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Frailty and sarcopenia
Frailty is a state of reduced reserve across many systems in which a small event (an infection, a new drug, an operation) causes a large drop in function; sarcopenia is loss of muscle strength and mass, and treatment of both rests on resistance exercise and adequate protein.
Why it matters in the exam
The exam asks about the definitions: the Fried phenotype with its five criteria (3 or more = frail, 1–2 = pre-frail), the Clinical Frailty Scale (1–9) and the frailty index based on accumulated deficits. A common question is the treatment: resistance exercise is the best-proven intervention.
For sarcopenia (EWGSOP2, 2019) candidates need to know that strength comes before mass: low grip strength raises suspicion ("probable sarcopenia"), low muscle mass confirms it, and poor performance (gait speed of 0.8 m/s or less) defines severe disease. Frailty also predicts complications after surgery and chemotherapy, so it is part of the assessment before a treatment decision.
In clinical questions frailty appears as an older woman who has lost weight, is tired, walks slowly and struggles to open a jar, and candidates are asked for the first intervention — a tailored exercise programme and protein-rich nutrition, together with a medication review. They are also asked about the prognostic meaning: a frail person undergoing surgery is at high risk of delirium, complications and moving into an institution, so frailty assessment is part of the goals-of-care discussion. Frailty is a dynamic state — pre-frailty can improve with intervention.
Key points
- Frailty = reduced reserve; a small event causes a large decline.
- Fried: 5 criteria; 3 or more frail, 1–2 pre-frail.
- Clinical Frailty Scale 5 or more = frail.
- Sarcopenia: low strength → probable; low mass → confirmed; poor performance → severe.
- Treatment: resistance training and protein 1.0–1.2 g/kg/day.
Summary table
| Concept | Definition | Values for the exam |
|---|---|---|
| Fried phenotype | Weight loss, exhaustion, low activity, slow gait, weak grip | 3 or more = frail; 1–2 = pre-frail |
| Clinical Frailty Scale | Clinical rating 1–9 | 5 or more = frail |
| Frailty index | Proportion of deficits from a list | About 0.25 or more = frail |
| Probable sarcopenia | Low grip strength or slow chair rise | Grip below 27 kg in men, below 16 kg in women |
| Confirmed and severe sarcopenia | Low muscle mass (DXA); severe = also poor performance | Gait speed 0.8 m/s or less |
| Treatment | Resistance training, protein, treat contributing causes | Protein 1.0–1.2 g/kg/day; no approved drug |
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Sources
- Revised European consensus on definition and diagnosis of sarcopenia (EWGSOP2), 2019 — Definition, diagnosis and severity
- International Conference of Frailty and Sarcopenia Research (ICFSR) clinical practice guidelines for frailty, 2019 — Screening and management
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Frailty
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.