Intended for healthcare professionals

Rapid response to:


Identifying frailty in primary care

BMJ 2017; 358 doi: (Published 27 September 2017) Cite this as: BMJ 2017;358:j4478

Rapid Response:

Fragility: a challenge in primary health care

After reading the article "Identifying frailty in primary care" by William Hamilton and Jack Round and just published in BMJ, we would like to comment on some aspects related to Fragility and its associated factors during its attention in primary health care in our country.

Fragility is a major challenge facing the world as the 21st century progresses, since a high rate of population aging has already become evident, which will inexorably lead to an increase in the most vulnerable elderly population.

Fragility is a physiological syndrome characterized by diminished reserves and reduced resistance to stressors as a result of the cumulative decline of multiple physiological systems that increase vulnerability to adverse health outcomes, among which are: risk of acute diseases, falls and their consequences (injuries, fractures), hospitalization, institutionalization (nursing home), disability, dependency and death.

Identification of the clinical features of the fragile syndrome has been the subject of several meetings of experts.

Decreased strength, tiredness, involuntary weight loss, sluggishness and inactivity appear to be the dominant manifestations, while several teams of researchers and clinicians add social isolation and conditions of other associated morbidities, including cognitive impairment and depression.

Primary care is increasingly attended by elderly people with fragility and many of them with chronic diseases that demand attention and care.

The relationship between frailty and chronic diseases is complex because the latter may contribute as a causal or precipitating factor of the fragile syndrome, while it may condition greater vulnerability and complications in the elderly who suffer from chronic basic diseases.

Fragility and chronic diseases are the major modulators of a person's health pathway in late adulthood. Both conditions may exist separate or coexist in the community population of older adults.

Fragility can be caused by a decrease in the physiological reserve of the organism due to subclinical multisystemic or "low-noise" insufficiency as a result of an unsatisfactory ("pathological") aging process. An older adult can become vulnerable and enter the cycle of fragility through the decline of several organ systems as a consequence of one or more chronic diseases, usually by combined effects (polymorphism or pluripathology) or by their long-term complications.

As the population ages, the prevalence of chronic and disabling diseases increases. Generally, diseases diagnosed in older adults are not curable and, if not treated properly and opportunely, tend to cause complications and squeal that hinder the independence and autonomy of these people.

The fragility syndrome is the other frequent companion of the process of aging of the elderly in the world today and is an expression of pathological aging. The fragile state is one on which we must act so that the old man does not become disabled, is interned in an institution or dies; hence the fragile older adult should be the focus, the primary beneficiary of geriatric assessment and care.

There is a close relationship between the fragility and the chronic diseases that accompany the advanced age with elements contributing to both their pathogenic expression and the adverse health outcomes of the elderly.

In Cuba there is a program structured by levels and levels of attention to face the challenge of aging, fragility, chronic diseases and the disability they generate, with tangible results that must be increased in the future with the training of human resources in and improvement of the program itself in Primary Health Care.


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Competing interests: No competing interests

07 October 2017
Moises A. Santos-Peña
Vice Director
Pujols-Enseñat Yeneys, Cabrera Romero AJ
Gustavo Aldereguia University General Hospital
Ave 5 de Septiembre and 51-A street. Cienfuegos city. Cuba 55100