Frailty Flashcards
Define/describe geriatric syndromes
Defined by the shared risk factors associated with them
Older age; cognitive/functional impairment; impaired mobility
Highly prevalent, especially in frail elderly
Chief complaint does not represent the specific pathological condition
Cross organ systems and discipline-based boundaries
What are examples of geriatrics syndromes?
Incontinence
falls
pressure ulcers
functional decline
Describe the prevalence of frailty
Challenging to determine due to: Definition/model of frailty used Inclusion/exclusion criteria More prevalent in: Women vs men Older age groups Most studies address white populations. May be higher in: Southern European Hispanic African American
Between ¼ and ½ of persons over age 85 estimated to be frail
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
Disproportionate change in health status
Ongoing debate on definitions, subdomains, and relationships to aging, disability, chronic diseases
Standardized definitions in clinical practice limited by:
Multiple factors influence functional status & physiologic reserve
Age, multi-morbidity and disability associated with frailty but do not establish the definition
Frailty transitions common
Describe frailty as a continuum
Not-frail (robust); pre-frail; frail
Frailty is not an irreversible process or an inevitable trajectory to death
72% of women had at least 1 transition between frailty states over 7.5 years*
1/3 of all 18-month transitions from states of greater to less frailty
2/3 not-frail (24 women) at baseline became frail slowly and progressively during study
1/3 (9 women) had rapid onset of frailty
Not-frail; pre-frail; frail
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 inter-related systems. Best studied are:
Brain
Endocrine
Immune
Skeletal muscle
What is the physiologic basis of frailty?
Sarcopenia: Progressive, age-related loss of skeletal muscle mass, strength, power
Sarcopenia is a key contributor to frailty
Deficiencies in sex steroids
Decreased estrogen in women/testosterone in men
Insulin resistance
Decrease in Vitamin D
Increase in cortisol
Decreased Growth Factor
In frailty, which systems have a reduced physiologic reserve?
Brain Endo Immune Skeletal muscle cardiovascular respiratory renal
What is the phenotype model of frailty?
Five variables: Unintentional weight loss Self-reported exhaustion Low energy expenditure Slow gait speed Weak grip strength 3/5 variables: Frail 2/5 variables: Pre-frail No variables: Robust/Not-frail **model suggests possibility for clinical translation
Describe the cumulative deficit model of frailty
Broader, multi-domain phenotype-
Defined as cumulative effect of individual deficits
Frailty Index*
Used in research e.g.., 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
Describe the frailty index
Score 0 or 1 for each of 5 domains: weight loss, weakness, low physical activity, exhaustion, slow walking speed
Approximately 10 minutes to administer
Weakness measured with hand ergometer
Walking speed: pt walks 15 feet and is timed
Weight loss= >10 pounds (unintentional) in past year
Additional 2 domains assessed by simple questions
Score 4-5=frail; 2-3=intermediately frail
What is included in frailty assessment?
Careful history and physical
Guides additional assessment and treatment plan
Consensus group recommends screening adults
> age 70 with chronic illness and/or
those with weight loss > 5% in one year
No data on whether screening based on age alone provides improved outcomes
What is the clinical presentation of frailty?
Non-specific
Extreme fatigue, unexplained weight loss, frequent infections
Falls
Delirium
Independent association with poor outcomes
Fluctuating disability
“Good” and “bad” days of independence
What is the FRAIL Scale? What does the scoring mean?
F- Fatigue (Are you fatigued?) 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
Approximately 30 seconds to administer
What is/should be included in laboratory evaluation of frailty?
Abnormal results of H&P, screening instruments: Consider further evaluation to detect underlying reversible conditions if any, such as hypothyroidism, vitamin D deficiency, anemia Based on history, physical exam CBC CMP TSH Vitamin D; ? Vitamin B12 ? Testosterone
To rule out/confirm potential etiologies or other causes; no evidence that any one test will diagnose frailty
