Frailty and Functional Decline Flashcards
What is Frailty?
- manifested by?
- characterized by?
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
How does frailty affect risk of death in OA
- risk of death increases with age, but not everyones risk is the same at the same age.
- frailty is an increased risk of death
Sacropenia
how is it associated with frailty?
age-related loss of skeletal muscle mass and function
- Marker of frailty as it is associated w/ mobility impairments and disability
How does an OA who is managing well vs frail respond to a stressor like a minor illness or injury
- 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.
What is iatrogenic disability
avoidable dependence, often happens during course of care with older adults that are frail
Fraily leads to adverse health outcomes, including:
- disability
- death
- hospitalization
- most important indicator for institutionalization
Why measure frailty?
- 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
Factors associated with increased risk of frailty?
- 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
Comprehensive Geriatric Assessment (CGA)
- data- gathering
- discussion among the team, increasingly including patient and/or caregiver as a member of team
- development, with the patient/caregiver, of a treatment plan
- implementation of the treatment plan
- monitoring of the treatment plan
- revising the treatment plan
What factors are associated with the Older patients outcome (CGA)
- functional status
- physical
- psychological
- socio-environmental
3 most common frailty clinical scales used in Canada
- Frailty Phenotype
- Frailty Index (deficit accumulation)
- Clinical Frailty Scale
What percentage of adults of 65 and 85 have frailty?
65- 25%
85- 50%
Frailty interventions
- exercise
- caloric and protein support
- vitamin D
- reduction of polypharmacy
What is functional decline?
a new loss of independence in self-care capabilities, associated with decreased mobility and the performance of ADL
Age-related changes associated with functional decline
- 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
Risk factors for functional decline
- age
- cognitive status
- depression
- lifestyle factors (inactivity)
Disuse muscle atrophy
reduction of muscle mass and strength caused by muscle inactivity or disuse
Functional mobility decline
the capacity to execute safe, efficient walking (w/ or w/o gait aid) within the environmental constraints of every day life
Functional decline related to hospitalization
- before hospital?
- while hospitalized?
- 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)
Hospitalization-associated disability
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
Top complications of hospitalization for OA
- delirium
- functional decline
care practices that contribute to functional decline in hospital
- 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
ISAR-HP
Identification of seniors at risk -hospitalized patients
predicts 90 day functional decline in OA who are acutely admitted to the department of internal medicine
Mobilization and exercise study, and functional decline
- 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