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What does the phenotype of frailty develop as a consequence of?

Decline in several physiological systems which collectively results in a vulnerability to sudden health state changes triggered by relatively minor stressor events


What is fundamental to the development of frailty?

Age-related changes to multiple physiological systems (especially neuromuscular, neuroendocrine, and immunological)


What interacts cumulatively and detrimentally resulting in a decline in physiological function an reserve?

Age-related changes


What happens when a cumulative threshold of changes is reached?

The ability of an individual to resist minor stressors and maintain physiological homeostasis is compromised


What can the loss of functional homeostatic reserve at the level of individual physiological systems ultimately do?

Adversely affect the whole person


What can be done on the basis of the resulting frailty phenotype?

Identify older people who are frail


What are frail people predisposed to?

Adverse health consequences (falls and delirium) following relatively minor stressor events


What is included in the frailty phenotype?

1. Sarcopenia: Loss of muscle mass and strength
2. Anorexia
3. Osteoporosis
4. Fatigue
5. Risk of falls
6. Poor physical health


What does the addition of a minor stressor event to a frail older person with impairment of balance or cognition explain?

The clinical syndromes of falls and delirium (respectively), as common consequences of frailty


Why do healthcare systems struggle to cope adequately with the common presentations of ill health in older people who are frail?

Mainly because their healthcare states change suddenly and unpredictable


What has been demonstrated to optimize outcomes for older people with frailty?

Comprehensive geriatric assessment


What is the frailty cycle or spiral?

Increasing frailty gives rise to increased risk of further decline towards disability and greater frailty (look at figure)


What can happen to a person who is functionally independent, but through the combined processes of aging, chronic diseases, and deconditioning is super close to a theoretical line of decompensation?

A small additional deterioration caused by a minor stressor event (usually a urinary infection, new medication prescription, ect.) results in a sudden and disproportionately severe heath state change from one of independence to one of dependence


What is a key component of frailty?



What is sarcopenia?

Progressive loss of skeletal muscle mass and strength


When can the syndrome of sarcopenia result?

When there is loss of physiological reserve in the neuromuscular system


What is proposed to contribute to the development of sarcopenia?

A complex relationship between muscle fiber loss, muscle fiber atrophy and multiple contributory factors (nutritional, hormonal, metabolic, immunological)


What % of loss in muscle strength per year has been reported in older people via observational studies?


-Even higher in the oldest old


What can the development of sarcopenia adversly affect?

The ability of an older person to remain functionally independent


What is required for the critical basic mobility skills of getting out of bed, standing up from a chair, walking a short distance, and getting off of the toilet?

Muscle strenth


What happens when the ability to perform critical skills is impaired?

An older person is at risk of becoming dependent for care needs


What are the 5 indicators of frailty according to the Fried model?

1. Weight loss
2. Exhaustion
3. Low energy expenditure
4. Slowness
5. Weakness


What is the measure for weight loss?

Self reported weight loss of 4.5 kg or recorded weight loss of over 5% per year


What is the measure for exhaustion?

Self-reported exhaustion on a CES-D scale (3-4 days per week or most of the time)


What is the measure for low energy expenditure?

Under 383Kcal/week in a man or under 270Kcal/week in a woman


What is the measure for slowness?

Standarized cut-off times to walk 15 feet, stratified for sex and height


What is the measure for weakness?

Grip strength, stratified by sex and BMI


What happens when the identified 5 key components are present in combination?

They have the potential to interact and cause a "critical mass" that compromises the frailty syndrome


Are the individual items in the Fried model of frailty identifiable to clinicians?



What is the precise and objective measurement of the 5 domains appropriate to?

Research studies... too complex for routine clinical care