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Frailty and neurology

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. Frailty is an umbrella term that combines information from a range of sources into a word that conveys neatly and quickly— in the right context—the sentiment of an individual’s physicality. Recent exposure to more stroke and general medicine during the COVID19 pandemic has reminded neurologists of its relevance to goal setting, particularly in relation to invasive treatments such as ventilation and cardiopulmonary resuscitation. An assessment of premorbid frailty— based on a range of factors including activity levels indoors and outdoors, presence or absence of symptoms, and dependency for activities of daily living—is now routinely scored and recorded in many medical and surgical settings, and used to inform treatment decisions. The popularity of the term and its role in decisionmaking justifies a pause to become more familiar with what frailty exactly means, and scrutinise the situations in which its use is likely to be appropriate or inappropriate. In this regard, Pollock and Smith’s article in this issue should be compulsory reading for everyone involved in healthcare. Ageing is a necessary but not sufficient condition for using the term frailty. It is a state of increased vulnerability—physiological and psychological—that results from an ageingassociated decline in the body’s reserves. In healthy adults, age is a major determinant of core functions such as walking speed, strength, swallowing capacity and pulmonary function. It is against this backcloth that two different models of frailty are described.