Musculoskeletal health, frailty and functional decline
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Frailty in older people is associated with a vulnerability to adverse events. While ageing is associated with a loss of physiological reserves identifying those with the syndrome of frailty has the potential to assist clinicians tailor treatments to those at risk of future decline into disability with increased risk of complications, morbidity and mortality. Sarcopenia is a key component of the frailty syndrome and on its own puts older people at risk of fragility fractures however the clinical syndrome of frailty affects musculoskeletal and non musculoskeletal systems. Hip fractures are becoming a prototype condition in the study of frailty. Following a hip fracture many of the interventions are focused on limiting mobility disability and restoring independence with activities of daily living but there are multiple factors to be addressed including osteoporosis, sarcopenia, delirium, weight loss. Established techniques of geriatric evaluation and management allow systematic assessment and intervention on multiple components by multidisciplinary teams and deliver the best outcomes. Using the concept of frailty to identify older people with musculoskeletal problems as at risk of a poor outcome assists in treatment planning and is likely to become more important as effective pharmacological treatments for sarcopenia emerge. This review will focus on the concept of frailty and its relationship with functional decline, as well as describing its causes, prevalence, risk factors and potential clinical applications and treatment strategies.