may be helpful for individuals who are experiencing an advanced state of frailty with possible other co-morbidities. improving quality of life by reducing pain and other harmful symptoms is the goal with palliative care. one study showed the cost reduction by focusing on palliative care rather than expensive treatments that may be unnecessary and unhelpful. surgical outcomes frail elderly people are at significant risk of post-surgical complications and the need for extended care. frailty more than doubles the risk of morbidity and mortality from surgery and cardiovascular conditions. assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories. the most widely used frailty scale consists of five items: unintentional weight loss >4.5 kg in the past year self-reported exhaustion <20th population percentile for grip strength slowed walking speed, defined as lowest population quartile on 4-minute walking test low physical activity such that persons would only rarely undertake a short walk a healthy person scores 0; a very frail person scores 5. compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. epidemiology and public health frailty is a common geriatric syndrome. estimates of frailty prevalence in older populations may vary according to a number of factors, including the setting in which the prevalence is being estimated – e.g., nursing home (higher prevalence) vs. community (lower prevalence) – and the operational definition used for defining frailty. using the widely used frailty phenotype framework proposed by fried et al. (2001), prevalence estimates of 7–16% have been reported in non-institutionalized, community-dwelling older adults. the occurrence of frailty increases incrementally with advancing age, is more common in older women than men, and among those of lower socio-economic status. frail older adults are at high risk for major adverse health outcomes, including disability, falls, institutionalization, hospitalization, and mortality. epidemiologic research to date has led to the identification of a number of risk factors for frailty, including: (a) chronic diseases, such as cardiovascular disease, diabetes, chronic kidney disease, depression, and cognitive impairment; (b) physiologic impairments, such as activation of inflammation and coagulation systems, anemia, atherosclerosis, autonomic dysfunction, hormonal abnormalities, obesity, hypovitaminosis d in men, and environment-related factors such as life space and neighborhood characteristics. advances about potentially modifiable risk factors for frailty now offer the basis for translational research effort aimed at prevention and treatment of frailty in older adults. a recent systematic review found that exercise interventions can increase muscle strength and improve physical function; however, results are inconsistent in frail older adults living in the community. a review looked at the relationship between the frailty syndrome and chronic lower extremity ischemia in those people with diabetes. on the one hand, chronic lower limb ischemia may predispose to the development of frailty, on the other hand, the presence of the frailty may affect the prognosis in patients with peripheral arterial disease. ongoing clinical trials as of september 2021, ongoing clinical trials on frailty syndrome in the us include: the impact of frailty on clinical outcomes of patients treated for abdominal aortic aneurysms the use of "pre-habilitation," an exercise regimen used before transplant surgery, to prevent the frailty effects of kidney transplant in recipients defining the acute changes in frailty following sepsis in the abdomen the efficacy of the anti-inflammatory drug, fisetin, in reducing frailty markers in elderly adults physical performance testing and frailty in prediction of early postoperative course after cardiac surgery (cardiostep) up-to-date information on ongoing clinical trials on frailty syndrome and other conditions can be found at clinicaltrials.gov.