Frailty and delirium: Unveiling the hidden vulnerability of older hospitalized patients

Published:October 24, 2019DOI:
      Frailty and delirium are two of the most problematic issues in the management of older hospitalized patients. The term frailty, from the Latin “fragilis” meaning “easily broken”, refers to a condition characterized by decreased homeostatic reserve that leads to a high vulnerability even to low-power stressors with a dramatic worsening in patients’ health status [
      • Clegg A.
      • Young J.
      • Iliffe S.
      • Rikkert M.O.
      • Rockwood K
      Frailty in elderly people.
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        • Clegg A.
        • Young J.
        • Iliffe S.
        • Rikkert M.O.
        • Rockwood K
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Inouye S.K.
        • Westendorp R.G.
        • Saczynski J.S
        Delirium in elderly people.
        Lancet. 2014; 383: 911-922
        • Bellelli G.
        • Morandi A.
        • Di Santo S.G.
        • Mazzone A.
        • Cherubini A.
        • Mossello E.
        • et al.
        Italian study group on delirium (ISGoD). "Delirium day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool.
        BMC Med. 2016 Jul 18; 14: 106
        • Persico I.
        • Cesari M.
        • Morandi A.
        • Haas J.
        • Mazzola P.
        • Zambon A.
        • et al.
        Frailty and delirium in older adults: a systematic review and meta-analysis of the literature.
        J Am Geriatr Soc. Oct 2018; 66: 2022-2030
        • Teale E.
        • Young J.
        Multicomponent delirium prevention: not as effective as nice suggest?.
        Age Ageing. Nov 2015; 44 (Epub 2015 Aug 26): 915-917
        • Bellelli
        • et al.
        The relationship among frailty, delirium and attentional tests to detect delirium: a cohort study.
        In press in this issue of Eur J Intern Med. 2019;
        • Cesari M.
        • Marzetti E.
        • Thiem U.
        • Pérez-Zepeda M.U.
        • Abellan Van Kan G.
        • Landi F.
        • et al.
        The geriatric management of frailty as paradigm of “The end of the disease era.”.
        Eur J Intern Med. 2016; 31: 11-14
        • Cunha A.
        Frailty as a predictor of adverse outcomes in hospitalized older adults: a systematic review and meta-analysis.
        Ageing Res Rev. 2019 Sep 10; ([Epub ahead of print])100960
        • Bellelli G.
        • Moresco R.
        • Panina-Bordignon P.
        • Arosio B.
        • Gelfi C.
        • Morandi A.
        • et al.
        Is delirium the cognitive harbinger of frailty in older adults? A review about the existing evidence.
        Front Med (Lausanne). 2017 Nov 8; 4 (eCollection 2017): 188
        • Kelaiditi E.
        • Cesari M.
        • Canevelli M.
        • van Kan G.A.
        • Ousset P.J.
        • Gillette-Guyonnet S.
        • IANA/IAGG
        Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group.
        J Nutr Health Aging. 2013; 17: 726-734
        • Borges M.K.
        • Canevelli M.
        • Cesari M.
        • Aprahamian I
        Frailty as a predictor of cognitive disorders: A systematic review and meta-analysis.
        Front Med (Lausanne). 2019 Feb 19; 6 (eCollection 2019): 26
        • Wallace L.M.K.
        • Theou O.
        • Godin J.
        • Andrew M.K.
        • Bennett D.A.
        • Rockwood K
        Investigation of frailty as a moderator of the relationship between neuropathology and dementia in alzheimer's disease: a cross-sectional analysis of data from the rush memory and aging project.
        Lancet Neurol. Feb 2019; 18: 177-184
        • Abraha I.
        • Trotta F.
        • Rimland J.M.
        • Cruz-Jentoft A.
        • Lozano-Montoya I.
        • Soiza R.L.
        • Pierini V.
        • Dessì Fulgheri P.
        • Lattanzio F.
        • O'Mahony D.
        • Cherubini A
        Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: a systematic overview. the senator project ontop series.
        PLoS ONE. 2015 Jun 10; 10e0123090
        • Bellelli G.
        • Nobili A.
        • Annoni G.
        • Morandi A.
        • Djade C.D.
        • Meagher D.J.
        • Maclullich A.M.
        • Davis D.
        • Mazzone A.
        • Tettamanti M.
        • Mannucci P.M.
        REPOSI (Registro POliterapie SIMI) investigators. under-detection of delirium and impact of neurocognitive deficits on in-hospital mortality among acute geriatric and medical wards.
        Eur J Intern Med. 2015; 26: 696-704