title: Frailty: Identifying elderly patients at high risk of poor outcomes.
abstract: OBJECTIVE
  To help family physicians better recognize frailty and its implications for managing elderly patients.
  
  
  METHODS
  PubMed-MEDLINE was searched from 1990 to 2013. The search was restricted to English-language articles using the following groups of MeSH headings and key words: frail elderly, frail, frailty; aged, geriatrics, geriatric assessment, health services for the aged; and primary health care, community health services, and family practice.
  
  
  RESULTS
  Frailty is common, particularly in elderly persons with complex chronic conditions such as heart failure and chronic obstructive pulmonary disease. Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. While there is currently a lack of consensus as to how best to assess and diagnose frailty in primary care practice, individual markers of frailty such as low gait speed offer a promising feasible means of screening for frailty. Identification of frailty in primary care might provide an opportunity to delay the progression of frailty through proactive interventions such as exercise, and awareness of frailty can guide appropriate counseling and anticipatory preventive measures for patients when considering medical interventions. Recognition of frailty might also help identify and optimize the management of coexisting conditions that might contribute to or be affected by frailty. Further research should be directed at identifying feasible and effective ways to appropriately assess and manage these vulnerable patients at the primary care level.
  
  
  CONCLUSIONS
  Despite its importance, little attention has been given to the concept of frailty in family medicine. Frailty is easily overlooked because its manifestations can be subtle, slowly progressive, and thus dismissed as normal aging; and physician training has been focused on specific medical diseases rather than overall vulnerability. For primary care physicians, recognition of frailty might help them provide appropriate counseling to patients and family members about the risks of medical interventions.
authors.affiliation: Family physician at the Centre for Family Medicine Family Health Team in Kitchener, Ont, and Associate Clinical Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont. lee.linda.lw@gmail.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Lee
authors.affiliation: Schlegel Research Chair in Geriatric Medicine and Associate Professor in the Faculty of Applied Health Sciences at the University of Waterloo in Ontario.
authors.forename: George
authors.initials: G
authors.lastname: Heckman
authors.affiliation: Medical Director of the Regional Geriatric Program of Eastern Ontario and Assistant Professor in the Department of Medicine at the University of Ottawa in Ontario.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Molnar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019468:Disease Management; D005194:Family Practice / Q000193:education / Q000379:methods*; D016330:Frail Elderly; D015577:Geriatric Assessment; D005853:Geriatrics / Q000193:education; D006299:Health Services for the Aged; D006801:Humans; D011320:Primary Health Care / Q000379:methods*