LO1 Frailty Flashcards
What is the definition of frailty?
Frailty is defined as a physiological syndrome with multiple causes and contributors characterised by decreased reserve and diminished resistance to stressors, resulting from cumulative decline across multiple physiological systems, and causing vulnerability to adverse outcomes: - Failure to thrive is the most extreme manifestation of this, with a low rate of recovery and pre-death state. -Stressors can include extremes of heat and cold, infection, injury, and medication changes
What is sarcopenia?
Sarcopenia is the degenerative loss of skeletal muscle mass (0.5–1% loss per year after the age of 50), quality, and strength associated with aging. Sarcopenia is a component of the frailty syndrome. Frailty and sarcopenia are inter-linked, but the exact nature of their association is unclear.
Name 13 factors that contribute to development of sarcopenia.
Intrinsic factors: age, sex, comorbidity, genetic factors. Diet: low protein intake, vitamin D deficiency. Body composition: significant weight loss, sarcopenic obesity. Pharmacological therapy: Use of ACE inhibitors, use of steroids. Lifestyle: cigarette smoking, excessive alcohol consumption, low physical activity
Frailty is thought to result from a multifactorial process involving dysregulation across many physiological systems. What conditions are known to pre-dispose to frailty?
- A proinflammatory state, sarcopenia, anaemia, insulin resistance, hormones, endocrine and metabolic altered systems immune function, oxidative stress, and nutrient deficiencies
What is the clinical frailty scale?
What is the Fried frailty scale?
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Fried Frailty Score defines frailty as three out of the five following criteria
- Low grip strength (<20th centile)
- Low energy (self-reported exhaustion)
- Slow walking speed (lowest quartile on 4-minute walking test, timed up and go test (over 3 metres))
- Low physical activity
- Unintentional weight loss (>4.5kg in the past year)
What is the electronic frailty index?
Identify all patients aged 65 and over who may be living with moderate or severe frailty;
For patients identified as living with severe frailty (around 3% of over 65s), undertake an annual medicines review, a falls risk assessment, if clinically appropriate, and promotion of the enriched Summary Care Record (SCR);
For patients identified as living with moderate frailty (around 12% of over 65s), consider undertaking a medicines review, a falls risk assessment if clinically appropriate, and promotion of the enriched SCR.
What is the Edmonton frail scale?
Consists of 9 domains each scoring between 0-2.
Cognition- Put numbers on a clock and draw a time.
General health- Subjective.
Functional independence- Subjective.
Social support- Subjective assessment of degree of support.
Medication use- Are they on 5 or more medications?(Yes=1), do they sometimes forget to take prescription medication? (Yes=1).
Mood- Do they often feel sad or depressed? (Yes scores 1)
Continence- Do they often lose control of their urine? (Yes scores 1)
Functional performance- Get Pt to walk 3 metres from a seated position, then turn around and sit back down. 10-20 secs- Scores 1, >20secs scores 2.
Frailty is then defined by cumulative score:
0-5 not very frail
6-7 vulnerable
8-9 mild frailty
10-11 moderate frailty
12-17 severe frailty
What are the 3 main groups of recognised risk factors for frailty?
- Chronic diseases = CKD, diabetes, CVD, dementia, depression
- Physiologic impairments = anaemia, activation of inflammatory/coagulation cascades, autonomic dysfunction
- Environment related factors = home environment, social life
What is the management of frailty?
- Exercise intervention, particularly involving strength work
- Nutrition, particularly involving protein or amino acid supplementation
- Comprehensive Geriatric Assessment (CGA)
What are the 5 geriatric giants?
Immobility
Incontinence
Instability
Impaired intellect
Iatrogenic disease
