Frailty & Geriatric Pharmacology

Question 1

How is frailty conceptualized by healthcare providers?

Answer 1

• a state of late life decline and vulnerability
• characterized by weakness and decreased physiologic reserve

Question 2

The increased vulnerability of the elderly contributes to increased risk for…..

Answer 2

• falls
• institutionalization
• disability
• death

Question 3

_______ itself does not define frailty.

Answer 3

Old age

Question 4

Frailty exists on a ______.

The end stage of the continuum of frailty is _______.

Answer 4

spectrum

failure to thrive

Question 5

Most definitions of frailty describe a syndrome that is marked by…….

Answer 5

• loss of function, strength, physiologic reserve
• increased vulnerability to morbidity and mortality.

Question 6

What are the 3 most commonly used measurements for frailty screenings?

Answer 6

• physical function
• gait speed
• cognition

Question 7

The presence of __________ increases the likelihood of adverse health outcomes in geriatric patients.

Answer 7

cognitive impairment

Question 8

What are the 3 most commonly used definitions of frailty?

Answer 8

• Cardiovascular Health Study (CHS)
• Fried Frailty Phenotype
• Study of Osteoporotic Fractures (SOF)
• Rockwood Frailty Index

Question 9

How does the Cardiovascular Health Study Index define frailty?

Answer 9

3 or more of the 5 criteria

• Weight loss
• Exhaustion
• Weakness
• Slow walking speed
• Decreased physical activity

Question 10

How does the Study of Osteoporotic Fractures index define frailty?

Answer 10

at least 2 of 3 components

• Weight loss of 5% in last year
• Inability to rise from a chair w/o use of arms
• A “no” response to the question “Do you feel full of energy?”

Question 11

How does the Rockwood frailty index define frailty?

Answer 11

• Uses 70 variables that range from medical conditions to functional decline
• The higher the score in this index, the more frail the individual
• Especially well suited for mortality risk assessment

Question 12

Frailty studies are often used to estimate _______.

Answer 12

adverse outcomes

Question 13

Frailty prevalence increases with _____.

The prevalence of frailty is more prominent in (women/men).

Answer 13

age

women

Question 14

Women who became frail were…….

Answer 14

• older
• less educated
• more likely to be current smokers
• more likely to be current hormone therapy users

Question 15

In which population is frailty more common?

• African Americans
• Asians
• Caucasians
• Hispanics

Answer 15

African Americans & Asians

Question 16

What is the relationship btwn intellectual disability & frailty? Depression?

Answer 16

They are both associated with an increased risk of frailty

Question 17

Dysregulation in the ________ system is a key feature of frailty.

The basis of this dysregulation is likely related to….

Answer 17

stress response

age-related molecular changes, genetics, specific disease states

Question 18

What are the 2 most common stress responses in frailty?

What does this contribute to?

Answer 18

• Inflammatory & endocrine pathways
• Contribute to decline in skeletal muscle

Question 19

What is Sarcopenia?

What parts of the endocrine & inflammatory pathways contribute to sarcopenia?

Answer 19

• Age-related loss of skeletal muscle & muscle strength
• Lower levels of IGF-1 & DHEA-S
• Inflammatory cytokines

Question 20

What are the multiple hormone changes that occur with frailty?

Answer 20

• Decline in sex steroids
• Low SHBG, low testosterone
• Increased GH
• Low IGF-1
• Low DHEA-S
• Cortisol levels higher in late afternoon
• Low 25(OH)D

Question 21

Inflammation & Immunity

Serum levels of what substances are elevated in frail adults?

Answer 21

• Pro-inflammatory cytokine IL-6
• C-reactive protein
• WBC count
• Monocyte count

Question 22

Chronic elevation of IL-6 contributes to ______.

There is an association btwn frailty & __________.

Answer 22

anemia

clotting markers

Question 23

Stress & metabolic systems

Age related changes in _________ & ________ likely impact sarcopenia & inflammation.

Dysregulated _____, ______, ______, & _____ response systems are important to the development of frailty.

Answer 23

renin-angiotensin system, mitochondria

immune, endocrine, stress, energy

Question 24

_________is believed to be the most effective of all interventions proposed to improve quality of life and functionality in older adults.

Answer 24

Exercise

exercise + weight loss diet better than either alone

Question 25

What is the best type of exercise for frail patients?

Answer 25

• resistance training
• walking

Question 26

What types of hormonal/nutritional interventions are used to treat frail patients?

Answer 26

• Testosterone replacement
• GH or GHRH supplementation
• DHEA-S supplementation
• Vitamin D supplementation

Question 27

How do these Pharmacokinetics change in the elderly?

• Absorption
• Distribution
• Metabolism
• Elimination

Answer 27

• Absorption
  
  • There is no major alteration in drug absorption with age
• Distribution
  
  • The elderly have reduced lean body mass, reduced body water, and increased fat as a percentage of body mass.
  • Decreased serum albumin
  • Increased serum orosomucoid
• Metabolism
  
  • Drugs with the greatest changes in metabolism are phase I rxns (P450)
  • Smaller changes in phase II rxns (conjugation)
• Elimination
  
  • Decline in creatinine clearance
  • Lungs excrete volatile drugs

Question 28

Pharmacodynamic changes

Elderly have a diminished response to _____________ agonists

Answer 28

ß-adrenoreceptor

Question 29

What are the most common behavioral & lifestyle changes in the elderly?

Answer 29

• Cognitive changes associated w/ vascular pathology
• Loss of a spouse
• Economic stresses