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Older Adult Exam 1 > Frailty > Flashcards

Frailty Flashcards

1
Q

what is the frailty perspective?

A
  • holistic perspective that shifts focus to a goal-directed approach
  • must be considered when PCPs consider invasive procedures/harmful meds/high risk interventions
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2
Q

what do we mean by multi-morbidity?

A

> 3 chronic conditions

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3
Q

what makes something considered a geriatric syndrome?

A

syndromes associated with

  • older age
  • cognitive/functional impairment
  • impaired mobility

highly prevalent, especially in frail elderly

chief complaint doesn’t represent specific pathological condition

cross organ systems and disipline-based boundaries

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4
Q

what are some examples or geriatric syndromes?

A
  • incontinence
  • falls
  • pressure ulcers
  • delirium
  • functional decline
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5
Q

what poor outcomes come from geriatric syndromes and frailty?

A
  • disability dependence
  • nursing home
  • death
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6
Q

in what populations is frailty more prevalent?

A
  • women > men
  • older age groups: 25-50% people over 85 estimated to be frail
  • southern european, hispanic, african american
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7
Q

for what poor outcomes are the frail at risk?

A

increased vulnerability to stressors and poor health outcomes:

  • acute illness
  • procedural complications
  • falls
  • institutionalization
  • disability
  • death
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8
Q

how do we define frailty?

A
  • a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems
  • further insult will result in: high potential for disability and disproportionate change in health status
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9
Q

what issues are there with defining frailty?

A
  • multiple factors influence functional status and physiologic reserve
  • age, multi-morbidity, and disability associated with frailty but do not establish the definition
  • frailty transitions common
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10
Q

what are the 3 states of frailty?

A
  • not-frail (robust)
  • pre-frail
  • frail
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11
Q

is frailty irreversible?

A
  • no
  • not an inevitable trajectory to death
  • continuum not necessarily linear
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12
Q

what is the pathophysiology of frailty?

A
  • cumulative, physiologic dysfunction that reaches an aggregate, critical level
  • underlying genetic and environmental factors likely play a role
  • physical activity and nutritional factors may be mediators
  • disorder of several interrelated systems, including brain, endocrine, immune, and skeletal muscle
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13
Q

what is the key contributor to frailty?

A

sarcopenia

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14
Q

what is sarcopenia?

A

progressive, age-related loss of skeletal muscle mass, strength, and power

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15
Q

what are some other physiologic changes that contribute to frailty?

A
  • deficiency in sex steroids, i.e. decreased estrogen in women and testosterone in men
  • insulin resistance
  • decrease in vitamin D
  • increase in cortisol
  • decreased growth factor
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16
Q

what 5 variables present in frailty?

A
  • unintentional weight loss
  • self-reported exhaustion
  • low energy expenditure
  • slow gait speed
  • weak grip strength
17
Q

how do you use these variables to determine position along the frailty spectrum?

A
  • 3/5 variables = frail
  • 2/5 variables = pre-frail
  • no variables = robust/not-frail
18
Q

what does the cumulative deficit model of frailty state?

A

cumulative effect of individual deficits

19
Q

how is the frailty index used in practice?

A
  • used in research for predicting outcomes in older patients undergoing surgery, predicting QOL and disability in older patients with CAD
  • strongly related to risk of death, risk of institutionalization
20
Q

how is the frailty index scored? what are the 5 domains on which the index is scored?

A

score 0 or 1 for each of 5 domains:

  • weight loss (> 10 lbs unintentional in past year)
  • weakness (measured w/ hand ergometer)
  • low physical activity
  • exhaustion
  • slow walking speed (pt walks 15 feet and is timed)

takes about 10 min to administer

score 4-5 = frail
score 2-3 = intermediately frail

21
Q

who should we screen for frailty?

A
  • > age 70 with chronic illnesses OR

- those w/ weight loss > 5% in a year

22
Q

what is the clinical presentation of someone who is frail?

A
  • non-specific: extreme fatigue, unexplained weight loss, frequent infections
  • falls
  • delirium: independent associate with poor outcomes
  • fluctuating disability: “good” and “bad” days of independence
23
Q

how do you score the FRAIL scale?

A 
F = fatigue
R = resistance (can you climb 1 flight of stairs?)
A = aerobic (can you walk 1 block?)
I = illness (5 or more)
L = loss of weight (> 5% in 6 months)

2 or more positive = frail
approx 30 sec to administer

24
Q

what are some reversible conditions that can contribute to frailty?

A
  • hypothyroidism
  • vitamin D deficiency
  • anemia
25
Q

what are some lab tests to consider to rule out reversible causes of frailty?

A
  • CBC
  • CMP
  • TSH
  • vitamin D
  • vitamin B12?
  • testosterone?
26
Q

what are some d/dx for frailty?

A
  • depression
  • malignancy
  • rheumatologic disease
  • endocrine disease
  • CV disease
  • renal disease
  • nutritional deficit
  • neurologic disease
27
Q

what are some interventions for frailty?

A
  1. exercise
  2. CGA/geriatrics-focused interprofessional care
  3. nutritional interventions
  4. pharmacologic therapies
28
Q

how does exercise help tx/prevent frailty?

A
  • physiologic effects on brain, endocrine, immune, and skeletal systems
  • can improve mobility and function; unsure of most effective intensity/duration
29
Q

how does exercise effect those who are very frail?

A
  • may receive smallest benefit

- may benefit most from strength/balance training and in turn, improvements in function

30
Q

how does CGA/geriatrics help tx/prevent frailty and what services does this entail?

A
  • ACE unit, PACE, conprehensive geriatric team
  • focus on complex mgmt of multi-morbidity
  • resource intensive
31
Q

how do nutritional interventions help tx/prevent frailty?

A
  • +/- evidence for supplements

- consider for addressing weight loss associated w/ frailty

32
Q

which pharmacologic therapies may help tx/prevent frailty?

A
  • ACE-I possibly help
  • testosterone: weight benefits/burdens
  • vitamin D: +/-

Older Adult Exam 1 (7 decks)

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