Skip to main content
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1997 Oct 15;157(8):1081–1084.

Medical management of frailty: confessions of a gnostic

K Rockwood 1
PMCID: PMC1228264  PMID: 9347779

Abstract

Geriatric Medicine is concerned chiefly with the care of frail elderly people, especially when they become ill. Physicians face special challenges in dealing with such patients, who tend to have multiple interacting medical and social problems, impaired function, altered pharmacokinetics and pharmacodynamics, atypical disease presentations and to be affected by polypharmacy. The joy of geriatrics is in systematically meeting each of these challenges, but the techniques that geriatricians use to do so must not be kept secret. More must be done to encourage all physicians to use these techniques in caring for frail elderly people who are ill.

Full Text

The Full Text of this article is available as a PDF (126.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berman P., Hogan D. B., Fox R. A. The atypical presentation of infection in old age. Age Ageing. 1987 Jul;16(4):201–207. doi: 10.1093/ageing/16.4.201. [DOI] [PubMed] [Google Scholar]
  2. Cole M. G., Primeau F. J., Bailey R. F., Bonnycastle M. J., Masciarelli F., Engelsmann F., Pepin M. J., Ducic D. Systematic intervention for elderly inpatients with delirium: a randomized trial. CMAJ. 1994 Oct 1;151(7):965–970. [PMC free article] [PubMed] [Google Scholar]
  3. Davidson W., Molloy D. W., Somers G., Bédard M. Relation between physician characteristics and prescribing for elderly people in New Brunswick. CMAJ. 1994 Mar 15;150(6):917–921. [PMC free article] [PubMed] [Google Scholar]
  4. Gurwitz J. H., Avorn J. The ambiguous relation between aging and adverse drug reactions. Ann Intern Med. 1991 Jun 1;114(11):956–966. doi: 10.7326/0003-4819-114-11-956. [DOI] [PubMed] [Google Scholar]
  5. Gustafson Y., Brännström B., Norberg A., Bucht G., Winblad B. Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients. J Am Geriatr Soc. 1991 Aug;39(8):760–765. doi: 10.1111/j.1532-5415.1991.tb02697.x. [DOI] [PubMed] [Google Scholar]
  6. Hogan D. B., Fox R. A. A prospective controlled trial of a geriatric consultation team in an acute-care hospital. Age Ageing. 1990 Mar;19(2):107–113. doi: 10.1093/ageing/19.2.107. [DOI] [PubMed] [Google Scholar]
  7. Hogan D. B., Fox R. A., Badley B. W., Mann O. E. Effect of a geriatric consultation service on management of patients in an acute care hospital. CMAJ. 1987 Apr 1;136(7):713–717. [PMC free article] [PubMed] [Google Scholar]
  8. Jarrett P. G., Rockwood K., Carver D., Stolee P., Cosway S. Illness presentation in elderly patients. Arch Intern Med. 1995 May 22;155(10):1060–1064. [PubMed] [Google Scholar]
  9. MacKnight C., Rockwood K. A Hierarchical Assessment of Balance and Mobility. Age Ageing. 1995 Mar;24(2):126–130. doi: 10.1093/ageing/24.2.126. [DOI] [PubMed] [Google Scholar]
  10. Meuleman J. R. Walking the tightrope: the challenge of elder care. J Am Geriatr Soc. 1996 Dec;44(12):1466–1468. doi: 10.1111/j.1532-5415.1996.tb04072.x. [DOI] [PubMed] [Google Scholar]
  11. Rockwood K., Cosway S., Stolee P., Kydd D., Carver D., Jarrett P., O'Brien B. Increasing the recognition of delirium in elderly patients. J Am Geriatr Soc. 1994 Mar;42(3):252–256. doi: 10.1111/j.1532-5415.1994.tb01747.x. [DOI] [PubMed] [Google Scholar]
  12. Rockwood K., Fox R. A., Stolee P., Robertson D., Beattie B. L. Frailty in elderly people: an evolving concept. CMAJ. 1994 Feb 15;150(4):489–495. [PMC free article] [PubMed] [Google Scholar]
  13. Rockwood K., Stolee P., Fox R. A. Use of goal attainment scaling in measuring clinically important change in the frail elderly. J Clin Epidemiol. 1993 Oct;46(10):1113–1118. doi: 10.1016/0895-4356(93)90110-m. [DOI] [PubMed] [Google Scholar]
  14. Stolee P., Rockwood K., Fox R. A., Streiner D. L. The use of goal attainment scaling in a geriatric care setting. J Am Geriatr Soc. 1992 Jun;40(6):574–578. doi: 10.1111/j.1532-5415.1992.tb02105.x. [DOI] [PubMed] [Google Scholar]
  15. Stuck A. E., Siu A. L., Wieland G. D., Adams J., Rubenstein L. Z. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993 Oct 23;342(8878):1032–1036. doi: 10.1016/0140-6736(93)92884-v. [DOI] [PubMed] [Google Scholar]
  16. Stuck A. E., Siu A. L., Wieland G. D., Adams J., Rubenstein L. Z. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993 Oct 23;342(8878):1032–1036. doi: 10.1016/0140-6736(93)92884-v. [DOI] [PubMed] [Google Scholar]
  17. Tamblyn R. M., McLeod P. J., Abrahamowicz M., Laprise R. Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations. CMAJ. 1996 Apr 15;154(8):1177–1184. [PMC free article] [PubMed] [Google Scholar]
  18. Young A. There is no such thing as geriatric medicine, and it's here to stay. Lancet. 1989 Jul 29;2(8657):263–265. doi: 10.1016/s0140-6736(89)90440-6. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES