Frailty

Question 1

Two rather wordy definitions of frailty?

Answer 1

One definition of frailty is “Medical syndrome or condition which results from a multi- system reduction in reserve capacity to the extent that a number of physiological systems are close to, or past, the threshold of symptomatic clinical failure. As a consequence the frail person is at increased risk of disability and death from minor external stresses” (Campbell and Buchner, 1997)

Or

“Frailty is related to the ageing process, that is, simply getting older. It describes how our bodies gradually lose their in-built reserves, leaving us vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication or environment” (Professor John Young, NHS England 2013)

Question 2

Different approaches to measures / scales of Frailty?

Answer 2

• defining phenotypes, in which specific characteristics are measured
• accumulation of deficits model, in which wider range of deficits are measured and represented as a ratio

Question 3

Which Frailty model uses phenotype?

What does it ask?

Answer 3

The Fried Model - 2001

The presence of three of more of the following characteristics:

1. unintentional weight loss
2. weakness evidenced by poor grip strength
3. self reported exhaustion
4. slow walking speed
5. low level of physical activity

Score of 2 is described as pre-frail.

Question 4

What Frailty measure use the accumulation of deficits?

What does it ask?

Answer 4

Rockwood Frailty Index - 2005
Count of health deficits, the more deficits accumulated the frailer the person and the higher the risk of deterioration and death.
30 deficits are asked about. Comprising:
- Sx
- signs
- disabilities
- investigation findings
- cognitive impairments
- diseases
- nutrition
- social vulnerability
- mood

Expressed a ratio:
number of deficits present / number of deficits asked about

< 0.09 - very fit

0. 1 - 0.27 mildly frail
1. 28 - 0.42 severely frail

Question 5

What is a more rapid assessment of Frailty than the Rockwood Frailty Index and the Fried Model?

Answer 5

the Clinical Frailty Scale

• widely used
• based on patient’s condition 2 weeks prior to presentation

Diagrams + descriptions of:
1 - very fit
2 - well 
3 - managing well
4 - vulnerable 
5 - mildy frail
6 - moderately frail
7 - severely frail
8 - very severely frail
9 - terminally ill <6months

Question 6

Why do people become frail?

Answer 6

• pro-inflammatory state
• sarcopenia
• anaemia
• relative deficiencies in anabolic hormones
• excessive exposure to catabolic hormones
• insulin resistance
• altered immune function
• micronutrient deficiencies
• oxidative stress

Question 7

3 things frailty is a predictor for?

Answer 7

• length of hospital stay
• higher rates of delirium
• altered cognitive decline in post operative patient

Question 8

How to optimise / help with frailty?

Answer 8

• recognise frailty Ising the Clinical Frailty Score
• comprehensive geriatric assessment
• addressing polypharmacy and undertake de-prescribing
• discuss priorities of care (advanced care plan, DNACPR)