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ISSN 0016-3813 (Impreso)

2008, Número 3

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Gac Med Mex 2008; 144 (3)


La fragilidad, concepto enigmático y controvertido de la geriatría. La visión biológica

Ávila-Funes JA, Aguilar-Navarro S, Melano-Carranza E

Idioma: Español
Referencias bibliográficas: 98
Paginas: 255-262
Archivo PDF: 83.57 Kb.


RESUMEN

La fragilidad es un concepto relativamente nuevo, complejo y controvertido. Con el aumento de los adultos mayores ha sido posible constatar el impacto de la fragilidad sobre las personas afectadas, sus familias, cuidadores y la sociedad. Puesto que es importante cambiar el antiguo concepto de los ochenta, cuando la fragilidad era sinónimo de discapacidad, presencia de una enfermedad crónica o envejecimiento extremo, los profesionales de la salud que trabajan con adultos mayores deben familiarizarse con este término, así como con sus características. Las publicaciones acerca este tema han crecido exponencialmente en el último decenio; sin embargo, todavía no hay una definición ni criterios universalmente reconocidos para su descripción. Puesto que se trata de un fenómeno multifactorial, la siguiente revisión tiene como propósito describir las características biológicas de la fragilidad, así como sus consecuencias, según los resultados de investigación recientes. Con la información presentada, el profesional de la salud conocerá los componentes fundamentales de la fragilidad hasta ahora propuestos, así como lo difícil que ha sido su integración.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Buchner DM, Wagner EH. Preventing frail health. Clin Geriatr Med 1992;8:1-17.

  2. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. 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.

  3. Walston J, Hadley EC, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 2006;54:991-1001.

  4. Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, et al. Frailty: An emerging research and clinical paradigm issues and controversies. J Gerontol A Biol Sci Med Sci 2007;62:731-737.

  5. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-M156.

  6. Morley JE, Perry HM 3rd, Miller DK. Editorial: Something about frailty. J Gerontol A Biol Sci Med Sci 2002;57:M698-704.

  7. Bergman H, Beland F, Karunananthan S, Hummel S, Hogan D, Wolfson C. Développement d’un cadre de travail pour comprendre et étudier la fragilité. Gérontologie et Societé 2004;109:15-29.

  8. Fried LP, Hadley EC, Walston JD, Newman A, Guralnik JM, Studenski S, et al. From bedside to bench: research agenda for frailty. Sci Aging Knowledge Environ 2005;2005:pe24.

  9. Rockwood K. Frailty and its definition: a worthy challenge. J Am Geriatr Soc 2005;53:1069-1070.

  10. Rockwood K. What would make a definition of frailty successful? Age Ageing 2005;34:432-434.

  11. Ferrucci L, Cavazzini C, Corsi A, Bartali B, Russo CR, Lauretani F, et al. Biomarkers of frailty in older persons. J Endocrinol Invest 2002;25:10-15.

  12. Rowe JW, Kahn RL. Successful aging. Gerontologist 1997;37:433-440.

  13. Word Health Organization. Classification internationale des handicaps: Déficiences, incapacités, désavantages. Paris, France: WHO; 1993.

  14. Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 1999;48:445-469.

  15. Woodhouse KW, Wynne H, Baillie S, James OF, Rawlins MD. Who are the frail elderly? Q J Med 1988;68:505-506.

  16. Gillick MR. Long-term care options for the frail elderly. J Am Geriatr Soc 1989;37:1198--1203.

  17. Mellinger JC. Emergency housing for frail older adults. Gerontologist 1989;29:401-404.

  18. Tennstedt SL, McKinlay JB, Sullivan LM. Informal care for frail elders: the role of secondary caregivers. Gerontologist 1989;29:677-683.

  19. Berkman B, Foster LW, Campion E. Failure to thrive: paradigm for the frail elder. Gerontologist 1989;29:654-659.

  20. Wynne HA, Cope LH, James OF, Rawlins MD, Woodhouse KW. The effect of age and frailty upon acetanilide clearance in man. Age Ageing 1989;18:415-418.

  21. Pawlson LG. Hospital length of stay of frail elderly patients. Primary care by general internists versus geriatricians. J Am Geriatr Soc 1988;36:202-208.

  22. MacAdam M, Capitman J, Yee D, Prottas J, Leutz W, Westwater D. Case management for frail elders: the Robert Wood Johnson Foundation’s Program for Hospital Initiatives in Long-Term Care. Gerontologist 1989;29:737-744.

  23. Williams FM, Wynne H, Woodhouse KW, Rawlins MD. Plasma aspirin esterase: the influence of old age and frailty. Age Ageing 1989;18:39-42.

  24. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. J Am Geriatr Soc 2004;52:625-634.

  25. Chin A, Paw MJ, de Groot LC, van Gend SV, Schoterman MH, Schouten EG, Schroll M, et al. Inactivity and weight loss: effective criteria to identify frailty. J Nutr Health Aging 2003;7:55-60.

  26. Brown M, Sinacore DR, Binder EF, Kohrt WM. Physical and performance measures for the identification of mild to moderate frailty. J Gerontol A Biol Sci Med Sci 2000;55:M350-355.

  27. Katz IR. Depression and frailty: the need for multidisciplinary research. Am J Geriatr Psychiatry 2004;12:1-6.

  28. Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP. The association between obesity and the frailty syndrome in older women: the women’s health and aging studies. J Am Geriatr Soc 2005;53:927-934.

  29. Morley JE. Hormones and the aging process. J Am Geriatr Soc 2003;51:S333-337.

  30. Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hebert R, Hogan DB. A brief clinical instrument to classify frailty in elderly people. Lancet 1999;353:205-206.

  31. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr 2002;2:1.

  32. Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 2002; 162:2333-2341.

  33. Leng SX, Xue QL, Tian J, Walston ID, Fried LP. Inflammation and frailty in older women. J Am Geriatr Soc 2007;55:864-871.

  34. Walston J, Fried LP. Frailty and the older man. Med Clin North Am 1999;83:1173-94.

  35. Ferrucci L, Harris TB, Guralnik JM, Tracy RP, Corti MC, Cohen HJ, et al. Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc 1999;47:639--646.

  36. Ferrucci L, Penninx BW, Volpato S, Harris TB, Bandeen-Roche K, Balfour J, et al. Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels. J Am Geriatr Soc 2002;50:1947-1954.

  37. Ponnappan U. Regulation of transcription factor NF kappa B in immune senescence. Front Biosci 1998;3:152-168.

  38. Baurnann H, Gauldie J. The acute phase response. Immunol Today 1994;15:74-80.

  39. Cohen HJ, Harris T, Pieper CF. Coagulation and activation of inflammatory pathways in the development of functional decline and mortality in the elderly. Am J Med 2003;114:180-187.

  40. Payette H, Roubenoff R, Jacques PF, Dinarello CA, Wilson PW, Abad LW, et al. Insulin- like growth factor-l and interleukin 6 predict sarcopenia in very old community-living men and women: the Framingham Heart Study. J Am Geriatr Soc 2003;51:1237-1243.

  41. Morley JE, Thomas DR. Anorexia and aging: pathophysiology. Nutrition 1999;15:499--503.

  42. Morley JE. Anorexia, sarcopenia, and aging. Nutrition 2001;17:660-663.

  43. Mitch WE, Goldberg AL. Mechanisms of muscle wasting. The role of the ubiquitin-proteasome pathway. N Engl J Med 1996;335:1897-1905.

  44. Barzilay JI, Blaum C, Moore T, Xue QL, Hirsch CH, Walston JD, et al. Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med 2007;167:635-641.

  45. Baldwin AS Jr. The NF-kappa B and I kappa B proteins: new discoveries and insights. Annu Rev Immunol 1996;14:649-683.

  46. Thompson MP, Morris LK. Unexplained weight loss in the ambulatory elderly. J Am Geriatr Soc 1991;39:497-500.

  47. Cappola AR, Bandeen-Roche K, Wand GS, Volpato S, Fried LP. Association of IGF-I levels with muscle strength and mobility in older women. J Clin Endocrinol Metab 2001;86:4139-146.

  48. Montero-Odasso M, Duque G. Vitamin D in the aging musculoskeletal system: an authentic strength preserving hormone. Mol Aspects Med 2005;26:203-219.

  49. Campisi J. Cellular senescence and apoptosis: how cellular responses might influence aging phenotypes. Exp Geronto12003;38:5-11.

  50. Evans WJ. What is sarcopenia? J Gerontol A Biol Sci Med Sci 1995;50:5-8.

  51. Rosenberg IH. Summary comments. Am J Clin Nutr 1989;50:1231-1233.

  52. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr 1997; 127:990S-991S.

  53. Roubenoff R, Hughes VA. Sarcopenia: current concepts. J Gerontol A Biol Sci Med Sci 2000;55:M716-724.

  54. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998;147:755-763.

  55. Roubenoff R, Rall LC, Veldhuis JD, Kehayias JJ, Rosen C, Nicolson M, et al. The relationship between growth hormone kinetics and sarcopenia in postmenopausal women: the role of fat mass and leptin. J Clin Endocrinol Metab 1998;83:1502-1506.

  56. Bross R, Javanbakht M, Bhasin S. Anabolic interventions for aging-associated sarcopenia. J Clin Endocrinol Metab 1999;84:3420-3430.

  57. Yarasheski KE, Pak-Loduca J, Hasten DL, Obert KA, Brown MB, Sinacore DR. Resistance exercise training increases mixed muscle protein synthesis rate in frail women and men ≥76 year old. Am J Physiol 1999;277:E118-125.

  58. Pollock ML, Graves JE, Swart DL, Lowenthal DT. Exercise training and prescription for the elderly. South Med J 1994;87:S88-S95.

  59. Frontera WR, Hughes VA, Fielding RA, Fiatarone MA, Evans WJ, Roubenoff R. Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol 2000;88:1321-1326.

  60. Frontera WR, Hughes VA, Lutz KJ, Evans WJ. A cross-sectional study of muscle strength and mass in 45- to 78-year-old men and women. J Appl Physiol 1991;71:644-650.

  61. Evans W. Functional and metabolic consequences of sarcopenia. J Nutr 1997;127:998S--1003S.

  62. Dutta C, Hadley EC. The significance of sarcopenia in old age. J Gerontol A Biol Sci Med Sci 1995;50 Spec No:1-4.

  63. Bassey EJ, Fiatarone MA, O’Neill EF, Kelly M, Evans WJ, Lipsitz LA. Leg extensor power and functional performance in very old men and women. Clin Sci 1992;82:321-327.

  64. Kirkland JL, Tchkonia T, Pirtskhalava T, Han J, Karagiannides I. Adipogenesis and aging: does aging make fat go MAD? Exp Gerontol 2002;37:757-767.

  65. Perry HM 3rd, Miller DK, Patrick P, Morley JE. Testosterone and Ieptin in older African-American men: relationship to age, strength, function, and season. Metabolism 2000;49:1085-1091.

  66. Morley JE, Kaiser FE, Perry HM 3rd, Patrick P, Morley PM, Stauber PM, et al. Longitudinal changes in testosterone, Iuteinizing hormone, and folliclestimulating hormone in healthy older men. Metabolism 1997;46:410-413.

  67. Morley JE. Growth hormone: fountain of youth or death hormone? J Am Geriatr Soc 1999;47:1475-1476.

  68. Roubenoff R, Parise H, Payette HA, Abad LW, D’Agostino R, Jacques PF, et al. Cytokines, insuIin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study. Am J Med 2003;115:429-435.

  69. Kaiser FE, SiIver AJ, Morley JE. The effect of recombinant human growth hormone on malnourished older individuals. J Am Geriatr Soc 1991;39:235-240.

  70. TakaIa J, Ruokonen E, Webster NR, Nielsen MS, Zandstra DF, VundeIinckx G, et al. Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 1999;341:785-792.

  71. Hauck SJ, Bartke A. Free radical defenses in the liver and kidney of human growth hormone transgenic mice: possible mechanisms of early mortality. J Gerontol A Biol Sci Med Sci 2001;56:B153-162.

  72. Baumgartner RN, Ross RR, Waters DL, Brooks WM, Morley JE, Montoya GD, et al. Serum leptin in elderly people: associations with sex hormones, insulin, and adipose tissue volumes. Obes Res 1999;7:141-149.

  73. Lesourd B. Nutrition: a major factor influencing immunity in the elderly. J Nutr Health Aging 2004;8:28-37.

  74. Gauchard GC, Gangloff P, Jeandel C, Perrin PP. Influence of regular proprioceptive and bioenergetic physical activities on balance control in elderly women. J Gerontol A Biol Sci Med Sci 2003;58:M846-850.

  75. Syddall H, Cooper C, Martin F, Briggs R, Aihie Sayer A. Is grip strength a useful single marker of frailty? Age Ageing 2003;32:650-656.

  76. Cesari M, Kritchevsky SB, Penninx BW, Nicklas BJ, Simonsick EM, Newman AB, et al. Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2005;53:1675-1680.

  77. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J GerontoI 1994;49:M85-M94.

  78. Ávila-Funes JA, Gray-Donald K, Payette H. Measurement of physical capacities in the elderly: A secondary analysis of the Québec longitudinal study NuAge. Salud Publica Mex 2006;48:446-454.

  79. Evans WJ. Exercise, nutrition, and aging. Clin Geriatr Med 1995;11:725-734.

  80. Evans WJ. Exercise training guidelines for the elderly. Med Sci Sports Exerc 1999;31:12-17.

  81. Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994;330:1769-1775.

  82. Nelson ME, Layne JE, Bernstein MJ, Nuernberger A, Castaneda C, Kaliton D, et al. The effects of multidimensional home-based exercise on functional performance in elderly people. J Gerontol A Biol Sci Med Sci 2004;59:154-160.

  83. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci 2005;60:324-333.

  84. Ávila-Funes JA, García-Mayo EJ. The benefits of doing exercise in the elderly. Gac Med Mex 2004;140:431-436.

  85. Gray-Donald K, Payette H, Boutier V. Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. J Nutr 1995;125:2965-2971.

  86. Muller M, Grobbee DE, Thijssen JH, van den Beld AW, van der Schouw YT. Sex hormones and male health: effects on components of the frailty syndrome. Trends Endocrinol Metab 2003;14:289-296.

  87. Tenover JS. Androgen replacement therapy to reverse and/or prevent ageassociated sarcopenia in men. Baillieres Clin Endocrinol Metab 1998;12:419-425.

  88. Bakhshi V, Elliott M, Gentili A, Godschalk M, Mulligan T. Testosterone improves rehabilitation outcomes in ill older men. J Am Geriatr Soc 2000;48:550-553.

  89. Zella JB, McCary LC, DeLuca HF. Oral administration of 1,25-dihydroxyvitamin D3 completely protects NOD mice from insulin-dependent diabetes mellitus. Arch Biochem Biophys 2003;417:77-80.

  90. Rockwood K, Stadnyk K, Carver D, MacPherson KM, Beanlands HE, Powell C, et al. A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people. J Am Geriatr Soc 2000;48:1080-1085.

  91. Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2002;347:1068-1074.

  92. Torpy JM, Lynm C, Glass RM. JAMA patient page. Frailty in older adults. JAMA 2006;296:2280.

  93. Strandberg TE, Pitkala KH. Frailty in elderly people. Lancet 2007;369:1328-1329.

  94. Lally F, Crome P. Understanding frailty. Postgrad Med J 2007;83:16-20.

  95. Vera O, Halabe J. Vasculitis. México: Alfil; 2006. 2. Liebow AA, Carrington CRB, Friedman PJ. Lymphomatoid granulomatosis. Hum Path 1972;3:457-460.

  96. Troussand X, Galateadux F. Lymphomatid granulomatosis. Cancer 2000;65:107-111.

  97. Lehman TJA, Church JA, Isaac H. Lymphomatoid granulomatosis. J Rheumatol 2005;16:325-328.

  98. Vikas A. Lymphomatoid granulomatosis. Indian J Med Sci 2004;58:67-71.




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