Frailty

Question 1

What is frailty - geriatric syndrome?

Answer 1

-Syndrome of physiological decline in later life
-Increased vulnerability to adverse health outcomes
-Less adaptable to stressors
-Increased r/f procedural complications, institutionalization, disability, death, falls, fractures, delirium , and incontinence
End-stage: FTT

Question 2

What are associated risk factors for frailty?

Answer 2

Older age, lower education level, current smoker, use of HRT, unmarried, depression, use of antidepressants, intellectual disability
Cultural: increased risk if hispanic or black in US

Question 3

Components of Frailty Trajectory

Answer 3

• Biologic function & homeostasis

- Physical function & independence

Question 4

Frailty

Differential Dx

Answer 4

• Depression
• Cancer
• Immune: polymyalgia rheumatic, vasculitis
• Endo: Thyroid dysregulation, DM
• CV: HTN, HF, CAD, PVD
• Renal insufficiency
• Myelodysplastic syndrome, IDA, Pernicious anemia, vitamin deficiency
• PDs, vascular dementia, lacunar infarcts

Question 5

What are the 4 cyclical compounding factors of frailty?

Answer 5

Chronic undernutrition
Sarcopenia
Decreased metabolic rate
Reduced energy expenditure

Question 6

What is sarcopenia?

Answer 6

Muscle loss with aging and decreased coordination

Question 7

Frailty

Physical Exam

Answer 7

• Ability to rise from chair 5 times without use of arms

- Ability to walk across room

Question 8

Frailty

Labs/Diagnostics

Answer 8

CBC, BMP, LFT, albumin, Vit B12, Vit D, TSH,

Question 9

Frailty

Screening Recommendations

Answer 9

• All persons >70yo
• Chronic disease dx
• > 5% TBW loss in 1yr

Question 10

Frailty

Screening Tools

Answer 10

• Frailty Index
• Physical Frailty Phenotype
• FRAIL
• Frailty Index-Comprehensive -Geriatric Assessment (FI-CGA)
• Clinical Frailty Scale

Question 11

Physical Frailty Phenotype

Answer 11

Positive if 3+/5 criteria

• Wt loss >5% in 1yr
• Exhaustion
• Weakness (decreased grip)
• Slowed gait (6-7seconds to walk 15ft)
• Decreased physical activity

Question 12

FRAIL

Screening tool

Answer 12

Score 3+ - frailty
Score 1-2 - pre-frailty
-Fatigue
-Resistance (climb one stair flight)
-Ambulation (walk 1 block)
-Illnesses (>5)
-Weight loss 5%

Question 13

Frailty

Management

Answer 13

• QOL, patient wishes
• Establish GOC
• Tailor interventions (exercise, nutrition, medications)
• Palliative care?

Question 14

Advance Care Planning

Life expectancy >1yr

Answer 14

Discuss
Identify barriers
Keep UTD

Question 15

Goals of Care (GOC) Discussion Components

Answer 15

• Understand illness/prognosis
• Decision-making, preferences
• Prognostic disclosure
• Patient goals
• Tradeoffs
• Family involvement

Question 16

Older Americans Act & Elder Justice Act

Answer 16

Federal legislation

Question 17

Elder Abuse

Answer 17

• mistreatment
• maltreatment
• financial exploitation