From dependency to prevention: the silent revolution in geriatrics
Why do some people recover quickly after a fracture while others, despite being the same age and apparently in good health, suddenly lose their independence? The concept of frailty, defined by Linda Fried in the early 2000s, sheds a decisive light and transforms the way we approach ageing.
Professor Antoine Piau
Frailty and prevention: rethinking ageing
Text transcription
Before the 90s, we could not explain how 2 people of the same age could react completely differently to the same situation.
One, for example, would heal perfectly after a fracture, returning home in good shape very quickly.
Whereas the other, who seemed no different from the first patient, would become confused, lose their autonomy, and very quickly decline into dependence for reasons we could not explain.
Linda Fried gave us the key with the concept of vulnerability. She discovered the famous risk factors for loss of autonomy.
Firstly, a patient will walk more slowly, lose weight involuntarily, become tired easily, lose muscular strength and become less active on a day-to-day basis.
A patient with 3 of these 5 factors can be classed as vulnerable.
We're talking about an autonomous person at home, who does not need human assistance to wash, go shopping, prepare food.
What does this change? Geriatrics used to be a relatively passive field. We waited for people to become severely dependent, with Alzheimer's, problems getting around, or incontinence, before we provided care.
But now, we're looking at a much larger population that is still doing okay. And if we treat these people, we may be able to extend their lives and keep them healthier for longer.
The concept of frailty: a new tool for understanding
Before this advance, geriatrics professionals mainly intervened late on, when severe conditions or dependency were already established. The frailty model means the first signs of vulnerability can be spotted early on.
Six simple indicators make it possible to identify someone who is frail:
- reduced walking speed,
- unintentional weight loss,
- persistent fatigue,
- decreased muscle strength,
- decreased physical activity,
- social isolation.
Presenting three of these criteria is enough to classify a person as frail, even if they continue to be independent.
This gives the gerontological evaluation a predictive value: a “weak signal” may reveal a future risk of loss of autonomy.
From reparatory medicine to active prevention
Until the 2000s, geriatrics was focused on repair: we took action after dependency had arisen. Today, the frailty model encourages a proactive approach, also supporting those who are “still doing well” to help them maintain their autonomy for longer.
This paradigm shift involves:
- moving from repair-focused or palliative medicine to forward-looking medicine,
- identifying and addressing vulnerabilities before they escalate.
Extending healthy life expectancy
Tacking action on frailty means: :
- delaying dependency,
- improving quality of life,
- allowing older people to remain stakeholders in their lives.
Frailty can be used to identify the risks of loss of autonomy early on, moving from reparatory medicine to proactive medicine. And as a result, ageing in good health becomes possible