Two elderly patients are admitted to the hospital. Both have the same condition, maybe pneumonia, maybe a hip fracture. Both are the same age. And both will get more or less the same medical care. The difference is hard to pinpoint, but from the moment they enter the hospital, a doctor can often tell that one will do well and the other poorly.
For a long time, medicine lacked a term to describe the patient who would do poorly, but now we have one: frailty. Frail patients are not sick—they have no particular diagnosable disease. But if they do fall ill or suffer an injury, they are much more likely than non-frail patients to fare badly. In one study that followed a group of elderly patients over seven years, the frail were more than three times likelier to die than their non-frail counterparts.
The precise definition of frailty is still evolving, but most frail people share a number of common traits. Five widely accepted features are weight loss of more than 10 pounds in the last year, frequent exhaustion, low levels of activity, slow gait, and poor grip strength. The syndrome was first defined by Dr. Linda Fried, and colleagues at Johns Hopkins in 2001.
Surgical patients who exhibit just two or three of these characteristics have a much higher risk of poor outcomes. They are twice as likely to suffer complications from surgery, spend an average of 50 percent more time in the hospital, and are three times more likely to be discharged to a skilled-nursing facility instead of to their homes.