Frailty and chronic disease

Chronic diseases and frailty represent the clinical expressions of the accumulations of biological deficits that occur with aging. However, when addressing chronic diseases, the evaluation of frailty is yet far to be part of routine clinical practice. Frailty and chronic diseases are often treated as different identities. However, the two concepts are related and present a certain amount of overlap and the presence of chronic diseases contributes to the onset of frailty. By taking into considerations not only the physical domain and function, but also psychological, socioeconomical and spiritual factors, frailty is a good descriptor of complexity found in older age. Strategies to identify, manage, and prevent frailty at any age in individuals with multimorbidity or chronic conditions are advised. Benefits and harms of pharmacological treatments should be weighted in older people considering the underlying frailty status. In fact, frailty acts as a modifier of the risks and benefits of chronic diseases treatments. Moreover, some treatments could lead to frailty itself (i.e. proton pump inhibitors, diuretics, hypoglycemic drugs, antihypertensive treatments), underlining the need of an individualized and flexible prescribing decision-making in this population. For these reasons, a different pathway of care for older patients with frailty and chronic diseases seems necessary. An assessment of frailty should be simple and not time consuming in order to address patient's needs and expectations, evaluating the social background, lifestyle and priorities. Empowering the patient implies a personalized evaluation and the development of individualized management plans which would ultimately lead to a reorganization of the health care provision and eventually increase quality of life in the elderly multimorbid frail patient.