Frailty- identification and interventions

Question 1

Changes in life expectancy and healthy life expectancy for men in the UK

Answer 1

Life expectancy at 65 is now 21 years for women and 19 years for men

• People over 65 account for 51% LEA spending on social care:
• 66% of primary care px costs

Question 2

What is frailty?

Answer 2

Frailty is a distinct clinical state in which there is a decline in multiple physiological systems

• This leads to increased vulnerability to minor external stressors
• Exposure to negative health outcomes

Question 3

What is disability?

Answer 3

• Disability is a physical or mental impairment that has a substantial negative effect on the ability to undertake normal daily activities:
• Represents a static and stable loss of function:
• Around 50% of disibility in older adults develops chronically and progressively in association with co-morbidity and frailty:
• The remaining 50% of disability in older adults develops after a single event such as a stroke:

Question 4

What is multimorbidity?

Answer 4

• Multi morbidity is the presence of 2 or more long term conditions (co-morbidity):
• Whilst most people who are frail have multimorbidity, the majority of those with multimorbidity do not fit the criteria for frailty.

Question 5

What is frailty?

Answer 5

• Around 25% of older people with frailty, have neither multiple co-morbidities or disability:
• Frailty represents a dynamic condition that is characterised by marked fluctuations in function. It can be thought of as an ‘unstable disability’

Question 6

What is the difference between aging and frailty?

Answer 6

• Although aging is associated with gradual physiological decline, this is accelerated in frailty:
• Leads to a loss of homeostatic function and reduced physiological reserve:
• Vulnerability to external stressors can lead to sudden marked deteriorations in function:

Question 7

What roles do genetic, environmental and epigenetic factors play in the development of frailty

Answer 7

​

• Accumulation of damage at cellular level leads to organ decline which translates to functional defecits:
• Best studied systems are brain, endocrine, immune and skeletal muscle:

Question 8

What changes in the aging brain contribute to frailty?

(Cerebral volume loss)

Answer 8

Cerebral volume loss:

• Loss of volume and weight from age 40 and accelerates after age 70:
• Loss of neurons in areas of high metabolic demand such as hippocampus and prefrontal cortex:
• Changes in structure and function of microglial cells cause hyperresponsiveness to stimuli leading to neuronal cell death (delirium)

Question 9

What changes in the aging brain contribute to frailty?

(Neurotransmitter pathway changes)

Answer 9

Neurotransmitter pathway changes:

• Reduced dopamine and serotonin pathways:
• Increased level of monoamine oxidase which encourages free radical formation:

Question 10

What changes in the aging brain contribute to frailty?

(Vascular changes)

Answer 10

Vascular changes:

• Increased white matter changes preferentially affecting frontal cerebral areas:
• Higher burden of cerebral angiopathy:

Question 11

What changes in the aging brain contribute to frailty?

(Changes in gene expression)

Answer 11

Changes in gene expression:

• Reduced expression of genes involved in mitochondrial energy metabolism:
• Increased expression of genes involved in stress response pathways, in particular, apolipoprotein D gene which has been implicated in Alzheimer’s disease.

Question 12

What changes in the aging brain contribute to frailty?

(Frailty and Cognition)

Answer 12

Frailty and Cognition:

• Aging is associated with a decline in a range of cognitive functions:
• Negative association between frailty and neurocognitive speed with observational and cohort studies supporting a close relationship between frailty and dementia.