Frailty, failure to thrive, disability

Question 1

Fraility

Answer 1

• AGS 2004: “a state of increased vulnerability to stressors due to age-related declines in physiologic reserve across neuromuscular, metabolic, and immune systems”
• 7-10% in population
• asian, african-american, female,
• SARCOPENIA, or age-related skeletal muscle WASTING and muscle strength, is a key physiologic component.
• Hormonal changes including lower levels of IGF-1 and DHEA-S, and higher levels of cortisol
• weight loss, slow walking speed, and low physical activity, and cognitive impairment were independently associated with disability, long-term nursing home residence, poor-surgical outcome and death.

Question 2

Cardiovascular Health Study index

Answer 2

3 out of 5

1. Weight loss (≥5 percent of body weight in last year)
2. Exhaustion (positive response to questions regarding effort required for activity)
3. Motor Weakness (decreased grip strength)
4. Slow walking speed (gait speed) (>6 to 7 seconds to walk 15 feet)
5. Decreased physical activity (Kcals spent per week: males expending <383 Kcals and females <270 Kcal)

Question 3

Disability

Answer 3

• A state of difficulty or dependency in completing tasks essential for self-care and independent living.
• 20-30% in elderly
  *

Question 4

ADLs

Answer 4

• Ambulate
• Bathing
• Controling bowel/ bladder
• Dressing
• Feeding
• Transfers

Question 5

Failure to Thrive

Answer 5

• A syndrome of global decline that occurs in elders as an aggregate of physical FRAILITY, COGNITIVE IMPAIRMEN, and functional DISABILITY; which resulted in declining functional status
• multiple contributing factors, including medication side effects, medical comorbidities, and psychosocial factors.

Question 6

Management FTT

Answer 6

• Treat underlying REVERSIBLE courses
• DISCONTINUE unnecessary medications.
• REMOVED: Dietary restrictions and patient’s preference diet.
• Nutritional supplements between meals.
• Assistance with feeding.
• AVOID routinely appetite stimulants (marginal benefit).
• Exercise
• Vit-D suppement
• Agreesively treat depression: antidepressants, a trial of a low-dose psychostimulant (methylphenidate 2.5 mg), or shock therapy.

Question 7

Hospice eleigibility

Answer 7

Non-disease specific criteria

• KPS<50
• 3/6 dependent in ADLs
• Idiopathic Weight loss >10%/6mo
• Albumin<2.5
• Recurrent or intractable infections
• Recurrent aspiration and/or inadequate oral intake due to intractable dysphagia
• Progressing dementia by objective measures
• Progressive pressure ulcers (stage 3 or 4) despite optimal care