CGA and Frailty

Question 1

Frailty is not a normal part of ageing. Epidemiology?

definition?

Answer 1

common 25-50% in over 85yrs

risk factor for adverse outcomes

3 year mortality is 6x higher than not frail

25% of frail people have no co-morbities. A lot of multi morbid aren’t frail.

“a distinct clinical state in which there is decline in multiple physiological systems”

Question 2

Models to identify frailty?

Answer 2

Freid Frailty Phenotype Model:
- weight loss
- reduced grip strength
- slow walking speed
- self reported exhaustion
(3 or more is frail)

Rockwood Frailty Index:
- defines frailty as a cumulative effect of individual deficits
- 92 variables including (acute illness, chronic illness, difficulty with activities of daily living, physical signs)
(has all the pictures 1-9)

Question 3

What are frailty syndromes. ie things that suggest they have frailty?

Answer 3

Delirium
Incontinence
Falls
Medication side effects
Immobility

(comes in “off legs”)

Question 4

What are some more tools /scales for assessing Frailty?

Answer 4

Patient Questionares
- PRISMA-7

Physical measures

• gait speed
• timed get up and go

Objective clinical scales

• Rockwood clinical frail scale
• Edmonton frail scale
• Electronic frailty index

Question 5

What is Comprehensive Geriatric Assessment?

Answer 5

Multidomain assessment (medical, functional, psychological and social)

Develop goal oriented patient centred plan

Involves doctors, therapists, nurses, pharmacists and community services

It can really help!

Question 6

What are the domains within a CGA?

Answer 6

Medical

• co-morbid conditions dn severity
• medication review
• nutritional status
• problem list

Mental Health

• cognition
• mood and anxiety
• fears

Functional Capacity

• basic activities of daily living
• gait and balance
• activity / exercise status
• instrumental ADLs

Social Circumstances

• informal support from family or friends
• social network such as visitors or daytime activities
• eligibility for being offered care resources

Environment

• home comfort, facilities and safety
• use or potential use of tele-health tech
• transport facilities
• accessibility to local resources