Frailty (lecture) Flashcards
What is Frailty?
A medical syndrome characterized by diminished strength, endurance, and reduced physiological reserve that increases vulnerability to dependency and death.
Correlates with age, disease, and disability.
What are the physiological markers of Frailty?
- Increased inflammation
- Insulin and glucose levels
- Low albumin
- Raised D-dimer and alpha-antitrypsin
- Low vitamin D levels
These markers indicate a higher risk for frail individuals.
What defines the Frailty phenotype according to the Fried model?
Presence of three or more of the following:
* Unintentional weight loss
* Weakness (poor grip strength)
* Self-reported exhaustion
* Slow walking speed
* Low level of physical activity
Individuals with one or two characteristics are considered pre-frail.
What is the difference between fit elderly and frail elderly individuals?
Fit elderly may get sick but recover quickly, while frail elderly may experience a significant drop in function and increased dependency.
Example: Two individuals react differently to a UTI.
What is the Fried Frailty Phenotype (FFP)?
A model defining a person as frail if they meet 3 out of 5 criteria:
* Unintentional weight loss
* Feeling exhausted
* Weak grip strength
* Slow walking
* Low physical activity
What does the Rockwood Frailty Index measure?
The number of health problems (out of 70) a person has, where more problems indicate greater frailty.
What is the Edmonton Frailty Scale (EFS)?
A quick test (5–10 minutes) assessing 10 areas like cognition, balance, and mood, useful in clinics and the community.
What is Comprehensive Geriatric Assessment (CGA)?
A full, in-depth review of a person’s medical, functional, and social needs to create a personalized care plan.
What are the steps included in the CGA process?
- Assessment
- Stratified Problem List
- Management Plan
- Goal Setting
What domains are assessed in a Comprehensive Geriatric Assessment?
- Physical health: illnesses, medications, pain, vision, hearing
- Mental health: cognition, depression
- Functional ability: daily tasks
- Social circumstances: living situation, support, finances
- Environment: safety, mobility aids, fall risk
What are some objective tools mentioned for assessing frailty?
- Barthel Index
- Cognitive Tests (MMSE, MoCA)
- Gait & Balance Tests (Timed Up-and-Go, Berg Balance)
- Depression Scale (Geriatric Depression Scale)
Who are the core team members in a Comprehensive Geriatric Assessment?
- Geriatrician
- GP
- Social Worker
- Occupational Therapist
- Physiotherapist
- Nurse
What impacts does frailty have in a hospital setting?
- Higher risk of delirium
- Longer hospital stays
- More likely to need care after discharge
What are the community impacts of frailty?
- More likely to fall
- Risk of social isolation
- Poor nutrition/malnutrition
What surgical complications are associated with frailty?
Higher chance of complications during and after surgery.
What are some interventions for frailty?
- Fix reversible causes (e.g., malnutrition, inactivity)
- Vitamin D supplementation
- Review polypharmacy
- Multidisciplinary support (e.g., Occupational Therapy)
- Vision and Hearing Checks
- Recognise advanced frailty as terminal when appropriate
What is the key takeaway about frailty?
- Frailty is a specific condition, not just aging
- Early screening and intervention are crucial
- Team-based care is essential
- Focus on improving quality of life
- End-of-life planning is important for severe frailty
What is frailty?
A clinical syndrome with reduced strength, endurance, and physiological reserve, increasing vulnerability to stressors like infections or falls.
How is frailty different from disability and long-term conditions?
Frailty ≠ Disability: Disability is difficulty doing daily tasks.
Frailty ≠ Long-term conditions: These are chronic diseases (e.g. COPD), but frailty is a separate condition that may coexist.
What are common physiological markers of frailty?
Increased inflammation
Low albumin
Insulin resistance
Low vitamin D
Raised D-dimer and alpha-antitrypsin
What are the 5 criteria of the Fried Frailty Phenotype?
Unintentional weight loss
Weak grip strength
Self-reported exhaustion
Slow walking speed
Low physical activity
What does “pre-frail” mean in the Fried model?
Having 1–2 of the 5 criteria.
What tools are used to assess frailty in general practice?
PRISMA-7 questionnaire
Electronic Frailty Index (eFI)
What tools are used to assess frailty in hospitals?
Fried Frailty Phenotype
Rockwood Clinical Frailty Scale (CFS)
Edmonton Frailty Scale (EFS)
Timed Up and Go (TUG) test
What are causes of frailty in older adults?
Muscle loss (sarcopenia)
Chronic illness
Malnutrition
Inactivity
Polypharmacy
Social isolation
Vision/hearing los
How can frailty be prevented or reduced?
Exercise (strength/balance)
Good nutrition & vitamin D
Medication review (STOPP/START)
Manage underlying conditions
Multidisciplinary care
Home adaptations
Social engagement
What are the 4 steps in the CGA process?
Assessment
Stratified problem list
Management plan
Goal setting
What domains does CGA assess?
Physical health
Mental health
Functional ability
Social circumstances
Environment
What are key tools used in CGA?
Barthel Index
MMSE or MoCA
Geriatric Depression Scale (GDS)
TUG test
Rockwood CFS
Who are the core members of the CGA team?
Geriatrician
GP
Social worker
Occupational therapist
Physiotherapist
Nurse
Who might be additional specialists in CGA?
Dietitian, dentist, audiologist, optometrist, orthotist, podiatrist, speech & language therapist
What are the impacts of frailty in hospitals, community, and surgery?
Hospital: Delirium, longer stays, care needs
Community: Falls, isolation, malnutrition
Surgery: Higher risk of complications
What are key interventions for frailty?
Nutrition, exercise, medication review
Vision/hearing checks
OT input (e.g. grab bars)
End-of-life planning
CGA as gold standard
