Fraility

Question 1

What is fragility?

Answer 1

Condition characterised by loss of biological reserves and vulnerability to adverse outcomes.

Question 2

What is the different between a stable or unstable person gets ill?

Answer 2

When a stable / healthy person gets a minor illness it is a lot less debilitating and they recover quicker.

Whereas, when an unstable / frail person gets a minor illness it is much more debilitating. So, they get much worse (disproportionately so) and it takes them much longer to recover.

Question 3

How do you measure frailty?

Answer 3

Frailty index score = no. Of deficits in an individual / total number of deficits measured.

Also a different measure of frailty in acute hospitals.

Question 4

What could be wrong with a frail person?

Answer 4

Literally anything!

Ageing
Co-morbidity 
Sarcopenia
Osteopenia
Weight loss
IL-1
CRP
Vitamin D
ADL decreased
Decreased cognition

Question 5

What do you have to consider when seeing a frail person?

Answer 5

37% mortality risk 
End of life care 
Increased LOS
Redmission 53% at on year 
Non-specific presentations
High risk of complications

Question 6

What kinds of non-specific presentations could a frail person present with?

Answer 6

Falls, immobility, off legs, collapse

Confusion (delirium and/or dementia)

“Acopia or “Socal admission” (dont use this)

Other diffuse or multiple statements related to disability

Question 7

What kinds of pathology are common in frail people?

Answer 7

Cognitive impairment 
Iatrogenesis 
Deafness and blindness
Axial osteoarthritis 
Vascular 
Diabetes
Respiratory disease 
Depression

Question 8

How does homeostasis change?

Answer 8

More difficult to regulate:

Balance, temperature, BP, Na

Biological systems usually robust: multiple feedback loops

Failure either due to overwhelming single disease or lesser disease with multiple co-morbidities

Question 9

What other things can make fraility worse?

Answer 9

Living alone
Poverty
Poor housing
Ageism

Question 10

What does presenting with a frail person mean?

Answer 10

Recognise non-specific presentations

When found:
Expect multiple pathology
Look beyond the acute presentations or consequences

Medical intervention could be:
At the acute precipitation
At co-pathology

Rehabilitation

History taking