The Physics of Frailty

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The contribution of frailty to human morbidity and mortality is immense. Yet it lacks a conceptual framework' By borrow-ine from the hypotheses provided by the thermophysicists' lríiriu .ã" ¡" uî'derstood ìn a way that both interrelates the r"iåïä"tttip Uetween form and function andprovides medical r.iã"."-*itln an operational insight that yields clinical benefit' ---f.uifty results ïhere the orgãnism is uncoupled from its environment yielding a break in the forward feedback cycle ãi stimulus tó reaction to growth to increased functional comoetence to improved response to stimulus' Recognition of tlie centrality oi this interrelatedness to health becomes a kãv theme for ílness prevention and therapy' ] Am Geriatr Soc ¿1:100¿-1008, 1993 l I I 'I I I t:, I. 1 .t 1 t ! 1 :i , I :tj .J I ',1 ii :1 j a , .t ïl v vealth policv increasingly reveals an awareness l-l of arì emphasis on thã quality of life as well as I I its duration' Both subjective estimates and functional capacities become part of the evaluative process previously dominated by clinical and labora-ïo* -"åt,ttu*utit' Outcomes aisessment technology o-rJrrid"t a powerful capacity to expand the framework ã" *f",i.n piactice zuidåtineé can evolve' With this shift hãs come'the iden"tification of "active life expectancy" ãì u Àot" perceptive look at remaining years of life' if',ir .t"."pt evo'lved by Katz et alt-asserts that not all life is of e^qual quality-and that effort should be ex-pended to extend the fully-functional portion' ' A ma¡or threat to acdvé life expectancy is the devel-opment of frailty. Frailty has until now, however' i"'.t"á a working definitiôn. Is frailty a disease? And' ii it ir, where dä we look for it in the pages oj 93r medical textbooks and diagnostic codings? Or is frailty a part of. aging,? The recolnidon that frailty is noted -ått com*änIy in older pelsont seems to indicate that chronology plays a part in its origin' But, quickly, we identifv fäii vó""eôr persons anã older persons who ãt"."itáf. Further, írailty is reversible as demonstrated in Ëiatarone et al's2 siudy on the improvement in nonagenarian muscle shéngth and balance by 1 *"ijfit-rifti"g protocol. ThereTore, the mere passage of ti-ädo"t noiiuffice to provide a causative mechanism for frailtv. In fact, no rigorous explanation has been advanceá. Frailty lacks a-conceptual framework' Despite abseice of easy categorization, there is no questiån as to the immense parlicipation of frailty in ¡=ott"t it',ai"iaual and composiie morbidity and mortal-itv. Recosnizing this pervasive impact on well being it ir'rtrung""to noie the iack of critical insight that attends it. If medical science is unable to provide a satisfactory model Íor frailly, then it seems logical to ask whether a kindted scieítific discipline might provide an ade-quate explanatory hypothesis. Thomas Huxley-in L867 irote, "ihu fi.tuioblôct of physiology is to deduce the bf morphology on the one hãnd and those of ã.oloev on tñe othîr from the laws of the molecular iot."J'of nature."3 Can the explanation for frailty-be lound in the realm of the physical sciences? ln 1'790 Kant arzued that biology, medicine's Parent, stands aoart frõm the physical ìciences and that living orga-.rirrn, ut" categorícally different from inanimate ob-ì"cis.n The "a.itonomú of biology" has been forcibly ätg"ua by Mayr; while acknowledging that "there is no"thine itt tne processes and functions and activities "f t"iñn oreanisms that is in conflict with or outside of anv"of ih" lu*" of physics and chemistry"' he concludes that "a full undèrstanding of organisms can-not be secured through the theories of physics and chemistrv alone."s On thé other hand Szent-Georgy observed "Biologic ohenomena, possibly, ate, to a great extent, the expres-åion of subtlé changes which take place in dimensions unknown" that "belong to the realm of quantum me-.t ""i.t and can be däscribed only in its language"'6 fu"fi"g credits Schrodinger's elaboration of the wave .ouadðns and quantum inechanics with the origin of -'oá"t" molecülar biology.T ln 1944, Schrodinger wrote, "Living matter, wliiie not eluding the laws of orrrrsiås u, urtäbnth"d to date, is likely to involve other lanís of physics hitherto unknown which, however' o".ã tn"y líave been revealed, will^form as integral a oart of tire science as the former'"8 Davies acknowl-ãdees that earlier formulation of physical laws based ánÏ.¡"*tonian mechanical principlès and quantum the-áiu a"rir'"a from Planck and ginstein were insufficient toþrovide an explanatory scheme for natural processes å"ã th* decay''He predicts a nelv physical theory' the ih"oru of ordér, thát will provide a framework from ; J""pu, understandittg muy-proceed'e Similarly' H;ki"; óbr"rrrut that the time for the unification of pftyti.utin"ory is close at hand'1o ORDER AND STRUCTURE In the last 20 years, Prigopne a¡{ his coworkers in Brussels and Aústin havõ þrovided a new physical paradiem of power and attiactiveness' It allows and '"n.o.täg"t approach to areas of everyday observation that had"fornierly lacked a theoretical access-'. Prigogine is credited with éxphcating the field of non-linear non-equilibrium therrnodynamics.-Prior to his work' most thloretical physicists had dealt with equilibrium ther-modynamici ín which time plays no role' Prigogine stresáes that this domain is alien to nature' Any prac-tical scheme must include the dimension of time' An organism is a complex interconnected set of molecules Address conespondence to Walter M Bortz II' MD' Palo Alto Medical Clinic' 300 Homer Avè., Palo Alto, CA 94301. IAGS 41:1004-1008,1993 A rcgS tu the American Geriatrics Slciety oo02-86141 s3 /63.50

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  • Walter M.Bortz II

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