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Rather than being a vague descriptor, frailty in older adults could be thought of as a clinical syndrome characterized by distinct physiological events, according to Columbia University Mailman School of Public Health Dean Linda Fried.

Fried made the assertion during the 2015 Kesten Memorial Lecture at the USC Leonard Davis School of Gerontology February 26. The Kesten Lectureship is an annual honor given to a leader in aging research; previous recipients include luminaries of aging study such as Leonard Hayflick and “father of gerontology” Nathan Shock.

USC Leonard Davis Dean Pinchas Cohen introduced Fried as a respected leader in epidemiology and geriatrics, praising her as someone who has “dedicated her career to the science of healthy aging.” He noted that Fried is also the senior vice president of Columbia University Medical Center, a recipient of the U.S. Congress’ Living Legend in Medicine recognition, and the creator of the Experience Corps, a scientifically designed community-based program that connects senior volunteers to kids in public schools in 19 cities.

Fried stated that the typical symptoms people think of when they picture a frail person—shrinking stature, slow movement, weakness, low activity, and low energy—illustrate a “cycle of frailty” that builds on itself and is a chronic, progressive process.
“This is a very vicious cycle that can be kicked off at any point and can become a downward spiral,” she said.

At its heart, frailty appears to be a problem connected to energy dysregulation and a decrease in the body’s ability to tolerate, respond to, and recuperate from stressors. A critical mass of physiological problems—such as a combination of inflammation, nutritional deficiency, irregular hormone levels, and other abnormalities in body systems—overpower the body’s natural regulatory processes and “fray the physiological safety net,” Fried explained.

Understanding the physiology of why older adults become frail is key to not only treating frailty and providing accurate prognoses for patients but also preventing its onset. In addition, more research on frailty may indicate changes are needed in the wider health care system in order to effectively address frailty at every stage, she said.
“In an era when so many are focused on improving health care, how can we use the science of what we do to design a system to improve health?” Fried said. “The potential for the prevention or treatment of frailty is high. Many approaches at many levels will be needed.”

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