Frailty

Question 1

Define frailty

Answer 1

mutisystem dysregulation, leading to loss of physiological reserve, resulting in a state of increased vulnerability to stressors

Question 2

What are the two models of frailty and who developed them?

Answer 2

1. Fried’s phenotype model

2. Deficit accumulation – Rockwood

Question 3

Describe Fried’s phenotype score

Answer 3

3 out of 5 needed to be frail (2 = pre-frail)
•	Unintentional weight loss
•	Self-reported exhaustion
•	Weakness – measured by grip strength 
•	Slow walking speed 
•	Low physical activity

Question 4

What measures are based on the deficit accumulation model?

Answer 4

1. Clinical frailty score - developed by Rockwood

2. e frailty index - Clegg et al. 2016

Question 5

How would you manage someone with mild frailty?

Answer 5

• exercise
• smoking cessation, reduce alcohol
• reduce social isolation
• housing adaptations

Question 6

How would you manage someone with moderate frailty?

Answer 6

• medication review
• falls management
• primary care MDT
• advanced care planning
• immunisation

Question 7

How would you manage someone with severe frailty?

Answer 7

• community geriatric services
• carers and carers support
• advance care planning
• bed based intermediate care eg frailty units or rapid response team
• palliative care

Question 8

What clinical measures are used to measure frailty?

Answer 8

Timed up and go

or

Walking speed

Question 9

What is timed up and go and what is a normal result?

Answer 9

Get up out of an arm chair, walk 3m and turn round and sit back down on the chair.
<12 seconds

Question 10

What is an abnormal result for walking speed?

Answer 10

walking less than 0.8ms

less than 4m in 5 seconds

Question 11

What are the complications of frailty?

Answer 11

delirium
falls 
pressure ulcers 
inadequate nutrition 
hospital admissions, increased length of stay 
residential care 
mortality