Intrinsic Capacity and Frailty Flashcards
Why do different age groups respond differently to the same illness
Physiological reserves are different
- sensory impairments
- sarcopenia, inflammation (diffuse marker of age related change)
- homeostatic dysregulation
- cognitive changes, dementia
What is health ageing
Process of developing and maintaining functional ability that enables wellbeing
- includes domains like happiness, satisfaction, fulfilment
- functional ability = enable people to be and do what they have reason to value
What are the 2 factors that make up functional ability
Intrinsic capacity = physical, mental capacities of the individual
- genetic, epigenetic potential => differences accumulate over life, variation peaks at end of life
- life events and personal characteristics
- NOT JUST ABOUT DISEASE STATES
Environmental = context of ones life
- home, communities, society
- relationships, attitudes, values
- health, social policies
- chance and specific risk exposures
Describe the trends between age and intrinsic capacity and functional ability
How does this relate to SES?
As you age, both decline
-intrinsic capacity declines greater than functional ability
Functional disability (living in poor health) has
- increased in lower SES => life expectancy is falling
- increasing less rapidly in higher SES => life expectancy is increasing
What is frailty
Multi system reduction in reserve capacity to the extent that some physiological systems are close to or past the threshold of symptomatic failure.
Decreased ability to return to initial state before stressor
Leads to increased risk of disability or death from minor stresses
What is the phenotype measure of frailty
Focus on physical elements
Decreased strength Gait speed Unintentional weight loss Increased tendency to exhaustion Usual physical activity in lowest quartile
DOES NOT ONLY CONSIDER DISEASE COUNT, also considers function
3+ = frail 1-2 = pre frailty 0 = robust
What is the Deficit accumulation model of frailty (Rockwood)
-how is this used in primary care?
Accumulation of deficits
- lifestyle and functional deficits
- symptoms, signs, disease states
Measured via the eFrailty Index
-higher frailty => more likely to be hospitalised, higher mortality
-increased frailty, need to assess medications and management plans
Who is more likely to be frail
What are the consequences
Increasing age
Lower SES
Increased likelihood of delirium, falls, immobility, incontinence during acute illness
Identifies who may need rehabiliation
How would you assess intrinsic capacity?
Vitality Locomotor Cognition Sensory Psychosocial
