Frailty in primary care: a review of its conceptualization and implications for practice

Thousands of times each day, physicians around the world encounter older adults with multiple, interacting, medical and social problems. Often, both they and their patients can feel overwhelmed, and in an effort to start somewhere, many focus on the illness which seems most important, or the one with which they feel the most comfortable. Many times they continue despite confusion and difficulties, but even the most determined physicians can share with their less tenacious colleagues a feeling of frustration with the incompleteness of what they offer in the face of so many needs. In this brief review, we propose to cast this problem as one of the complexity of frailty.Our goals in this review of how to recognize and address frailty in primary care are to show how frailty can be conceptualized in relation to complexity, and how principles having to do with the management of complex systems that are close to failure can be employed in everyday office practice to achieve better care for frail older adults. Specifically, we propose to look at what defines the "at risk" state that is frailty. We will then address how recognizing frailty helps us in managing older people who are frail. We also aim to call attention to the reality that defining the prospect of successful treatment requires understanding patients' problems and life goals. In this, family physicians have a natural advantage, given their training and predisposition towards thinking about not just diseases, but the patients in whom they occur. We hope to show how much of the intuition associated with this predisposition and training can be leveraged in understanding frailty and its determinants.Complexity is a term that often is used synonymously with frailty, or in some settings, with the idea of physical frailty only [1]. Complexity has also been used in a restricted sense - and not without controversy [2] - to measure degrees of interaction in a system [3], or to describe non-linear increases in vulnerabilit