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Ruiz-Cantero" "autores" => array:1 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Ruiz-Cantero" "email" => array:1 [ 0 => "aruizc@telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de la Serranía, Ronda, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Trabajo Paciente Pluripatológico y Edad Avanzada, Sociedad Española de Medicina Interna, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fragilidad" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Frailty is the quality of being frail, which is defined in the Spanish dictionary as “weak, that which can deteriorate easily (to have frail health).” The Oxford dictionary defines it as “physically weak and thin (especially of an old person)” and the Cambridge dictionary defines it as “weak or unhealthy, or easily damaged, broken, or harmed.” Some antonyms are tough or sturdy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The PubMed® thesaurus (MeSH, Medical Subject Headings), introduced in 2018, includes “frailty” and describes it as a state of increased vulnerability to stressors, following declines in function and reserves across multiple physiological systems, characterized by muscle weakness; fatigue; slowed motor performance; low physical activity; and unintentional weight loss.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The above thesaurus and its entry dates and duration of indexation are as follows: <span class="elsevierStyleItalic">Aged</span> (1977–1990); <span class="elsevierStyleItalic">Aged, 80 and over</span> (1987–1990); <span class="elsevierStyleItalic">Health Services Needs and Demand</span> (1986–1990); <span class="elsevierStyleItalic">Health Services for the Aged</span> (1983–1990), and <span class="elsevierStyleItalic">Frail Elderly</span> (1990–2017), year of introduction 1991. The first article in which said thesaurus heading appears is from 1953<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. From that year until 2003, fewer than 100 articles were indexed per year; since 2004, there have been more than 100 per year; since 2015, more than 1000 per year; and in 2022, there were a record 4772 articles. In total, there are 24,977 articles.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The term “frailty” is ambiguous. There is no universal consensus on its definition except for what is indicated above, which is in the most recent publications. The same occurs with so-called “frailty syndrome”<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">For a long time, the Fried et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> criteria have and continue to be used. These criteria define frailty as a clinical syndrome in which three or more of the following criteria are present: unintentional weight loss (10<span class="elsevierStyleHsp" style=""></span>lb (4.5<span class="elsevierStyleHsp" style=""></span>kg) in the last year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. As the authors themselves indicate, the study provides a possible standardized definition of frailty in community-dwelling older adults and offers concurrent, predictive validity for the definition. In a study by Ramírez et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>, the Fried criteria and the Edmonton Frail Scale are compared.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In many situations, different studies establish intrinsic components and stress factors (called stressors in psychology, a term whose Spanish translation is not accepted in the Dictionary of the Royal Spanish Academy), which include the onset of multiple, concurrent chronic diseases in a single person, weakness, and finally, disability. They are usually related to older adults and those of advanced age, with the exception of other clinical situations that occur in young people such as the presence of hereditary degenerative and rare diseases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">For years, various frailty scales with highly disparate psychological, physical, social, environmental, or lifestyle components have been developed in order to measure frailty and the condition of prefrailty. In a systematic review<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> published in 2019, after screening 5604 articles found online, 96 were selected which referred to 49 frailty measurement instruments. The setting where they are administered was evaluated, which was mainly in the community and hospital. Among other points of evaluation, the authors included reliability, validity, and positive and negative predictive values.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Some scales are unidimensional and others are multidimensional. The Edmonton Frail Scale (EFS) is classified as a community scale and is multidimensional (it assesses the physical, psychological, and social domains). The FRAIL scale, which only evaluates the physical domain, is also classified as a “community” scale.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the 2006 study by Rolfson et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> on the validity and reliability of the EFS, most patients came from the community: 43% lived at home without help and 42% lived at home with help, 14% received assistance, and 1% lived in a nursing home. The evaluations were also conducted in outpatients: 56% in specialized clinics; 4% in day hospitals, and in hospitalized patients: 22% in intensive care units and 18% in geriatric rehabilitation units.</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> [Prevalence and factors associated with frailty in older hospitalized patients]<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> published in this issue of the <span class="elsevierStyleItalic">Revista Clínica Española</span>. The work by Morley et al.<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, though it has also been validated in other studies on different populations. Therefore, in the article presented<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>, two scales are used in the community setting with different domains in hospital care and with different prevalences of frailty: 57.4% according to the FRAIL scale and 46.8% according to the EFS.</p><p id="par0055" class="elsevierStylePara elsevierViewall">What are the consequences of this? 1) There is no single definition of frailty, frailty syndrome, or prefrailty. 2) Very different frailty measurement instruments are used in the studies published. 3) Data from one study cannot be compared to those from another as they use different measurements. 4) 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>. 5) Sociodemographic components should be incorporated into the different scales.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore, 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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative frailty of patients with chromophobe adenoma of abnormal symptomatology; prognostic value of homonymous lateral hemianopsia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. 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