[3] Frailty Flashcards
How is frailty defined by international consensus?
As a medical syndrome with multiple causes and contributors that is characterised by diminished strength and endurance, and reduced physiological function that increases an individuals vulnerability for developing increased dependency and/or death
What is the relationship between frailty and ageing?
It is recognised to correlate with increasing age, disease, or disability, but is a separate entity in its own right
When might it be possible to intervene to stop a person becoming frail?
If we understand what causes a person to be frail
What concepts are used to understand frailty?
- Frailty phenotype
- Accumulation of deficits model
What is the Fried model of phenotypic frailty defined as?
The presence of 3 or more of;
- Unintentional weight loss
- Weakness evidenced by poor grip strength
- Self-reported exhaustion
- Slow walking speed
- Low levels of physical activity
How are individuals with one or two characteristics on the Fried model of phenotypic frailty defined?
Pre-frail
How are individuals with no characteristics on the Fried model of phenotypic frailty defined?
Robust
What is phenotypic frailty predictive of?
Higher risk of falls, hospitalisation, disability, and death
What is the frailty index?
A count of health deficits
What does more deficits mean in the frailty index?
The more deficits accumulated, the frailer the person and the greater the risk of deterioration and death
What is the best known frailty index?
The Rockwood Frailty Index
What are ‘deficits’ in the frailty index?
- Symptoms
- Signs
- Diseases
- Disabilities
- Investigation findings
How many deficits are there in the Rockwood frailty index?
Different versions ranging between 30-70, but requires at least 30 to work
How is the Rockwood frailty index expressed?
As a ratio
How is the Rockwood frailty index calculated?
Number of deficits an individual has / total number of deficits considered
How were the deficits used in the Rockwood frailty index decided on?
They are designed to be a reflection of health status, were considering to increase in prevalence with age, and cover a wide range of systems
What do higher scores on the Rockwood frailty index predict?
Increased risk of deterioration in health, institutionalisation, and death
What score is considered to be very fit on the Rockwood frailty index?
0.09 or less
What score is considered to be mildly frail on the Rockwood frailty index?
0.10-0.27
What score is considered to be severely frail on the Rockwood frailty index?
0.28-0.42
What score is considered to be terminally ill on the Rockwood frailty index?
Over 0.42
What is the limitation of the phenotypic model and frailty index?
Requirement for either detailed measurements or collation of patient data, which can be challenging in clinical settings where more rapid assessment is required
What is a solution to the limitations of the phenotypic model and frailty index?
The clinical frailty scale
What are the categories on the clinical frailty scale?
- Very fit
- Well
- Managing well
- Vulnerable
- Mildly frail
- Moderately frail
- Severely frail
- Very seriously frail
- Terminally ill
What is considered to be ‘very fit’ on the clinical frailty scale?
People who are robust, active, energetic and motivated. These people commonly exercise regularly. They are among the fittest of their age
What is considered to be ‘well’ on the clinical frailty scale?
People who have no active disease
symptoms but are less fit than category 1. Often they exercise or are very active occasionally. e.g. seasonally
What is considered to be ‘managing well’ on the clinical frailty scale?
People whose medical problems are well controlled, but are not regularly active beyond routine walking
What is considered to be ‘vulnerable’ on the clinical frailty scale?
While not dependent on others for
daily help, often symptoms limit activities. A common complaint is being “showed up”, and/or being tired during the day
What is considered to be ‘mildly frail’ on the clinical frailty scale?
These people often have more
evident slowing, and need help in high order IADLs (finances, transportation, heavy housework, medications). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework
What is considered to be ‘moderately frail’ on the clinical frailty scale?
People need help with all
outside activities and with keeping house. Inside they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing
What is considered to be ‘severely frail’ on the clinical frailty scale?
Completely dependent for personal care, from whatever cause (Physical or cognitive). Even so, they seem stable and not at high risk of dying (within-6 months)
What is considered to be ‘very seriously frail’ on the clinical frailty scale?
Completely dependent, approaching the end of life. Typically they could not recover even from a minor illness
What is considered to be ‘terminally ill’ on the clinical frailty scale?
Approaching the end of life. This catagory applies to people with a life expectancy <6 month, who are not otherwise evidently frail
What evidence of frailty may there be on a physiological level?
- Increased inflammation
- Elevated insulin and glucose levels in fasting state
- Low albumin
- Raised D dimer and alpha1-antitrypsin
- Low vitamin D levels
Is routine testing for the physiological markers of frailty recommended?
Not outside research purposes
What interventions may be useful in frailty?
- Physical activity
- Protein-calorie supplementation
- Vitamin D management
- Polypharmacy management
How can physical activity be encouraged in the elderly?
Exercise programmes
What exercise programmes in particular can be useful in the frailty?
Those focusing on strength and balance
What do exercise programmes in frail people result in?
Improved muscle strength and functional abilities
What is the best current advice regarding exercise to prevent frailty?
To incorporate regular strength and balance training into lifestyle from middle age to prevent progression to frailty
Describe the role of protein-calorie supplementation in preventing frailty?
It may prevent progression to more advanced frailty states, but conclusive data is not yet available
What is vitamin D deficiency associated with?
Muscle weakness and sarcopenia
Describe the role of vitamin D supplementation in frailty?
It clearly has benefit in patients who have a vitamin D deficiency, but it’s use outside this context remains controversial
Why is polypharmacy important to consider in frailty?
It is associated with an increased risk of progression to more advanced frailty states
Describe the role of management of polypharmacy in frailty?
Definitive RCT evidence is lacking but, given the other benefits of reduction of inappropriate prescribing, this intervention is relatively uncontroversial.
Give 3 benefits of reduction in inappropriate prescribing?
- Decreased falls risk
- Improved cognition
- Improved compliance
Is routine screening for pre-frailty or early frailty undertaken in the UK?
No
Why is routine screening for pre-frailty or early-frailty not undertaken in the UK?
Because treatments to reverse frailty are of uncertain clinical and cost benefit at an individual level
Describe the relationship between frailty and dementia?
The degree of frailty corresponds with the degree of dementia
What are the common symptoms of mild dementia?
- Forgetting details of recent events, but remembering event itself
- Repeating same question/story
- Social withdrawal
What happens in moderate dementia?
Recent memory is impaired, but can remember past life well. They can do personal care without prompting
What happens in severe dementia?
Cannot do personal care without help
