LO1- Frailty and Sarcopenia

Question 1

What is frailty?

Answer 1

Medical syndrome that is characterised by diminished strength, endurance and reduced physiological function that increases an individual’s vulnerability for developing increased dependency and/or death

Factors that increased risk of adverse outcomes such as death or institutionalisation

Question 2

What is sarcopenia?

Answer 2

Sarcopenia is loss of muscle mass.

Severe sarcopenia is associated with loss of muscle mass, reduced muscle strength and poor physical performance

Question 3

How can physical performance be assessed in elderly patients?

Answer 3

A timed walk test

Can do a 10m timed walk test. Time is measured for the middle 6m with 2m either side for acceleration or deceleration. Be sure to stay close to patients with poor balance in case of falls.

Question 4

What three features make up severe sarcopenia?

Answer 4

Reduced muscle mass
Poor physical performance
Reduced muscle strength

Question 5

How can muscle strength be tested in individuals who may have sarcopenia?

Answer 5

Hand grip strength

This uses a grip dynamometer

Question 6

How do sarcopenia and cachexia differ?

Answer 6

Both involve loss of muscle mass but cachexia is due to metabolic disturbance, such as with malignancy, with weight loss too.

Sarcopenia is loss of muscle mass that is age related.

Question 7

What are the features of pre-sarcopenia?

Answer 7

Reduced muscle mass

But not reduced physical performance or reduced muscle strength- if these were present it is severe sarcopenia

Question 8

How is frailty diagnosed?

Answer 8

Gold standard- Comprehensive Geriatric Assessment

Electronic frailty index- computer scoring system that is used by GPS, includes 36 different criteria

Edmonton Frail Scale- often used in surgical settings, short questionnaire with a quick assessment of physical function- Get up and Go test (GUG) and cognition assessment (drawing a clock)

Question 9

What is included in the Edmonton Frail scale?

Answer 9

Short questionnaire

Assessment of physical function- Get up and go test

Assessment of cognition- Clock drawing

Question 10

Where is the Edmonton Frail Scale often used?

Answer 10

In surgical settings

Question 11

What is the Timed Up and Go test?

Answer 11

This is a test of functional mobility and balance

Question 12

What does the timed up and go test involve?

Answer 12

Patient sitting in a chair, sitting comfortably and upright
When you’re ready stand up and walk three metres at a comfortable pace to a marker that is placed 3 m away (check this measurement)
When you reach it turn around, walk back at a comfortable pace and then sit down

Time as soon as you say go and then stop once their bottom hits the chair.

15 seconds or more suggests there is a risk of fall due to weakness/frailty. Requires further investigation/help. Less than 15 seconds is normal.

Be sure to walk with the patient, comfort them and say I am here if you feel unsteady. Ask them about their walking ability first.

Check patients understanding before they start by asking them to repeat it back to you.

Question 13

How long is abnormal of a timed up and go test?

Answer 13

15 seconds or more- this suggests there is an increased risk of falls.

Question 14

Describe the layout for the timed up and go test?

Answer 14

Chair
Marker placed three metres away
Stopwatch
Measuring tape

Question 15

What pace should people go at for a timed up and go test?

Answer 15

A comfortable and safe walking pace- don’t rush

Question 16

What is used to assess cognition in the Edmonton frail scale?

Answer 16

Clock drawing with time- 10 past eleven

Question 17

How is sarcopenia diagnosed?

Answer 17

First work out their physical performance by assessing their walking pace. Walk 10 m and time the middle 6 m (allows for time for acceleration/deceleration)

If less than 0/8m/s do a DEXA scan

If more than 0.8m/s test grip strength (reduced muscle strength is 1/3 for severe sarcopenia). If this is reduced do a DEXA scan.

Severe sarcopenia= Reduced muscle mass, reduced muscle strength (grip strength) and reduced physical performance

If DEXA gives low muscle mass they have sarcopenia

Question 18

What are some proven effective interventions for frailty and sarcopenia?

Answer 18

Comprehensive Geriatric Assessment
Exercise interventions- role of physiotherapists is really important
Nutrition- Include dietician, supplements that are high in protein or amino acids may help.

Question 19

What are the geriatric giants?

Answer 19

Immobility
Incontinence
Instability
Impaired memory or cognition

Question 20

If off legs a diagnosis?

Answer 20

Absolutely no

Its merely a symptoms and can be due to a number of causes.

Question 21

What are some causes of immobility?

Move down from head to toe with causes.

Answer 21

This list is absolutely huge, use a head to toe approach

Brain- Stroke (acute onset, other features), Intracranial Mass (Insidious onset of weakness), Parkinson’s, MS, Depression and anxiety (reduced drive to move), Subdural haematoma and other bleeds, Antipsychotics medications and other drugs

Eyes- Poor vision reducing confidence and not comfortable moving. Cataract, Macular degeneration, Diabetic eye disease, Hypertensive eye disease, Glaucoma

Chest- COPD, Heart Disease, Breathlessness, Lightheadedness (AS, LHF, AF), Syncope, Drugs- antiarrhythmics, beta blockers, antihypertensives

Abdomen-
Malignancy, GI bleeding, IDA, Malnourished, dehydration,

Hips and Lower Limb- Fractures (pain on weight bearing), osteoarthritis, RA other arthropathy

Spinal Cord- Claudication, Compression, spinal cord stroke

PNS- Motor neurone disease, GBS, Neuropathy, myasthenia gravis

Feet- Poor footwear, painful feet- ulcers, arterial, venous, cellulitis, poorly fitting footwear and trousers dragging, arthritis in the feet