Ger 8 Fraility Flashcards
What does the phenotype of frailty develop as a consequence of?
Decline in several physiological systems which collectively results in a vulnerability to sudden health state changes triggered by relatively minor stressor events
What is fundamental to the development of frailty?
Age-related changes to multiple physiological systems (especially neuromuscular, neuroendocrine, and immunological)
What interacts cumulatively and detrimentally resulting in a decline in physiological function an reserve?
Age-related changes
What happens when a cumulative threshold of changes is reached?
The ability of an individual to resist minor stressors and maintain physiological homeostasis is compromised
What can the loss of functional homeostatic reserve at the level of individual physiological systems ultimately do?
Adversely affect the whole person
What can be done on the basis of the resulting frailty phenotype?
Identify older people who are frail
What are frail people predisposed to?
Adverse health consequences (falls and delirium) following relatively minor stressor events
What is included in the frailty phenotype?
- Sarcopenia: Loss of muscle mass and strength
- Anorexia
- Osteoporosis
- Fatigue
- Risk of falls
- Poor physical health
What does the addition of a minor stressor event to a frail older person with impairment of balance or cognition explain?
The clinical syndromes of falls and delirium (respectively), as common consequences of frailty
Why do healthcare systems struggle to cope adequately with the common presentations of ill health in older people who are frail?
Mainly because their healthcare states change suddenly and unpredictable
What has been demonstrated to optimize outcomes for older people with frailty?
Comprehensive geriatric assessment
What is the frailty cycle or spiral?
Increasing frailty gives rise to increased risk of further decline towards disability and greater frailty (look at figure)
What can happen to a person who is functionally independent, but through the combined processes of aging, chronic diseases, and deconditioning is super close to a theoretical line of decompensation?
A small additional deterioration caused by a minor stressor event (usually a urinary infection, new medication prescription, ect.) results in a sudden and disproportionately severe heath state change from one of independence to one of dependence
What is a key component of frailty?
Sarcopenia
What is sarcopenia?
Progressive loss of skeletal muscle mass and strength
When can the syndrome of sarcopenia result?
When there is loss of physiological reserve in the neuromuscular system
What is proposed to contribute to the development of sarcopenia?
A complex relationship between muscle fiber loss, muscle fiber atrophy and multiple contributory factors (nutritional, hormonal, metabolic, immunological)
What % of loss in muscle strength per year has been reported in older people via observational studies?
1-3%
-Even higher in the oldest old
What can the development of sarcopenia adversly affect?
The ability of an older person to remain functionally independent
What is required for the critical basic mobility skills of getting out of bed, standing up from a chair, walking a short distance, and getting off of the toilet?
Muscle strenth
What happens when the ability to perform critical skills is impaired?
An older person is at risk of becoming dependent for care needs
What are the 5 indicators of frailty according to the Fried model?
- Weight loss
- Exhaustion
- Low energy expenditure
- Slowness
- Weakness
What is the measure for weight loss?
Self reported weight loss of 4.5 kg or recorded weight loss of over 5% per year
What is the measure for exhaustion?
Self-reported exhaustion on a CES-D scale (3-4 days per week or most of the time)
What is the measure for low energy expenditure?
Under 383Kcal/week in a man or under 270Kcal/week in a woman
What is the measure for slowness?
Standarized cut-off times to walk 15 feet, stratified for sex and height
What is the measure for weakness?
Grip strength, stratified by sex and BMI
What happens when the identified 5 key components are present in combination?
They have the potential to interact and cause a “critical mass” that compromises the frailty syndrome
Are the individual items in the Fried model of frailty identifiable to clinicians?
YES
What is the precise and objective measurement of the 5 domains appropriate to?
Research studies… too complex for routine clinical care
What characterizes a robust older person?
People with none of the 5 indicators
What happens when a person has one or two indicators?
They are hypothesized to compromise and intermediate or pre-frail group
When is someone considered frail?
When they have 3 or more indicators
Why is there some uncertainty about the relationship between frailty, cognitive impairment, and dementia?
Because older people who scored less than 18 on the Mini-Mental State examination (with moderate/severe cognitive impairment) were excluded from the cohort in which the Fried model of frailty was developed
What is a diagnostic tool designed to identify frail older people in clinical settings that requires less than 5 mintues to administer and is valid and reliable when performed by a non-specialist?
The Edmonton frail scale (EFS)
What has the reported EFS been developed to more recently measure?
Frailty in an acute hospital inpatient setting
What were the frailty prevalence rates found for men and women in the UK study presented?
Women: 8.5%
Men: 4.1%
Based on the US study presented, what was the frailty prevalence of men and women 65+?
6.9%
What was the prevalence of frailty for the age groups
65-70
75-79
85-89?
- 2%
- 5%
- 7%
* Frailty increased with age
What was the 3 year frailty incidence rate found in the US study?
7%, with a further 7% between years 4 and 7
What is frailty associated with?
Important adverse health consequences
Older people defined as being frail on the basis of the Fried criteria were at significantly increased risk of what?
Disability, hospitalization, death
What is the relationship between frailty, disability, and comorbidity?
Complex
What is comorbidity defined as?
2 or more chronic diseases
Do frailty, disability, and comorbidity exhibit significant overlap?
Yes, they are closely related
Are frailty, disability, and comorbidiy synonymous?
NO
If it possible that an individual may be phenotypically and measurable frail (frailty develops with multisystem physiological decline) in the absence of cormorbidity?
YES
What can add further complexity to the situation?
The effects of single severe disease, presence of subclinical disease, or the presence of undiagnosed disease
What can be measured using standardized instruments that assess activities of daily living (like the Barthel index)?
Disability
How can disability develop?
- Progressively (from frailty)
2. Catastrophically (result of a stroke or hip fracture)
What % of disability develops in older age progressively?, catastrophically?
50%, 50%
What is likely to be significant to the development of disability in older age?
The contribution of physiological fraitly
What does the association between frailty and adverse health outcomes carry?
Significant health resource implications
What are reductions in the prevalence or severity of frailty likely to have large benefits for?
The individual, family, and society
What are natural targets for treatment of frailty?
Sarcopenia and chronic undernutrition
What has been successful at improving muscle strength and functional abilities in frail people?
Interventions involving strength and balance training
What did one study conclude regarding physical rehabilitation for older people in permanent long-term care (frail population)?
There is good evidence that individual or group exercise programs are both acceptable and effective in improving mobility and other daily living tasks in this vulnerable population
Where else has physical activity interventions targeted at improving the functional status of frail older people been successful?
For people living in the community
True or False: When combined with physical activity interventions, nutritional supplementation doesn’t appear to be independently effective at improving functional abilities of frail older people compared to just physical activity interventions?
TRUE
So are nutritional interventions effective?
Not so much
What pharmacological agents have actions and effects with the potential to limit the development and progression of frailty?
Anabolic steroids, statins, ACEi, ect.
Has evidence of a beneficial effect from pharmacological agents been reliably demonstrated?
No
What is an important and common clinical condition associated with significant adverse health outcomes, including the development of disability in older age with its attendant personal and societal costs?
FRAILTY
What are common manifestations of frailty?
Falls and delirium
What has the potential to prevent disability in older age, and thereby the potential to improve general health and well-being?
Physical activity interventions that limit the progression of frailty
What is frailty?
An important and common clinical condition characterized by a vulnerability to heath state change following minor stressor events
What is fundamental to the development of frailty?
Age-related changes to multiple physiological systems
What are identifiable characteristics of the frailty phenotype?
Sarcopenia (loss of muscle mass and strength), anorexia, osteoporosis, fatigue, risk of falls, and poor physical health
What is frailty associated with?
Important adverse health outcomes, including increase in the risks of disability in older age and of admission to long-term care and increased mortality
What do interventions that limit the progression of frailty have the potential to prevent?
Disability in older age, and thereby the potential to improve general health and well-being
What 3 outcomes do people with frailty have increased risk of?
- Worsening ADL/disability
- Hospitalization
- Death
What is categorized as no frailty?
None of the 5 operationalized Fried criteria for frailty
What is intermediate frailty?
1 or 2 criteria for frailty
What is frail?
3 or more criteria for fraitly
