Frailty rapidshare

Cycle of frailty. Understanding points of onset of frailty is vital to early identification of at-risk individuals and intervention on those components that are first affected, when reversal may be most possible. Preclinical detection of early manifestations leading to the frailty syndrome requires understanding of the natural history of frailty development. We suggest two potential hypotheses as to the natural history of frailty initiation and progression.

Based on a 7. That weakness should presage frailty onset is consistent with earlier reports that loss of muscle strength begins in midlife 19 - Decline in strength has been attributed to the loss of muscle mass and muscle quality referred to as sarcopenia, resulting from anatomic and biochemical changes in the aging muscle The causal mechanisms underlying sarcopenia are many, including oxidative stress, dysregulation of inflammatory cytokines and hormones, malnutrition, physical inactivity, and muscle apoptosis 23 , 24 , all of which have been hypothesized to contribute to frailty through interactive pathways at multiple temporal and spatial scales The finding of heterogeneity in initial criteria is consistent with the hypothesis that the cycle of frailty may be initiated by insults at many points in a hypothesized cycle of dysregulated energetics 2 , 7.

Notably, it was not the number of early manifestations i. Specifically, women with exhaustion or weight loss as initial presenting symptoms were 3—5 times more likely to become frail than were women without any criterion, after adjusting for baseline age, race, education, and comorbidity. Notably, neither slow walking speed nor low activity at baseline was significantly associated with incident frailty.

It remains to be determined whether the different patterns of initial accumulation of frailty criteria represent different etiologic pathways with different rates of progression to frailty, either organ-specific or representing systemic physiologic dysregulations of aging.

This finding raises the possibility that decreased energy production or increased utilization, as in wasting conditions, may be involved in the threshold transition in a final common pathway toward frailty. That weight loss and exhaustion rarely developed alone, but rather co-occurred with other manifestations, is consistent with the reliability theory 25 whereby an emergent aggregation of multiple frailty manifestations would result from depletion of system redundancy or compensatory mechanisms, such that any new deficit leads to failure of the whole organism 26 - The clinical utility of these findings lies in the fact that weakness was the most common initial manifestation of the frailty phenotype.

It evidenced only moderate predictive validity for incident frailty; however, by our conceptualization the development of frailty is progressive and multisystemic, and any one specific criterion alone, especially at an early stage in the process as in the case of weakness, may be neither sufficient nor specific for frailty prediction.

Given that the criterion defining thresholds for grip strength are known to be associated with meaningfully greater risk of adverse outcomes including disability and mortality 30 , weakness may nevertheless be a clinically meaningful indicator of increasing vulnerability at a relatively early stage of the frailty process, when preventive intervention could be easiest to implement and theoretically most effective.

Therefore, consideration should be given to the possible tradeoff between risk prediction and potential for benefits in deciding the proper timing and targets of interventions. To formally evaluate the degree to which the frailty phenotype conforms to the definition of a medical syndrome, Bandeen-Roche et al. Patterns of criteria co-occurrence that would support the syndrome definition are a manifestation in a critical mass; and b aggregation in a hierarchical order, as would occur in a cycle in which dysregulation in a sentinel system may trigger a cascade of alterations across other systems.

Propensity for criteria to co-occur in distinct subgroups would suggest the effects of distinct biologic processes rather than a syndrome.

These findings supported the internal validity of the frailty criteria vis a vis stated theory characterizing frailty as a medical syndrome and provided justification to the current counting strategy for defining frailty categories i. In the CHS, prevalence of frailty increased with age from 3. Similar age trends and gender differences have been reported for older adult populations in European and Latin American countries Table 2.

A recent survey of 7, community-dwelling older adults in 10 European countries found that prevalence of frailty ranged from 5. Epidemiological data on transitions between frailty states i. However, the likelihood of transitioning from being frail to non-frail was extremely rare during each of the month intervals.

In WHAS II, frailty status of women representing two-thirds least disabled community-dwelling women aged was repeatedly assessed at baseline and at least one of 4 follow-up visits spanning 7. Seventy-two percent of the women had at least one transition between frailty states over 7. Consistent with Gill et al. This suggests that the rate at which frailty progresses may vary dramatically among older adults, i.

Similar findings have been reported Gill et al. Due to low frailty incidence, we had limited power in detecting factors differentiating the pace of frailty development. As some misconstrue frailty as a pre-morbid state defining end-of-life, the findings reported above suggest that frailty is not an irreversible process, certainly not inevitable trajectory to death.

Therefore, the development and evaluation of interventions designed to prevent or ameliorate frailty should remain as one of the top priorities in frailty research. An overt state of frailty is believed to be preceded by behavioral adaptation made in response to declining physiologic reserve and capacity with which to meet environmental challenges.

The causes of this loss of physiologic reserve are likely to be multifactorial, including both environmental challenges e. Observations of early behavioral changes during this preclinical phase in older adults in whom frailty is developing, but as yet undetected, could provide insight into the frailty development process and suggest means for early intervention.

Therefore, assessment of changes in real life may reflect net impact of declining reserve, taking into account the balance between internal physiologic capacity and external challenges older adults experience in daily life. We analyzed the 3-year cumulative incidence of frailty using the WHAS phenotype in relation to baseline life-space constriction among community-dwelling women aged 65 years or older who were not frail at baseline.

Frailty-free mortality i. Multivariate survival models showed that, compared with women who left the neighborhood four or more times per week, those who left the neighborhood less frequently were 1. It is particularly intriguing to find that difficulty with mobility, IADL, and ADL tasks alone did not necessarily lead to a reduction in life space.

Such discordance between functional capacity and actual performance has been reported in a number of other studies 31 , 35 , To explain the discrepancy, one could argue that some people may compensate for underlying functional decrements by adapting to a modified daily routine e.

Although the exact reasons for this discrepancy remain unknown, we hypothesize that the employment of external e. On the other hand, the ability to compensate effectively for functional limitations may itself be a function of physiologic reserve.

It may be the interplay of functional limitations and functional reserve that determines actual function and behavior. Theoretical model of the association of life space with the clinical syndrome of frailty. Solid and dashed lines represent direct and indirect effects, respectively; arrows represent causal direction. Obtaining empirical evidence of this association is the critical first step towards evaluating a broad conceptual framework about the etiology of frailty Figure 2.

In the case of life space, it is theorized that constriction of life space is a marker of declines in physiologic reserve and that constriction of life space itself could lead to decreased physical activity and social engagement, accelerated deconditioning, and exacerbated decline in physiologic reserve, directly contributing—as these processes progress—to the development of clinical frailty and subsequent mortality.

Future development of tools for the assessment of physiologic reserve and analysis of their relations to behavioral mal-adaptations could help in delineating the hypothesized causal pathway.

The recent work on natural history of frailty has advanced our understanding of the aging process and its potential physiological correlates. The ongoing debate on the operational definition of frailty, its subdomains e. Despite this debate, researcher and clinicians have no disagreement on severe impact of frailty on older adults, their care givers, and on society as a whole.

While specific treatments for frailty are yet to be developed and tested, the existing clinical measures of frailty provide useful means for identify high risk individuals, therefore could lead to improved treatment decision making and management of care by taking into account individual vulnerabilities and propensity for adverse health outcomes.

In particular, an absolute e relative increase of old and very old persons is also projected for the next 30 years. This demographic phenomenon is substantially responsible for the growing prevalence of frailty in our societies. Frailty is a clinical condition characterized by an excessive vulnerability of the individual to endogenous and exogenous stressors. The homeless man did not want charity, so Paxton instead offered to buy the use of the man's name for his movie.

The homeless man's name was Otis. Quotes Young Adam : I've got the joy joy joy joy down in my heart, down in my heart Connections Featured in The Making of 'Frailty' User reviews Review. Top review. Good start, great middle, laughable ending. I was completely taken with this movie. I loved the whole good-and-evil thing, the feeling of powerlessness in childhood, the dark places, the doom. Paxton's performance is terrific, but his direction takes "Hitchcockian" too far.

And then, suddenly, the last 10 minutes of this terrifying tale of delusion and isolation turns into "The X-Files.

But it's still worth seeing, if you can handle the gloom. Details Edit. Release date April 12, United States. United States Germany. Box office Edit. Technical specs Edit. Runtime 1 hour 40 minutes. Related news.