Response to the Letter to the Editor From Xue and Varadhan Titled 'What Is Missing in the Validation of Frailty Instruments?'

摘要

Drs Xue and Vardhan comment in their letter on the validity and applicability of assessment tools to address frailty as a relevant clinical complication of ageing and of progressing disabling disease.1 They dwell on the distinction between 2 principal approaches to defining physical frailty based on opposite directions of causality of the indicators and the clinically construct of frailty. While this distinction may emphasize the pathophysiologically relevant specific characteristics of both concepts, it remains a theoretical disputation of secondary relevance when it comes to clinical applicability of the assessment tools to identify a patient with frailty and at risk of disability. Clearly, there is an unmet clinical need to identify patients with frailty in a range of chronic diseases,2 to prevent or reverse further functional decline, and to improve the symptomatic state and, potentially, even the prognosis. As the title of the consensus statement by Morley et al. insinuates, clinical action is warranted to meet the challenge of growing numbers of patients with or at risk of frailty.3 To that aim, a practical approach is required and a recommendation is needed on how, in whom, and when screening activities should begin to identify frailty in the clinical context of elderly and often multi-morbid patients. Notably, a previous effort to find a consensus on frailty agreed merely on the need to define frailty as a condition to be clinically addressed.4 It failed, however, to provide such a practical framework as the wider variety of theoretical considerations that were to be included by the consensus group prevented a joint concept.