Frailty: Prävention

Das Syndrom der Frailty steht meist im Zusammenhang mit dem Alterungsprozess und dem chronologischen Alter, ist aber keine unvermeidliche Folge davon – zumindest bis zur letzten Lebensphase. Maßnahmen der Primärversorgung, die körperliche Aktivität und Ernährung fördern, können das Fortschreiten von Pre-Frailty zu Frailty verhindern. Dieser Beitrag stellt den aktuellen Kenntnisstand zur Primär- und Sekundärprävention der Frailty vor.

Abstract

The Frailty syndrome is usually related to the aging process and chronological age, but it is not an inevitable consequence of it – at least until the final phase of life. Primary care interventions that promote physical activity and nutrition can prevent the progression from pre-frailty to frailty. This article presents the current state of knowledge on primary and secondary prevention of frailty.

Kernaussagen

• Maßnahmen in der Primärversorgung, die vor allem körperliche Aktivität, aber auch Ernährung fördern, verhindern das unerwünschte Fortschreiten von Pre-Frailty zu Frailty.

• Die Prävention der Frailty kann die Verbesserung der funktionellen Autonomie und der Lebensqualität unterstützen.

• In verschiedenen Studien zur Primär- und Sekundärprävention konnten positive Effekte durch körperliche, soziale und ernährungsbezogene Interventionen erzielt werden. Aber es mangelt an großen randomisiert-kontrollierten Studien, um eine starke Evidenz zu schaffen, sowie an der Vergleichbarkeit der durchgeführten Studien.

• Angesichts des Zusammenhangs zwischen Frailty und der Entwicklung verschiedener Krankheiten könnte die Vermeidung der Frailty einen zusätzlichen Nutzen für die primäre und sekundäre Prävention von Komorbiditäten und Multimorbidität haben.

• Die enge longitudinale Beziehung, die zwischen Hausarzt und Patient besteht, kann die Prioritäten und Präferenzen der Patienten auch im Hinblick auf die Frailty-Prävention unterstützen.

Schlüsselwörter

Frailty - Pre-Frailty - Prävention - körperliche Aktivität - Ernährung

Keywords

frailty - pre-frailty - prevention - physical activity - nutrition

Publication History

Article published online:
29 December 2023

• Literatur

• 1 Fried LP, Tangen CM, Walston J. et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
• 2 Clegg A, Young J, Iliffe S. et al. Frailty in elderly people. Lancet 2013; 381: 752-762
• 3 Zampino M, Polidori MC, Ferrucci L. et al. Biomarkers of aging in real life: three questions on aging and the comprehensive geriatric assessment. Geroscience 2022; 44: 2611-2622
• 4 Fried LP, Ferrucci L, Darer J. et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59: 255-263
• 5 Vetrano DL, Palmer K, Marengoni A. et al. Frailty and multimorbidity: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2019; 74: 659-666
• 6 Hanlon P, Nicholl BI, Jani BD. et al. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants. Lancet Public Health 2018; 3: e323-e332
• 7 Serra-Prat M, Sist X, Domenich R. et al. Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial. Age Ageing 2017; 46: 401-407
• 8 Romera-Liebana L, Orfila F, Segura JM. et al. Effects of a primary care-based multifactorial intervention on physical and cognitive function in frail, elderly individuals: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2018; 73: 1688-1674
• 9 Gene Huguet L, Navarro Gonzalez M, Kostov B. et al. Pre Frail 80: Multifactorial intervention to prevent progression of pre-frailty to frailty in the elderly. J Nutr Health Aging 2018; 22: 1266-1274
• 10 Veronese N. Frailty and Cardiovascular Diseases – Research into an Elderly Population. Berlin: Springer; 2020
• 11 Teh R, Barnett D, Edlin R. et al. Effectiveness of a complex intervention of group-based nutrition and physical activity to prevent frailty in pre-frail older adults (SUPER): a randomised controlled trial. Lancet Healthy Longev 2022; 3: e519-e530
• 12 Meyer AM, Bartram MP, Antczak P. et al. A tailored discharge program improves frailty and mood in patients undergoing usual rehabilitative care: a randomized controlled trial. J Am Med Dir Assoc 2022; 23: 1962.e1-1962.e13
• 13 Rainero I, Summers MJ, Monter M. et al. The My Active and Healthy Aging ICT platform prevents quality of life decline in older adults: a randomised controlled study. Age Ageing 2021; 50: 1261-1267
• 14 Bernabei R, Landi F, Calvani R. et al. Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project). BMJ 2022; 377: e068788
• 15 Pahor M, Guralnik JM, Ambrosius WT. et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014; 311: 2387-2396
• 16 Veronese N, Cereda E, Stubbs B. et al. Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis. Ageing Res Rev 2017; 35: 63-73
• 17 Meyer AM, Siri G, Becker I. et al. The Multidimensional Prognostic Index in general practice: One-year follow-up study. Int J Clin Pract 2019; 13: e13403
• 18 Hoogendijk EO, Afilalo J, Ensrud KE. et al. Frailty: implications for clinical practice and public health. Lancet 2019; 394: 1365-1375
• 19 Hilmer SN, Gnjidic D, Le Couteur DG. Thinking through the medication list – appropriate prescribing and deprescribing in robust and frail older patients. Aust Fam Physician 2012; 41: 924-928
• 20 Lorenzo-Lopez L, Maseda A, de Labra C. et al. Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr 2017; 17: 108
• 21 Martemucci G, Portincasa P, Di Ciaula A. et al. Oxidative stress, aging, antioxidant supplementation and their impact on human health: An overview. Mech Ageing Dev 2022; 206: 111707
• 22 Polidori MC, Sieber C, Meyer AM. Special Issue “Nutrition and Aging – Featured Perspectives on Health and Metabolism”. Nutrients 2022/2023.
• 23 Polidori MC. Special Issue “Lifestyle Strategies in Cognitive Decline: Focus on Nutrition”. Nutrients. 2019
• 24 Bauer JM, Denkinger M. Frailty. In: Bauer JM, Becker C, Denkinger M, Wirth R. Geriatrie. Stuttgart: Kohlhammer; 2024: 207-214
• 25 Soh YY, Zhang H, Toh JJY. et al. The effectiveness of tele-transitions of care interventions in high-risk older adults: A systematic review and meta-analysis. Int J Nurs Stud 2023; 139: 104428
• 26 Theou O, Campbell S, Malone ML. et al. Older adults in the emergency department with frailty. Clin Geriatr Med 2018; 34: 369-386
• 27 Engel JS, Beckerleg W, Wijeysundera DN. et al. Association of preoperative anaesthesia consultation prior to elective noncardiac surgery with patient and health system outcomes: a population-based study. Br J Anaesth 2023;
• 28 Mehta P, Lemon G, Hight L. et al. A systematic review of clinical practice guidelines for identification and management of frailty. J Nutr Health Aging 2021; 25: 382-391
• 29 Howe TE, Shea B, Dawson LJ. et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2011; 7: CD000333
• 30 Sherrington C, Fairhall NJ, Wallbank GK. et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 1: CD012424
• 31 Marzetti E, Calvani R, Landi F. et al. Innovative Medicines Initiative: The SPRINTT Project. J Frailty Aging 2015; 4: 207-208