aging and frailty Flashcards
1
Q
sarcopenia vs frailty
A
- sarcopenia: skeletal muscle loss, poor muscle quality
- frailty: deficits accumulation, fatigue, sedentary behavior, weight loss, cognitive impairment, social isolation
2
Q
frailty
A
- decreased reserve and resistance to stressors, that result in cumulative declines across multiple physiologic systems, causing heightened vulnerability to adverse outcomes
- multiple components
3
Q
frailty predicts
A
- falls, ED visits and hospitalization and readmission, entry into residential care, survival
4
Q
functional status
A
- single best predictor of institutionalization is imapired functional status
- self-reported function is an accurate predictor of health risks and costs
- 23% of older adults report some functional limitation in either ADLs or IADLs much higher percentage for the older segments
5
Q
ADLs vs iADLs
A
- ADL: bathing, dressing, transferring, toileting, grooming, feeding, mobility
- iADLs: telephone, meal prep, mangaing finances, taking medications, doing laundry, shopping, managing transportation
6
Q
fred’s frailty phenotype components
A
- shrinking: > 10 pounds lost unintentionally in past year
- self-reported exhaustion: self-report of exhaustion on CES-D (center for epidemiologic studies - depression) questions
- weakness (grip strength): grip strength lowest 20% adjsuted for gender and BMI
- slow walking speed: slowest 20% to walk 15 feet
- low physical activity: lowest quintile of weighted kilocalorie expended per week
frailty - deficits in =/> 3
7
Q
fred’s frailty phenotype components
A
- shrinking: > 10 pounds lost unintentionally in past year
- self-reported exhaustion: self-report of exhaustion on CES-D (center for epidemiologic studies - depression) questions
- weakness (grip strength): grip strength lowest 20% adjsuted for gender and BMI
- slow walking speed: slowest 20% to walk 15 feet
- low physical activity: lowest quintile of weighted kilocalorie expended per week
frailty - deficits in =/> 3
8
Q
why use grip strength for frailty
A
- correlated with overall body strength
- can use for goals
- cutoffs by gender and BMI
9
Q
why does gait speed predict survival
A
- requires integration of a lot of systems: brain function, strength, motor control, motor plan
10
Q
clinical frailty scale
A
- easier than fried’s phenotype
11
Q
sarcopenia
A
- degenerative loss (atrophy) of skeletal muscle mass (0.5-1% loss per year after the age of 25) - loss of muscle quality and loss of strength associated with aging
- imbalance between protein synthesis and degradation rates
- sarcopenia is a component of the frailty syndrome
- still unknown whether sarcopenia is inevitable result of aging or due to combo of factors
- decreased force production with decrease muscle quality/attenuation
12
Q
frailty intervention trial (FIT)
A
- aim to identify frail older people and address frailty signs and symptoms
- FIT: community dwelling > 70 yrs, assessed using Fried’s criteria, RCT assessed frail with intervention
13
Q
aerobic capacity (on average) drops about [ ] in adults 50-70 years old
A
- 1.5%
- loss of aerobic capacity (12.2%) after 10 days of bed rest was equivalent to almost a decade of decline
14
Q
older people who develop new functional deficits during hospitalization are
A
- older people who develop deficits during hospitalization are less likely to recover lost function
15
Q
[ ] is the leading complication of hospitalization for the elderly
A
- functional decline
- occurs in 34-50% of hospitalized older adults
- leads to previously independent patients requiring post-acute care (SNF, IRF, LTACH, home care)
16
Q
detraining
A
- don’t have to be completely “sedentary” - simple decline in usual activity
17
Q
CV adaptations with deconditioning and bedrest
A
- decreased CO, decreased SV
- increased HR (limits HR reserve)
- decreased plasma volume
- increased blood viscosity
- orthostatic hypotension
- VTE (DVT and PE)
reduced CV reserve (decreased aerobic capacity)
18
Q
neurologic adaptations with bedrest
A
- decreased parasympathetic activity
- increased sympathetic activity
- loss of baroreceptor sensitivity
- increase in postural sway (body oscillation amplitude and frequency) after prolonged bed rest
- decreased balance and coordination - altered motor control
- risk of peripheral nerve compression
contribute to orthostatic intolerance, fall risk, cognitive changes
19
Q
3 orthostatic syndromes
A
- orthostatic hypertension: BP down, HR up - gradual, sustained (get fluids)
- postural tachycardia (POTS): BP steady, HR up
- reflex syncope (vasovagal): BP and HP down - get medical management
20
Q
orthostatic vital signs exam
A
- patient supine 5-10 minutes
- BP and HR measured at 1 and 3 minutes after standing - symptoms like dizziness and syncope are sensitive indicators of volume loss
- decrease in SBP of > 20 mmHg or DBP > 10 mmHgor increase in HR > 20 BPM
21
Q
pulmonary changes after deconditioning and bed rest
A
- in supine, decreased ribcage movement and lung volume - breathe more frequently
- atelectasis: collapse or closure of lung regions (alveoli) - gas exchange declines
- diaphragm moves cephalad in supine - decrease thoracic volume, tidal volume decrease
- forced expiratory flow decreases - decreased cough effectiveness
result in atelectasis and oxygen desat -> pneumonia
22
Q
bone changes with bedrest
A
- decreased bone mineral density (BMD) - especially weight bearing bones (calcaneus)
- increase serum Ca2+ (hypercalcemia)
- increase fracture risk
23
Q
muscle changes with deconditioning and bed rest
A
- T2A transitions to T2B
- decrease force and power > decrease CSA (muscle atrophy)
- T1 (slow/anaerobic) -> T2 (fast/aerobic)
- reduced muscle strength, particularly in postural and proximal muscle groups
- shortening of muscle and of connective tissue around joints -> contracture
24
Q
immobilization decreases strength by [ ]
stength can decrease as much as [ ]
A
- immobilization decreases strength by 1.0-1.5%/day
- strength can decrease as much as 20-30% during only a week to nine days of bed rest
25
Q
integumentary changs with deconditioning and bed rest
A
- a pressure ulcer or decubitus ulcer is the consequence of ischemia and anoxia to tissue
- tissues are compressed, BVs are compressed and blood flow is diverted by continual pressure on the skin and underlying structures
- cellular respiration is impaired and cells die
26
Q
other complications of bed rest
A
- renal: bone demineralization and hypercalcemia may lead to kidney/urinary tract stone formation
- gastrointestinal: decreased GI motility/increased constipation
- psychiatric: altered MS - anxiety, depression, delirium
27
Q
prevention of unnecessary bed rest
A
- prevention is key
28
Q
early mobilization in community acquired pneumonia
A
- hospital LOS significantly less in early mobilization (EM) group
- 5.8 vs 6.9 days 0 adjusted difference 1.1 days
- so people should be as mobile as possible
