Aarts S, Patel KV, Garcia ME Co-presence of multimorbidity and disability with frailty: an examination of heterogeneity in the frail older population. J Frailty Aging. 2015; 4:(3)131-138

Global status report on noncommunicable diseases 2010. 2011. (accessed 15 May 2019)

Alzheimer's Society. Types of dementia. 2019. (accessed 12 June 2019)

Azzopardi RV, Vermeiren S, Gorus E Linking frailty instruments to the international classification of functioning, disability, and health: a systematic review. J Am Med Dir Assoc. 2016; 17:(11)

Azzopardi RV, Beyer I, Vermeiren S Increasing use of cognitive measures in the operational definition of frailty – a systematic review. Ageing Res Rev. 2018; 43:10-16

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380:37-43

Bonner S, Lone NI. The younger frail critically ill patient: a newly recognised phenomenon in intensive care?. Critical Care. 2016; 20:(1)–8

Boockvar KS, Meier DE. Palliative care for frail older adults: ‘there are things I can't do anymore that I wish I could…’. JAMA. 2006; 296:(18)2245-53

Buffel du Vaure C, Dechartres A, Battin C, Ravaud P, Boutron I. Exclusion of patients with concomitant chronic conditions in ongoing randomised controlled trials targeting 10 common chronic conditions and registered at a systematic review of registration details. BMJ Open. 2016; 6:(9)1-8

Chouliara Z, Kearney N, Stott D, Molassiotis A, Miller M. Perceptions of older people with cancer of information, decision-making and treatment: a systematic review of selected literature. Ann Oncol. 2004; 15:(11)1596-602

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013; 1381:(9868)752-62

De Vries NM, Staal JB, Van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van Der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011; 10:(1)104-14

Evans SC. Ageism and dementia. Springer. 2018; 19:263-275

Fried LP, Tangen CM, Walston J Frailty in Older Adults: Evidence for a Phenotype. J Gerontol Med Sci. 2001; 56:(3)M146-56

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; 59:255-63

Fulop T, Larbi A, Witkowski JM Aging, frailty and age-related diseases. Biogerontology. 2010; 11:(5)547-663

Gobbens J, Luijkx KG, Wijnen-Sponselee MT, Schols JM. In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc. 2010; 11:(5)338-43

Gobbens RJ, van Assen MA, Luijkx KG, Schols JM. Testing an integral conceptual model of frailty. J Adv Nurs. 2012; 68:(9)2047-60

Isaacs B. Introduction to geriatrics.London: Balliere, Tindall and Cassell; 1965

Kelaiditi E, Cesari M, Canevelli M Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J Nutr Health Aging. 2013; 17:(9)726-34–2

Kelaiditi E, van Kan GA, Cesari M. Frailty: role of nutrition and exercise. Curr Opin Clin Nutr Metab Care. 2014; 17:(1)32-39

Biomedical versus BioPsychosocial model of frailty. 2016. (accessed 15 May 2019)

Mezuk B, Edwards L, Lohman M, Choi M, Lapane K. Depression and frailty in later life: A synthetic review. Int J Geriatr Psychiatry. 2012; 27:(9)879-92

Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Scientific World Journal. 2001; 1:323-36

NHS England. Supporting routine frailty identification and frailty through the GP Contract 2017/2018. 2017. (accessed 6 June 2019)

Office For National Statistics. Living longer: caring in later working life. 2019. (accessed 6 June 2019)

Panza F, Lozupone M, Solfrizzi V Different cognitive frailty models and health- and cognitiverelated outcomes in older age: from epidemiology to prevention. J Alzheimers Dise. 2018; 62:(3)993-1012

Panza F, Solfrizzi V, Frisardi V Different models of frailty in predementia and dementia syndromes. J Nutr Health Aging. 2011; 15:(8)711-19

Rockwood K, Song X, MacKnight C A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173:(5)489-95

Rockwood K, Mitnitski A, Song X, Steen B, Skoog I. Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc. 2006; 54:(6)975-9

Royal College of General Practitioners. The GSF prognostic indicator guidance. 2011. (accessed 6 June 2019)

Royal College of Nursing. Frailty in older people. 2018. (accessed 6 June 2019)

Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA. Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2011; 61:(582)12-21

Sourial N, Wolfson C, Bergman H A correspondence analysis revealed frailty deficits aggregate and are multidimensional. J Clin Epidemiol. 2010; 63:(6)647-54

Strandberg TE, Pitkälä KH. Frailty in elderly people. Lancet. 2007; 369:(9570)1328-9

Szanton SL, Allen JK, Seplaki CL, Bandeen-Roche K, Fried LP. Allostatic load and frailty in the women's health and aging studies. Biol Res Nurs. 2009; 10:(3)248-56

Woods AJ, Cohen RA, Pahor M. Cognitive frailty: frontiers and challenges. J Nutr Health Aging. 2013; 17:(9)741-3

Assessment of frailty in Alzheimer's: a literature review

02 July 2019
Volume 30 · Issue 7


As the UK's older population continues to rise, the more likely it is for practice nurses to encounter patients living with Alzheimer's and frailty. Kirsty Smith and Sophie Wallington explore the definitions and models of frailty available in medical literature

As a consequence of an ageing global population, it is likely that encounters between health professionals and frail patients will rise. Patients with both suspected frailty and Alzheimer's disease are frequently encountered in primary care. There are links and overlaps between these disease states; however, the key theories and models of frailty propose some contradictions. This review of the definition, theories and models of frailty, and relevance to patients with Alzheimer's disease will add a quality, evidence-based approach to the assessment of frailty in patients in primary care living with Alzheimer's disease.

There are multiple definitions of frailty across medical literature, and despite more focus on this condition in academia, no consensus on frailty's definition or criteria has been agreed (Panza et al, 2011). The principal features of physical frailty include a decline in reserve capacity, characterised by an increase of adverse health outcomes such as falls, vulnerability to functional decline and disability, institutionalisation, hospitalisation, morbidity and mortality (Fried et al, 2001; Gobbens et al, 2010; Aarts et al, 2015). It is now accepted that these features can extend beyond the confines of age, with frailty no longer being limited to a ‘geriatric syndrome’ (Bonner and Lone, 2016; NHS England, 2017).

The UK's population is ageing and the Office for National Statistics (ONS) (2019) predicted that by 2066 there will be an additional 8.6 million people in the UK aged 65 years and over. While frailty and old age are not inevitably linked, it is widely acknowledged that one of the consequences of an increased life expectancy is an increased prevalence of older people living with frailty (Fried et al, 2004; Rockwood et al, 2006; Szanton et al, 2009; Royal College of Nursing, 2018). Indeed, NHS England (2017) argued that frailty is projected to be the most challenging aspect of ageing in modern healthcare.

Register now to continue reading

Thank you for visiting Practice Nursing and reading some of our peer-reviewed resources for general practice nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month