Frailty in Older Adults With Heart Failure

Frailty is considered a health issue limiting physical activities among the elderly, making them disabled.¹ Frailty can be detected at early stages to slow its development. The emergence of frailty can be identified when focusing on general body strength.¹ Those older people in prefrail conditions tend to move slower than usual and usually get exhausted faster. Unintentional weight, inflammation, and osteoporosis should be of more concern because they can be a separate syndrome or even one of the signs of frailty.¹ It is crucial to monitor those diseases that are medically claimed to be connected with frailty, such as heart failure. For instance, healthcare professionals should focus on those patients who have heart failure diseases or cardiovascular diseases. Heart failure has become the leading cause of hospitalization among older people.² Heart failure develops when one’s heart fails to pump enough blood to provide the body with the nutrients and oxygen it needs.² The perspective of this study is to describe how elderly patients with heart failure are often affected by frailty.

According to the research, heart failure is a common and quickly escalating disease because of its “high prevalence” globally and its impact on mortality and morbidity.² The physical appearance of victims with heart failure is complex due to their survival from other chronic states and continuous aging.³ Patients with heart failure present with damage to various body organs and body systems that need complicated and entangled therapeutic schemes.³ The usual comorbidities and clinical damages in heart failure victims include diabetes, anemia, injuries of the kidney, and depression.⁴ The non-clinical comorbidities include living alone, isolation, and institutionalization. Comorbidities show various patterns in victims having heart failure and may accumulate defects that make victims more vulnerable.

According to the current High Functioning Autism paper on frailty in heart failure victims, frailty has been termed as independent of age and a multidimensional dynamic condition that makes a person with heart failure more vulnerable to stressors.⁴ When heart failure patients are exposed to either chronic or acute stressors, they are at a high risk of adverse outcomes.⁴ Due to this, all patients with heart failure disease are at increased risk of becoming frail because of their state of vulnerability. Research has indicated that frailty is mostly common in heart failure victims, having an approximate “prevalence” of about 45%.^4-5 The intersection between heart failure and frailty is adverse in victims with heart failure who are six times probably to be frail.

Similarly, frail people had a remarkably increased chance of attaining a brand heart failure disease. Despite both heart failure and frailty being common in older people compared to young people, both of their occurrences are independent of age.⁵ Victims with heart failure, regardless of their chronological age, must be examined for the threat of frailty. Even if the etiology of frailty has not yet been known, the association of heart failure and frailty intensify each other over many compounded pathogenic systems like disorders.

Frailty has a significant prognostic role in victims of heart failure as it can worsen the progression of heart failure, which may lead to mortality and a lower likelihood of living more than ten years.⁵ Hence the spotting of frailty is of more importance in victims diagnosed with heart failure. Possible treatments for frailty in heart failure are exercise, caloric, vitamin D supplementation, protein support, reducing polypharmacy in the elderly, and those recorded as Guideline Directed Medical Therapy (GDMT) by the scientific guidelines.⁵ Furthermore, the therapeutic perspective should also be upheld considering the “non-clinical” part of frailty. The therapeutic approach should involve social, psychological, and occupational therapy support and even supporting the patient and their families.

Conclusion

The existence of a complicated projection between heart failure and frailty, the upcoming and expanding information on the predictive position of frailty, and the involvement of frailty with the targeted treatment of heart failure victims are most of the basis for why frailty should be normally examined in heart failure victims. The correct and accurate evaluation of frailty in heart failure victims is an essential and mandatory step to constructing a secure healthcare system to reduce dependency, improve prognosis, and increase the quality of life.

References

1. Kleipool EE, Hoogendijk EO, Trappenburg MC, Handoko ML, Huisman M, Peters MJ, Muller M. Frailty in older adults with cardiovascular disease: cause, effect or both? Aging and disease. 2018 Jun;9(3):489.
2. Kleipool EE, Hoogendijk EO, Trappenburg MC, Handoko ML, Huisman M, Peters MJ, Muller M. Frailty in older adults with cardiovascular disease: cause, effect or both? Aging and disease. 2018 Jun;9(3):489.
3. Damluji AA, Huang J, Bandeen‐Roche K, Forman DE, Gerstenblith G, Moscucci M, Resar JR, Varadhan R, Walston JD, Segal JB. Frailty among older adults with acute myocardial infarction and outcomes from percutaneous coronary interventions. Journal of the American Heart Association. 2019 Sep 3;8(17): e013686.
4. Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing research reviews. 2020 Jul 1; 60:101047.
5. Ijaz N, Buta B, Xue QL, Mohess DT, Bushan A, Tran H, Batchelor W, DeFilippi CR, Walston JD, Bandeen-Roche K, Forman DE. Interventions for frailty among older adults with cardiovascular disease: JACC state-of-the-art review. Journal of the American College of Cardiology. 2022 Feb 8;79(5):482-503.