What is frailty and why does it matter?

By: Michael (Mike) Murphy

What Is Frailty?

Frailty is a clinical syndrome characterized by a reduction in an individual’s physiological reserve and increased vulnerability to stressors, often seen in older adults.1 Characteristics of frailty include low physical activity, muscle weakness, slowed performance, fatigue or poor endurance, and unintentional weight loss.2 

Health Risks and Clinical Impacts of Frailty

Frail patients often have multiple complex comorbidities, decreased ability for independent living, may have impaired mental abilities, and often require assistance for activities of daily living. They have increased risk of adverse health outcomes including falls, hospitalization, disability, and mortality.  

Frailty necessitates comprehensive assessments and individualized care plans focusing on nutrition, physical activity, and psychosocial support. It is estimated that frail patients account for over 40% of potential preventable Medicare expenditures despite making up only 4% of the Medicare population.3 

Frailty in Research: Challenges and Real-World Evidence Gaps

Frailty impacts medication response, safety, and health outcomes. Pharmacokinetics and pharmacodynamics may be altered in frail patients, and they are more likely to be on multiple medications with increased risk for drug-drug interactions. Frail patients may have decreased adherence to medication and increased risk for a variety of adverse outcomes. 

Because frail patients are often excluded from clinical trials, real world data is increasingly used to fill evidence gaps in this population. But observational studies will produce biased results without good methods to identify and adjust for frailty status. This is difficult because the defining features of frailty may not be readily identifiable in claims data.  

Multiple claims-based indices have been developed and validated to identify frailty.4 However these methods often identify varying subsets of patients because of important differences in methods: 

  • Types of data used: ICD-9 or ICD-10 diagnosis codes, CPT and HCPCS codes, demographic data 
  • Lookback period: a longer lookback may exclude more patients who lack data while a shorter lookback period may underestimate frailty 
  • Interpretation: some methods estimate severity of frailty while others estimate the probability of a frail state 

Selecting the right method for your study will depend on the availability data and the research question of interest. 

Magnolia Market Access and Frailty

Identification of frail patients is critical for assessment of appropriate prescribing and health outcomes. Our team has experience implementing validated frailty measures in claims data. Contact us today to learn more about our health economics and outcomes research capabilities and how we can help support the design and planning of your research. 

References:  

  1. Kim DH, Rockwood K. Frailty in Older Adults. N Engl J Med 2024; 391(6):538-548. 
  1. Torpy JM, Lynm C, Glass RM. Frailty in Older Adults JAMA 2006; 296(18):2280. 
  1. Figueroa JF, Joynt Maddox KE, Beaulieu N, Wild RC, Jah AK. Concentration of Potentially Preventable Spending among High-Cost Medicare Subpopulations: An Observational Study. Ann Intern Med 2017; 167(10): 706-713. 
  1. Kim DH, Patorno E, Pawar A, Lee H, Schneeweiss S, Glynn RJ. Measuring Frailty in Administrative Claims Data: Comparative Performance of Four Claims-Based Frailty Measures in the US Medicare Data. J Gerontol A Biol Sci Med Sci 2020; 75(6):1120-1125. 

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