Frailty and Functional Decline

Question 1

What is Frailty?

• manifested by?
• characterized by?

Answer 1

no exact definition

• manifested by a loss of function
• in consequence to multi system impairment AND at higher risk of dying
• Characterized by: decreased reserve and resistance to stressors, vulnerable to adverse outcomes. Decreased function and homeostatic mechanism

Question 2

How does frailty affect risk of death in OA

Answer 2

• risk of death increases with age, but not everyones risk is the same at the same age.
• frailty is an increased risk of death

Question 3

Sacropenia

how is it associated with frailty?

Answer 3

age-related loss of skeletal muscle mass and function

- Marker of frailty as it is associated w/ mobility impairments and disability

Question 4

How does an OA who is managing well vs frail respond to a stressor like a minor illness or injury

Answer 4

• well person: function high, decrease in function during illness/injury, and back to baseline upon healing
• mild frailty: functioning lower than ‘expected’, injury or illness causes a decrease in illness, than upon recovering functioning level is decreased from baseline
• severely frail: OA may be just above independence baseline, has a stressor an become independent, and slightly improves but never becomes independent.

Question 5

What is iatrogenic disability

Answer 5

avoidable dependence, often happens during course of care with older adults that are frail

Question 6

Fraily leads to adverse health outcomes, including:

Answer 6

• disability
• death
• hospitalization
• most important indicator for institutionalization

Question 7

Why measure frailty?

Answer 7

• informs clinical decision-making.
• failure to detect exposes pts to interventions they may not benefit from or be harmed by
  (have to assess, not assume)
  –> identifies those at risk, that need an assessment now. doesn’t provide specific info

Question 8

Factors associated with increased risk of frailty?

Answer 8

• lower education/income
• living alone
• social vulnerabilty (and cognitive decline, mortality)
• low socioeconomic status
• having few relatives/neoughbours or contacts
• low participating in community/religions
• low social support

Question 9

Comprehensive Geriatric Assessment (CGA)

Answer 9

1. data- gathering
2. discussion among the team, increasingly including patient and/or caregiver as a member of team
3. development, with the patient/caregiver, of a treatment plan
4. implementation of the treatment plan
5. monitoring of the treatment plan
6. revising the treatment plan

Question 10

What factors are associated with the Older patients outcome (CGA)

Answer 10

• functional status
• physical
• psychological
• socio-environmental

Question 11

3 most common frailty clinical scales used in Canada

Answer 11

1. Frailty Phenotype
2. Frailty Index (deficit accumulation)
3. Clinical Frailty Scale

Question 12

What percentage of adults of 65 and 85 have frailty?

Answer 12

65- 25%

85- 50%

Question 13

Frailty interventions

Answer 13

1. exercise
2. caloric and protein support
3. vitamin D
4. reduction of polypharmacy

Question 14

What is functional decline?

Answer 14

a new loss of independence in self-care capabilities, associated with decreased mobility and the performance of ADL

Question 15

Age-related changes associated with functional decline

Answer 15

• decline in muscle strength and aerobic capacity
• vasomotor instability
• reduced bone density
• diminished pulmonary ventilation
• alter sensory continence, appetite and thirst
• a tendecy towards urinary incontinence

Question 16

Risk factors for functional decline

Answer 16

• age
• cognitive status
• depression
• lifestyle factors (inactivity)

Question 17

Disuse muscle atrophy

Answer 17

reduction of muscle mass and strength caused by muscle inactivity or disuse

Question 18

Functional mobility decline

Answer 18

the capacity to execute safe, efficient walking (w/ or w/o gait aid) within the environmental constraints of every day life

Question 19

Functional decline related to hospitalization

• before hospital?
• while hospitalized?

Answer 19

• Before: functional decline may occur a few days before hospitalization due to acute illness
• During: functional losses can occur as early as 2nd day hospitalized
  (30-60% experience functional decline resulting in more dependence in ADLs and other adverse events)

Question 20

Hospitalization-associated disability

Answer 20

during hospitalization of an acute medical issue, the pt is discharged with a major new disability that was not present before the acute illness.
- at least 30% of pts 70 or older leave hospital with new ADL disability

Question 21

Top complications of hospitalization for OA

Answer 21

• delirium

- functional decline

Question 22

care practices that contribute to functional decline in hospital

Answer 22

• bedrest order
• physical restrains
• mobility restricting devices (catheter, IV)
• insufficient nutrition/hydration
• deconditioning
• polypharmacy
• late discharge planning
• social deprivation
• physical environment does not encourage mobility

Question 23

ISAR-HP

Identification of seniors at risk -hospitalized patients

Answer 23

predicts 90 day functional decline in OA who are acutely admitted to the department of internal medicine

Question 24

Mobilization and exercise study, and functional decline

Answer 24

• significantly decline in functional mobility over 2 month study
• person-centered walking intervention reduced functional mobility decline and led to improvements. pts regained what they loss over control period