &#8220;weak&#44; that which can deteriorate easily &#40;to have frail health&#41;&#46;&#8221; The Oxford dictionary defines it as &#8220;physically weak and thin &#40;especially of an old person&#41;&#8221; and the Cambridge dictionary defines it as &#8220;weak or unhealthy&#44; or easily damaged&#44; broken&#44; or harmed&#46;&#8221; Some antonyms are tough or sturdy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The PubMed&#174; thesaurus &#40;MeSH&#44; Medical Subject Headings&#41;&#44; introduced in 2018&#44; includes &#8220;frailty&#8221; and describes it as a state of increased vulnerability to stressors&#44; following declines in function and reserves across multiple physiological systems&#44; characterized by muscle weakness&#59; fatigue&#59; slowed motor performance&#59; low physical activity&#59; and unintentional weight loss&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The above thesaurus and its entry dates and duration of indexation are as follows&#58; <span class="elsevierStyleItalic">Aged</span> &#40;1977&#8211;1990&#41;&#59; <span class="elsevierStyleItalic">Aged&#44; 80 and over</span> &#40;1987&#8211;1990&#41;&#59; <span class="elsevierStyleItalic">Health Services Needs and Demand</span> &#40;1986&#8211;1990&#41;&#59; <span class="elsevierStyleItalic">Health Services for the Aged</span> &#40;1983&#8211;1990&#41;&#44; and <span class="elsevierStyleItalic">Frail Elderly</span> &#40;1990&#8211;2017&#41;&#44; year of introduction 1991&#46; The first article in which said thesaurus heading appears is from 1953<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; From that year until 2003&#44; fewer than 100 articles were indexed per year&#59; since 2004&#44; there have been more than 100 per year&#59; since 2015&#44; more than 1000 per year&#59; and in 2022&#44; there were a record 4772 articles&#46; In total&#44; there are 24&#44;977 articles&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The term &#8220;frailty&#8221; is ambiguous&#46; There is no universal consensus on its definition except for what is indicated above&#44; which is in the most recent publications&#46; The same occurs with so-called &#8220;frailty syndrome&#8221;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">For a long time&#44; the Fried et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> criteria have and continue to be used&#46; These criteria define frailty as a clinical syndrome in which three or more of the following criteria are present&#58; unintentional weight loss &#40;10<span class="elsevierStyleHsp" style=""></span>lb &#40;4&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41; in the last year&#41;&#44; self-reported exhaustion&#44; weakness &#40;grip strength&#41;&#44; slow walking speed&#44; and low physical activity&#46; As the authors themselves indicate&#44; the study provides a possible standardized definition of frailty in community-dwelling older adults and offers concurrent&#44; predictive validity for the definition&#46; In a study by Ram&#237;rez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; the Fried criteria and the Edmonton Frail Scale are compared&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In many situations&#44; different studies establish intrinsic components and stress factors &#40;called stressors in psychology&#44; a term whose Spanish translation is not accepted in the Dictionary of the Royal Spanish Academy&#41;&#44; which include the onset of multiple&#44; concurrent chronic diseases in a single person&#44; weakness&#44; and finally&#44; disability&#46; They are usually related to older adults and those of advanced age&#44; with the exception of other clinical situations that occur in young people such as the presence of hereditary degenerative and rare diseases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For years&#44; various frailty scales with highly disparate psychological&#44; physical&#44; social&#44; environmental&#44; or lifestyle components have been developed in order to measure frailty and the condition of prefrailty&#46; In a systematic review<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> published in 2019&#44; after screening 5604 articles found online&#44; 96 were selected which referred to 49 frailty measurement instruments&#46; The setting where they are administered was evaluated&#44; which was mainly in the community and hospital&#46; Among other points of evaluation&#44; the authors included reliability&#44; validity&#44; and positive and negative predictive values&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Some scales are unidimensional and others are multidimensional&#46; The Edmonton Frail Scale &#40;EFS&#41; is classified as a community scale and is multidimensional &#40;it assesses the physical&#44; psychological&#44; and social domains&#41;&#46; The FRAIL scale&#44; which only evaluates the physical domain&#44; is also classified as a &#8220;community&#8221; scale&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the 2006 study by Rolfson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> on the validity and reliability of the EFS&#44; most patients came from the community&#58; 43&#37; lived at home without help and 42&#37; lived at home with help&#44; 14&#37; received assistance&#44; and 1&#37; lived in a nursing home&#46; The evaluations were also conducted in outpatients&#58; 56&#37; in specialized clinics&#59; 4&#37; in day hospitals&#44; and in hospitalized patients&#58; 22&#37; in intensive care units and 18&#37; in geriatric rehabilitation units&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The FRAIL scale was also referenced by the authors of the study entitled <span class="elsevierStyleItalic">Prevalencia y factores asociados a la fragilidad en pacientes mayores hospitalizados</span> &#91;Prevalence and factors associated with frailty in older hospitalized patients&#93;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> published in this issue of the <span class="elsevierStyleItalic">Revista Cl&#237;nica Espa&#241;ola</span>&#46; The work by Morley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> was conducted in the community setting among African Americans from 49 to 65 years of age&#44; though it has also been validated in other studies on different populations&#46; Therefore&#44; in the article presented<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; two scales are used in the community setting with different domains in hospital care and with different prevalences of frailty&#58; 57&#46;4&#37; according to the FRAIL scale and 46&#46;8&#37; according to the EFS&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">What are the consequences of this&#63; 1&#41; There is no single definition of frailty&#44; frailty syndrome&#44; or prefrailty&#46; 2&#41; Very different frailty measurement instruments are used in the studies published&#46; 3&#41; Data from one study cannot be compared to those from another as they use different measurements&#46; 4&#41; The prevalence of frailty has a highly variable range both due to its definition and the tool used to measure it<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; 5&#41; Sociodemographic components should be incorporated into the different scales&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore&#44; the current challenge is to create universal definitions of the different concepts and develop measurement instruments that can be compared and which include a sociodemographic component due to the differences that exist among countries and within single countries&#46;</p></span>"
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Journal Information
Vol. 223. Issue 2.
Pages 98-99 (February 2023)
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Vol. 223. Issue 2.
Pages 98-99 (February 2023)
Editorial
Frailty
Fragilidad
Visits
32
A. Ruiz-Canteroa,b
a Servicio de Medicina Interna, Hospital de la Serranía, Ronda, Málaga, Spain
b Grupo de Trabajo Paciente Pluripatológico y Edad Avanzada, Sociedad Española de Medicina Interna, Spain
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