What is frailty - geriatric syndrome?
-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
What are associated risk factors for frailty?
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
Components of Frailty Trajectory
- Biologic function & homeostasis
- Physical function & independence
Frailty
Differential Dx
- 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
What are the 4 cyclical compounding factors of frailty?
Chronic undernutrition
Sarcopenia
Decreased metabolic rate
Reduced energy expenditure
What is sarcopenia?
Muscle loss with aging and decreased coordination
Frailty
Physical Exam
- Ability to rise from chair 5 times without use of arms
- Ability to walk across room
Frailty
Labs/Diagnostics
CBC, BMP, LFT, albumin, Vit B12, Vit D, TSH,
Frailty
Screening Recommendations
- All persons >70yo
- Chronic disease dx
- > 5% TBW loss in 1yr
Frailty
Screening Tools
- Frailty Index
- Physical Frailty Phenotype
- FRAIL
- Frailty Index-Comprehensive -Geriatric Assessment (FI-CGA)
- Clinical Frailty Scale
Physical Frailty Phenotype
Positive if 3+/5 criteria
- Wt loss >5% in 1yr
- Exhaustion
- Weakness (decreased grip)
- Slowed gait (6-7seconds to walk 15ft)
- Decreased physical activity
FRAIL
Screening tool
Score 3+ - frailty Score 1-2 - pre-frailty -Fatigue -Resistance (climb one stair flight) -Ambulation (walk 1 block) -Illnesses (>5) -Weight loss 5%
Frailty
Management
- QOL, patient wishes
- Establish GOC
- Tailor interventions (exercise, nutrition, medications)
- Palliative care?
Advance Care Planning
Life expectancy >1yr
Discuss
Identify barriers
Keep UTD
Goals of Care (GOC) Discussion Components
- Understand illness/prognosis
- Decision-making, preferences
- Prognostic disclosure
- Patient goals
- Tradeoffs
- Family involvement
Older Americans Act & Elder Justice Act
Federal legislation
Elder Abuse
- mistreatment
- maltreatment
- financial exploitation
