Frailty Thy Name Is ... Phrailty?

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Abstract
THE precise characterization of frailty as a state of physiologic vulnerability has been extremely useful for research (1,2). In particular, the frailty index first validated in the Cardiovascular Health Study (CHS) is a reliable predictor of adverse outcomes and a valuable and versatile tool (3–7). In contrast, conceptualizing frailty as physiologic vulnerability can be problematic, partly because clinicians typically apply the word “frail” to functionally limited or even overtly disabled elders who are suffering the cumulative effects of disease-related, psychosocial, and environmental challenges (8–13). Thus, the research definition creates cognitive dissonance because it does not fully equate to what many physicians have in mind when they envision a frail elder (Figure 1).