aging and frailty

Question 1

sarcopenia vs frailty

Answer 1

• sarcopenia: skeletal muscle loss, poor muscle quality
• frailty: deficits accumulation, fatigue, sedentary behavior, weight loss, cognitive impairment, social isolation

Question 2

frailty

Answer 2

• decreased reserve and resistance to stressors, that result in cumulative declines across multiple physiologic systems, causing heightened vulnerability to adverse outcomes
• multiple components

Question 3

frailty predicts

Answer 3

• falls, ED visits and hospitalization and readmission, entry into residential care, survival

Question 4

functional status

Answer 4

• single best predictor of institutionalization is imapired functional status
• self-reported function is an accurate predictor of health risks and costs
• 23% of older adults report some functional limitation in either ADLs or IADLs much higher percentage for the older segments

Question 5

ADLs vs iADLs

Answer 5

• ADL: bathing, dressing, transferring, toileting, grooming, feeding, mobility
• iADLs: telephone, meal prep, mangaing finances, taking medications, doing laundry, shopping, managing transportation

Question 6

fred’s frailty phenotype components

Answer 6

• shrinking: > 10 pounds lost unintentionally in past year
• self-reported exhaustion: self-report of exhaustion on CES-D (center for epidemiologic studies - depression) questions
• weakness (grip strength): grip strength lowest 20% adjsuted for gender and BMI
• slow walking speed: slowest 20% to walk 15 feet
• low physical activity: lowest quintile of weighted kilocalorie expended per week

frailty - deficits in =/> 3

Question 7

fred’s frailty phenotype components

Answer 7

• shrinking: > 10 pounds lost unintentionally in past year
• self-reported exhaustion: self-report of exhaustion on CES-D (center for epidemiologic studies - depression) questions
• weakness (grip strength): grip strength lowest 20% adjsuted for gender and BMI
• slow walking speed: slowest 20% to walk 15 feet
• low physical activity: lowest quintile of weighted kilocalorie expended per week

frailty - deficits in =/> 3

Question 8

why use grip strength for frailty

Answer 8

• correlated with overall body strength
• can use for goals
• cutoffs by gender and BMI

Question 9

why does gait speed predict survival

Answer 9

• requires integration of a lot of systems: brain function, strength, motor control, motor plan

Question 10

clinical frailty scale

Answer 10

• easier than fried’s phenotype

Question 11

sarcopenia

Answer 11

• degenerative loss (atrophy) of skeletal muscle mass (0.5-1% loss per year after the age of 25) - loss of muscle quality and loss of strength associated with aging
• imbalance between protein synthesis and degradation rates
• sarcopenia is a component of the frailty syndrome
• still unknown whether sarcopenia is inevitable result of aging or due to combo of factors
• decreased force production with decrease muscle quality/attenuation

Question 12

frailty intervention trial (FIT)

Answer 12

• aim to identify frail older people and address frailty signs and symptoms
• FIT: community dwelling > 70 yrs, assessed using Fried’s criteria, RCT assessed frail with intervention

Question 13

aerobic capacity (on average) drops about [ ] in adults 50-70 years old

Answer 13

• 1.5%
• loss of aerobic capacity (12.2%) after 10 days of bed rest was equivalent to almost a decade of decline

Question 14

older people who develop new functional deficits during hospitalization are

Answer 14

• older people who develop deficits during hospitalization are less likely to recover lost function

Question 15

[ ] is the leading complication of hospitalization for the elderly

Answer 15

• functional decline
• occurs in 34-50% of hospitalized older adults
• leads to previously independent patients requiring post-acute care (SNF, IRF, LTACH, home care)

Question 16

detraining

Answer 16

• don’t have to be completely “sedentary” - simple decline in usual activity

Question 17

CV adaptations with deconditioning and bedrest

Answer 17

• decreased CO, decreased SV
• increased HR (limits HR reserve)
• decreased plasma volume
• increased blood viscosity
• orthostatic hypotension
• VTE (DVT and PE)

reduced CV reserve (decreased aerobic capacity)

Question 18

neurologic adaptations with bedrest

Answer 18

• decreased parasympathetic activity
• increased sympathetic activity
• loss of baroreceptor sensitivity
• increase in postural sway (body oscillation amplitude and frequency) after prolonged bed rest
• decreased balance and coordination - altered motor control
• risk of peripheral nerve compression

contribute to orthostatic intolerance, fall risk, cognitive changes

Question 19

3 orthostatic syndromes

Answer 19

• orthostatic hypertension: BP down, HR up - gradual, sustained (get fluids)
• postural tachycardia (POTS): BP steady, HR up
• reflex syncope (vasovagal): BP and HP down - get medical management

Question 20

orthostatic vital signs exam

Answer 20

1. patient supine 5-10 minutes
2. BP and HR measured at 1 and 3 minutes after standing - symptoms like dizziness and syncope are sensitive indicators of volume loss
3. decrease in SBP of > 20 mmHg or DBP > 10 mmHgor increase in HR > 20 BPM

Question 21

pulmonary changes after deconditioning and bed rest

Answer 21

• in supine, decreased ribcage movement and lung volume - breathe more frequently
• atelectasis: collapse or closure of lung regions (alveoli) - gas exchange declines
• diaphragm moves cephalad in supine - decrease thoracic volume, tidal volume decrease
• forced expiratory flow decreases - decreased cough effectiveness

result in atelectasis and oxygen desat -> pneumonia

Question 22

bone changes with bedrest

Answer 22

• decreased bone mineral density (BMD) - especially weight bearing bones (calcaneus)
• increase serum Ca2+ (hypercalcemia)
• increase fracture risk

Question 23

muscle changes with deconditioning and bed rest

Answer 23

• T2A transitions to T2B
• decrease force and power > decrease CSA (muscle atrophy)
• T1 (slow/anaerobic) -> T2 (fast/aerobic)
• reduced muscle strength, particularly in postural and proximal muscle groups
• shortening of muscle and of connective tissue around joints -> contracture

Question 24

immobilization decreases strength by [ ]
stength can decrease as much as [ ]

Answer 24

• immobilization decreases strength by 1.0-1.5%/day
• strength can decrease as much as 20-30% during only a week to nine days of bed rest

Question 25

integumentary changs with deconditioning and bed rest

Answer 25

• a pressure ulcer or decubitus ulcer is the consequence of ischemia and anoxia to tissue
• tissues are compressed, BVs are compressed and blood flow is diverted by continual pressure on the skin and underlying structures
• cellular respiration is impaired and cells die

Question 26

other complications of bed rest

Answer 26

• renal: bone demineralization and hypercalcemia may lead to kidney/urinary tract stone formation
• gastrointestinal: decreased GI motility/increased constipation
• psychiatric: altered MS - anxiety, depression, delirium

Question 27

prevention of unnecessary bed rest

Answer 27

• prevention is key

Question 28

early mobilization in community acquired pneumonia

Answer 28

• hospital LOS significantly less in early mobilization (EM) group
• 5.8 vs 6.9 days 0 adjusted difference 1.1 days
• so people should be as mobile as possible