frailty and sarcopenia

Question 1

frailty and acute illness

Answer 1

o Greater vulnerability to illness
o Greater drop in function to dependent status in frail vs non frail
o Less bounce back/recovery

Question 2

frailty and critical illness

Answer 2

Frail
 Immediate death or steep decline
 Unable to come out of disabled level of function

Non-frail
 Steep drop but still within independent level of function
* Greater rate and amount of recovery
o Can reach nearly PLOF

Question 3

functional status predicts

Answer 3

• Institutionalization
• Health risks and costs
• Longer ICU/hospital stays
• Increased rate of readmission
• Increased post-op complications

Question 4

cycle of frailty: disease

Answer 4

o Insulin resistance
o Increased inflammation
o Decreased anabolic hormones

Question 5

cycle of frailty: loss of muscle mass/sarcopenia

Answer 5

o Decreased strength and power
o Decreased VO2max
o Decreased resting metabolic rate

Question 6

cycle of frailty: decreased walking speed

Answer 6

o Disability
o Dependency

Question 7

cycle of frailty: chronic undernutrition

Answer 7

o Inadequate intake of protein and energy
o Micronutrient deficiencies

Question 8

Fried’s frailty phenotype components

Answer 8

shrinking
self reported exhaustion
weakness (grip strength)
slow walking speed
low physical activity

score: frailty = deficits in >/= 3 areas

Question 9

shrinking

Answer 9

> 10 lbs lost unintentionally in past year

Question 10

self-reported exhaustion

Answer 10

CES-D questionnaire

Question 11

sarcopenia definition

Answer 11

Degenerative loss of skeletal muscle mass (.5-1% loss per year after age 25), loss of muscle quality, loss of strength

Question 12

sarcopenia mechanisms

Answer 12

Protein imbalance
 Increase protein degradation
 Decrease protein synthesis

Decrease anabolic hormones
 Testosterone
 Growth hormone and IGF-1
 DHEA

Inactivity
 Sedentary lifestyle
 Bed rest

Mitochondrial dysfunction
Insulin resistance
Decreased dietary intake
Increased inflammatory factors

Question 13

Outcomes of bed rest study

Answer 13

Decreased LE strength

Decreased max aerobic capacity
o 12% decrease equivalent to a decade of decline
o Aerobic capacity typically drops 1.5% per year in adults 50-70 y/o

Decreased stair climbing power

Little to no change in SPPB and physical performance test

Question 14

normal physiologic changes with aging

Answer 14

o Decreased muscle strength and aerobic capacity
o Vasomotor instability
o Decrease bone density
o Decreased ventilation
o Decreased sensory continence
o Altered thirst and nutrition
o Fragile skin
o Tendency for urinary incontinence

Question 15

Hazards of bed rest and hospitalization

Answer 15

Decreased muscle mass
Decreased plasma volume/dehydration
Decreased HR/SV/CO
Accelerated bone loss
Decreased lung volumes and gas exchange
Sensory deprivation/isolation

Question 16

blood composition

Answer 16

decrease plasma volume
increase blood viscosity

Question 17

cardiovascular adaptations

Answer 17

decrease CO, SV
HR compensation, limits HR reserve
orthostatic hypotension
DVT/PE
reduced CV reserve

Question 18

neurologic adaptations

Answer 18

decrease PNS
increase SNS (altered baroreceptor sensitivity)
decrease balance/coordination
sensory deprivation
risk of peripheral nerve compression

Question 19

baroreceptors

Answer 19

poor sympathetic response and inability to compensate for postural reduction in SV

Question 20

pulmonary adaptations

Answer 20

decrease thoracic volume
tidal volume decreases
increased RR
decreased ERV - decrease cough effectiveness
gas exchange declines

atelectasis and O2 desat - pneumonia

Question 21

bone changes

Answer 21

decreased BMD
increased calcium concentration (hypercalcemia)
increase fx risk

Question 22

muscle changes

Answer 22

decrease force, power, strength
contracture
atrophy
increased type 2 (highly fatiguable)
decrease type 1