Aging, Frailty, Sarcopenia Flashcards
Sarcopenia vs Frailty:
Sarcopenia:
-skeletal muscle loss
-poor muscle quality
Frailty:
-deficits accumulation
-fatigue
-sedentary behavior
-weight loss
-cognitive impairment
-social isolation
Response to an adverse event in a non-frail vs frail older person
-ACUTE MINOR ILLNESS: in a frail person–> they take a lot more time to recover and when they finally recover fully, they are below their baseline level of function
-ACUTE CRITICAL ILLNESS: the frail person does not recover much of their original capacity; this illness may result in death
-rate and amount of recovery in an non-frail person is much more
-FRAIL: often have a prolonged hospitalization
Definition of Frailty:
a syndrome of decreased reserve and resistance to stressors, that result in cumulative declines across multiple physiologic systems, causing heightened vulnerability to adverse outcomes
-multiple components must be present to constitute frailty
Multiple components that constitute frailty:
-decreased activity
-decreased walking speed
-sarcopenia
-decreased strength and power
-decreased VO2max
Factors that contribute to the development of frailty:
a.Body mass changes
b.MSK changes
–> sarcopenia
–> bone, muscle, skin, and CT changes
c.Social/support networks
–> limited friend support
–> much of family may have passed away aside from children
d.Physiological changes (hormones? Inflammation? Nutrition?)
–> increased insulin resistance
–> increased inflammation
–> decreased anabolic hormones
–> chronic undernutrition (inadequate protein intake, micronutrient deficiencies)
What is frailty linked to?
survival
Impact of Frailty in Acute Care and ICU
-decreased HRQOL
-delirium
-falls
-greater debility
-institutionalization
-longer ICU and hospital stay
-post-op complications
-readmission
-fewer social supports
What does frailty predict?
-falls
-ED visits and hospitalization and readmission
-entry into residential care
-survival
-risk of institutional care or help plan interventions
-greater frailty (lack of function)–> higher health care expenditures
What is the single best predictor of institutionalization?
functional status
-self reported function is an accurate predictor of health risks and costs
Fried’s Frailty Phenotype Components
-shrinking
–> >10 pounds lost unintentionally in past year
-self-reported exhaustion
–> Self-report of exhaustion on CES-D (Center for Epidemiologic Studies-Depression) questions
–> I felt that everything I did was an effort; I could not get “going”
-weakness (grip strength)
–> Grip strength lowest 20% adjusted for gender & BMI
–> frailty cutoffs associated with BMI
-slow walking speed
–> slowest 20% to walk 15 feet
–> there are cutoffs for frailty based on height and gender
-low PA
–> lowest quintile of weighted kcal expended per week
** MUST HAVE DEFICITS IN AT LEAST 3/5–> FRAILTY
Clinical Frailty Scale:
Mildly frail: more evident, slowing and need help in high order IADLs, impairs shopping and walking outside alone, meal prep and housework
Moderately Frail: need help with all outside activities and keeping house, problems with stairs, need help bathing and might need min assist dressing
Severely Frail: Completely dependent for personal care; not at high mortality risk
Very Severely Frail: completely dependent, approaching end of life
Terminally Ill: approaching the end of life; life expectancy < 6 months
Definition of sarcopenia:
The 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.
-LOSS OF MS. MASS, QUALITY, AND STRENGTH
-sarcopenia is a component of the frailty syndrome
-unknown whether it is inevitable or due to a combo of illness, poor nutrition, and inactivity or result of aging
Components of sarcopenia:
-inactivity
-protein imbalance (increased degradation and decreased synth)
-decreased anabolic hormones
-increased inflammatory factors
-decreased dietary intake
-mitochondrial dysfunction–> decreased aerobic capacity
-increased insulin resistance
Myosteatosis and sarcopenia:
-adipose that surrounds muscle tissue
-increases with
-can have an impact on metabolism
Muscle quality changes with age:
decrease in quality; decrease in the density of muscle
-lower values reflect increased muscle lipid content
When should palliative care of a patient begin?
as soon as a person is diagnosed with a chronic condition
-want to minimize losses in muscle mass and strength with aging
When is an individual at an increased risk of hospital readmission?
-when their function goes below the threshold of independence
-rehab in hospital can help to mitigate this
What encompasses palliative care?
-symptom relief
-setting patient centered goals
-family and caregiver support
- different than hospice care
Physical inactivity increases with ____
age
Strength improvements regardless of age, study results:
3x week, 16 weeks, training included knee extension, leg press, and squat
-improvement in isometric knee extension and 1RM knee extension strength is young and old group –>
-increased strength, CSA in group of men that performed 3 days/week 80% 1 RM
FIT STUDY:
-used Fried Frailty criteria to define frailty
-used SPPB to measure mobility
10 PT visits in 12 months
-focused on exercise: balance and LE strengthening
-20-30 min 3-5x’s/week for 1 year
-decreases in the number of frail individuals, decreases in the number of ppl that are frail–> improvements were greater with greater adherence
KEY interventions today for older adults:
1) HIRT - (MOST)
2) moderate to high intensity motor control based gait, balance, and ADL training
3) moderate intensity aerobic training
4) general conditioning activities ( LEAST)
-greater improvements in strength and endurance in study subjects that perform high int. training as opposed to low-mod intensity; improved walking distance, power, and chair rising time
In patients with heart failure, is high int rehab dangerous:
no, very low risk if proper safety parameters are taken
Are frailty and sarcopenia reversible?
yes and yes
