Lecture 20: Frailty

Question 1

Aging is NOT a

Answer 1

Disease

Question 2

Aging process vs disease process examples

Answer 2

aging process: age associated atheroscelrosis, balance and vision changes (normal changes associated with aging)
disease process: anginal symptoms, heart attack, hip fracture

Question 3

senescence

Answer 3

inevitable decline or rate of decline (after maturation) in systems, purely as a function of “usual” aging

Question 4

Frailty

Answer 4

senescence can contribute to frailty but “unusal” aging and disease can contribute to frailty as well

Question 5

frality is thought of as a

Answer 5

geriatric syndrome
-a health condition that occurs when the accumulated effects of impairments or, more broadly, deficits render an older adult vulnerable to situational challenges

Question 6

frailty is distinct from

Answer 6

comorbidity; however, comorbidity is a risk factor for frailty

disability; however, frailty is a risk factor for disability

Question 7

common definition of frailty

Answer 7

a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death

Question 8

Frailty as a state

Answer 8

a clinical state in which there is an increase in an individual’s vulnerability for developing increased dependency and/or mortality when exposed to a stressor

-being a state we know that there will be transitions in and out of this state; non-frail, pre-frail, frail

Question 9

physical frailty

Answer 9

impairments in strength, endurance, balance, and mobility that increases susceptibilty to falls, injury, and dependence on others

Question 10

frailty is affected by social facotrs

Answer 10

• low income
• low education
• lack of family, church, or other social supports

Question 11

persons with heart failure, cancer, renal failure, HIV, or diabetes as well as those undergoing surgery are more likely to be

Answer 11

frail and have more adverse outcomes than those who are not frail

Question 12

adverse outcomes resulting from frailty

Answer 12

• falls
• injuries
• acute illnesses
• hospitilizations
• physical disability and dependence
• institutionalization and death

Question 13

adverse outcomes to frailty chart

Answer 13

Question 14

who needs to be screened for frailty

Answer 14

• health care providers should screen all older adults > 70 years of age for frailty
• a positive screen should result in instiuting a management for frailty plan

Question 15

most common method to define frailty

Answer 15

as a phenotype (clinical presentation)

Question 16

frailty as a phenotype - 5 criteria (the clinical presentation)

Answer 16

1. slow gait speed
2. low physical activity
3. unintentional weight loss
4. self-reported exhaustion
5. muscle weakness

Question 17

classification of frailty is based on the

Answer 17

of characteristics present

Question 18

robust

Answer 18

no frailty components = not frail

Question 19

pre-frail

Answer 19

1-2 frailty components; need intervention in a preventative form

Question 20

frial (classsification)

Answer 20

• 3 or more components; interventions needed, but outcomes aren’t great

Question 21

cardiovascular health study frailty screening scale

Answer 21

1. weight loss - 10lbs or 5% unintentional within the past year
2. exhaustion - self report or unusual tiredness in the last month
3. low activity
4. slowness
5. weakness - hand grip

Question 22

Simplified F.R.A.I.L assessment

Answer 22

Fatigue: are you fatigued?
Resistance: cannot walk up 1 flight of stairs?
Aerobic: cannot walk 1 block?
Illness: do you have more than 5 illnesses?
Loss of weight: have you lost more than 5% of your weight in the last 6 months?
3+ = frailty
1-2: pre-frail

Question 23

frailty as an accumulation of deficits

Answer 23

• the more deficits the greater the liklihood the person is frail
• physical and non-physical defecits
• in a frality index (# of deficits present / # of possible deficits listed); closer to 1 = fraility

Question 24

frailty treatment (multi-factorial & integrated)

Answer 24

1. treat the weakness with exercise - resistance and aerobic
   (FITT)
2. treat weight loss with caloric and protein support critical
3. Vitamin D for those defecient
4. reduction in polypharmacy
5. treat depression, cognitive impairment, visual and hearing problems, diabetes, CHF
6. manage reversible diseases

Question 25

enthusiasm for exercise is often lower than

Answer 25

levels that are needed to reduce frailty

• compliance to and HEP is low
• barriers are often characteristics of frailty; important to catch them before