Lecture 20: Frailty Flashcards
Aging is NOT a
Disease
Aging process vs disease process examples
aging process: age associated atheroscelrosis, balance and vision changes (normal changes associated with aging)
disease process: anginal symptoms, heart attack, hip fracture
senescence
inevitable decline or rate of decline (after maturation) in systems, purely as a function of “usual” aging
Frailty
senescence can contribute to frailty but “unusal” aging and disease can contribute to frailty as well
frality is thought of as a
geriatric syndrome
-a health condition that occurs when the accumulated effects of impairments or, more broadly, deficits render an older adult vulnerable to situational challenges
frailty is distinct from
comorbidity; however, comorbidity is a risk factor for frailty
disability; however, frailty is a risk factor for disability
common definition of frailty
a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death
Frailty as a state
a clinical state in which there is an increase in an individual’s vulnerability for developing increased dependency and/or mortality when exposed to a stressor
-being a state we know that there will be transitions in and out of this state; non-frail, pre-frail, frail
physical frailty
impairments in strength, endurance, balance, and mobility that increases susceptibilty to falls, injury, and dependence on others
frailty is affected by social facotrs
- low income
- low education
- lack of family, church, or other social supports
persons with heart failure, cancer, renal failure, HIV, or diabetes as well as those undergoing surgery are more likely to be
frail and have more adverse outcomes than those who are not frail
adverse outcomes resulting from frailty
- falls
- injuries
- acute illnesses
- hospitilizations
- physical disability and dependence
- institutionalization and death
adverse outcomes to frailty chart
who needs to be screened for frailty
- health care providers should screen all older adults > 70 years of age for frailty
- a positive screen should result in instiuting a management for frailty plan
most common method to define frailty
as a phenotype (clinical presentation)
frailty as a phenotype - 5 criteria (the clinical presentation)
- slow gait speed
- low physical activity
- unintentional weight loss
- self-reported exhaustion
- muscle weakness
classification of frailty is based on the
of characteristics present
robust
no frailty components = not frail
pre-frail
1-2 frailty components; need intervention in a preventative form
frial (classsification)
- 3 or more components; interventions needed, but outcomes aren’t great
cardiovascular health study frailty screening scale
- weight loss - 10lbs or 5% unintentional within the past year
- exhaustion - self report or unusual tiredness in the last month
- low activity
- slowness
- weakness - hand grip
Simplified F.R.A.I.L assessment
Fatigue: are you fatigued?
Resistance: cannot walk up 1 flight of stairs?
Aerobic: cannot walk 1 block?
Illness: do you have more than 5 illnesses?
Loss of weight: have you lost more than 5% of your weight in the last 6 months?
3+ = frailty
1-2: pre-frail
frailty as an accumulation of deficits
- the more deficits the greater the liklihood the person is frail
- physical and non-physical defecits
- in a frality index (# of deficits present / # of possible deficits listed); closer to 1 = fraility
frailty treatment (multi-factorial & integrated)
- treat the weakness with exercise - resistance and aerobic
(FITT) - treat weight loss with caloric and protein support critical
- Vitamin D for those defecient
- reduction in polypharmacy
- treat depression, cognitive impairment, visual and hearing problems, diabetes, CHF
- manage reversible diseases
