Frailty Flashcards
what is the frailty perspective?
- holistic perspective that shifts focus to a goal-directed approach
- must be considered when PCPs consider invasive procedures/harmful meds/high risk interventions
what do we mean by multi-morbidity?
> 3 chronic conditions
what makes something considered a geriatric syndrome?
syndromes associated with
- older age
- cognitive/functional impairment
- impaired mobility
highly prevalent, especially in frail elderly
chief complaint doesn’t represent specific pathological condition
cross organ systems and disipline-based boundaries
what are some examples or geriatric syndromes?
- incontinence
- falls
- pressure ulcers
- delirium
- functional decline
what poor outcomes come from geriatric syndromes and frailty?
- disability dependence
- nursing home
- death
in what populations is frailty more prevalent?
- women > men
- older age groups: 25-50% people over 85 estimated to be frail
- southern european, hispanic, african american
for what poor outcomes are the frail at risk?
increased vulnerability to stressors and poor health outcomes:
- acute illness
- procedural complications
- falls
- institutionalization
- disability
- death
how do we define frailty?
- a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems
- further insult will result in: high potential for disability and disproportionate change in health status
what issues are there with defining frailty?
- multiple factors influence functional status and physiologic reserve
- age, multi-morbidity, and disability associated with frailty but do not establish the definition
- frailty transitions common
what are the 3 states of frailty?
- not-frail (robust)
- pre-frail
- frail
is frailty irreversible?
- no
- not an inevitable trajectory to death
- continuum not necessarily linear
what is the pathophysiology of frailty?
- cumulative, physiologic dysfunction that reaches an aggregate, critical level
- underlying genetic and environmental factors likely play a role
- physical activity and nutritional factors may be mediators
- disorder of several interrelated systems, including brain, endocrine, immune, and skeletal muscle
what is the key contributor to frailty?
sarcopenia
what is sarcopenia?
progressive, age-related loss of skeletal muscle mass, strength, and power
what are some other physiologic changes that contribute to frailty?
- deficiency in sex steroids, i.e. decreased estrogen in women and testosterone in men
- insulin resistance
- decrease in vitamin D
- increase in cortisol
- decreased growth factor
what 5 variables present in frailty?
- unintentional weight loss
- self-reported exhaustion
- low energy expenditure
- slow gait speed
- weak grip strength
how do you use these variables to determine position along the frailty spectrum?
- 3/5 variables = frail
- 2/5 variables = pre-frail
- no variables = robust/not-frail
what does the cumulative deficit model of frailty state?
cumulative effect of individual deficits
how is the frailty index used in practice?
- used in research for predicting outcomes in older patients undergoing surgery, predicting QOL and disability in older patients with CAD
- strongly related to risk of death, risk of institutionalization
how is the frailty index scored? what are the 5 domains on which the index is scored?
score 0 or 1 for each of 5 domains:
- weight loss (> 10 lbs unintentional in past year)
- weakness (measured w/ hand ergometer)
- low physical activity
- exhaustion
- slow walking speed (pt walks 15 feet and is timed)
takes about 10 min to administer
score 4-5 = frail
score 2-3 = intermediately frail
who should we screen for frailty?
- > age 70 with chronic illnesses OR
- those w/ weight loss > 5% in a year
what is the clinical presentation of someone who is frail?
- non-specific: extreme fatigue, unexplained weight loss, frequent infections
- falls
- delirium: independent associate with poor outcomes
- fluctuating disability: “good” and “bad” days of independence
how do you score the FRAIL scale?
F = fatigue R = resistance (can you climb 1 flight of stairs?) A = aerobic (can you walk 1 block?) I = illness (5 or more) L = loss of weight (> 5% in 6 months)
2 or more positive = frail
approx 30 sec to administer
what are some reversible conditions that can contribute to frailty?
- hypothyroidism
- vitamin D deficiency
- anemia
what are some lab tests to consider to rule out reversible causes of frailty?
- CBC
- CMP
- TSH
- vitamin D
- vitamin B12?
- testosterone?
what are some d/dx for frailty?
- depression
- malignancy
- rheumatologic disease
- endocrine disease
- CV disease
- renal disease
- nutritional deficit
- neurologic disease
what are some interventions for frailty?
- exercise
- CGA/geriatrics-focused interprofessional care
- nutritional interventions
- pharmacologic therapies
how does exercise help tx/prevent frailty?
- physiologic effects on brain, endocrine, immune, and skeletal systems
- can improve mobility and function; unsure of most effective intensity/duration
how does exercise effect those who are very frail?
- may receive smallest benefit
- may benefit most from strength/balance training and in turn, improvements in function
how does CGA/geriatrics help tx/prevent frailty and what services does this entail?
- ACE unit, PACE, conprehensive geriatric team
- focus on complex mgmt of multi-morbidity
- resource intensive
how do nutritional interventions help tx/prevent frailty?
- +/- evidence for supplements
- consider for addressing weight loss associated w/ frailty
which pharmacologic therapies may help tx/prevent frailty?
- ACE-I possibly help
- testosterone: weight benefits/burdens
- vitamin D: +/-
