Frailty, Sarcopenia and Immobility Flashcards
What is frailty?
A medical syndrome in which an individual has decreased strength, endurance and physiological function, this increases their risk of dependency and death
What is the difference between sarcopenia and cachexia?
Sarcopenia is age related loss of muscle mass. Cachexia is loss a metabolic condition resulting in loss of weight and muscle mass
What are the three criteria that make up sarcopenia and how are they measured?
Low muscle mass
Poor physical performance (timed walk test)
Poor muscle strength (grip test)
If all three are present then severe sarcopenia, if just low muscle mass then pre-sarcopenia
How do geriatricians diagnose frailty?
With the comprehensive geriatric assessment
What are the two methods that non geriatricians can use to diagnose frailty?
Electronic frailty index - computer calculated
Edmonton Frail Scale - questionnaire of physical function and cognition
How is sarcopenia diagnosed?
First gait speed is measured:
- if it is less than 0.8m/s then imaging is used (usually DEXA) to diagnose low muscle mass
- if it is greater than 0.8m/s then grip strength is tested and imaging is only used if this is low
What is the management for frailty and sarcopenia?
Both reversible conditions:
- exercise intervention - particularly involving strength work
- Nutrition involving protein or amino acid supplementation
- Comprehensive geriatric assessment - demonstrated to reverse frailty and improve outcomes
What are the main causes of immobility?
Previous fall - injury or fear prevents mobilisation Osteoarthritis Parkinsons Stroke Visual impairment Chronic Cardiorespiratory disease Feet or footwear
How is immobility managed?
It is a multidisciplinary approach
Need to identify the cause of the immobility and treat it
Requires physio and occupational therapist input
What is the WHO definition of osteoporosis?
This is 2.5 standard deviations (SD) below the bone mineral density of the general population
What are the risk factors for osteoporosis?
Female Increased Age Corticosteroid use smoking alcohol Low BMI Family history
What screening tool should be used for osteoporosis, what does it work out?
Should use frax or q fracture
Generate the 10 year risk of patients developing fragility fractures
How is actual bone mineral density calculated? what results must be treated?
Using DEXA scanning of hips and lumbar spine
A T score of less than -2.5 should be treated with bisphosphonates
What does a t score of -1 to -2.5 suggest vs a score of less than -2.5?
This shows osteopenia and less than -2.5 shows osteoporosis
What are some of the causes for a patient presenting ‘off legs’?
Vitamin CDE
Vascular - silent MI or DVT
Infective - UTI or LRTI
Trauma - Hip fracture - could be non traumatic
Autoimmune - not really
Metabolic - hypo/hypernatraemia, hypercalcaemia common causes of lethargy and confusion
Inflammatory - Pressure sores could stop them getting out of bed
Neoplastic - cause lethargy and cachexia, if deteriorating for a while this could be the cause
Congeital - no
Degenerative - OA
Endocrine - addisons can cause low BP and lethargy
