Physiologic changes with aging: muscle and bone
- decreased lean body mass
- decreased muscular mass
- decreased skeletal mass
- increased % of adipose tissue
- decreased bone mass
- increased fx risk
Physiologic changes with aging: eyes
- increased glare in eyes
- difficulty adjusting to changes in lighting
- decreased visual acuity
Physiologic changes with aging: heart
- decreased HR and HRmax
- blunted baroreflex
- decreased diastolic relaxation
- increased atrioventricular conduction time
- increased atrial and ventricular ectopy
Physiologic changes with aging: liver
- changes in drug levels (meds)
- decreased activity of enzyme breakdown
Physiologic changes with aging: nose
- decreased taste and smell
- decreased appetite
Physiologic changes with aging: peripheral nervous system
- increased tendency toward syncope
- increased response to beta blockers
Physiologic changes with aging: pulmonary system
- decreased vital capacity
- decreased lung elasticity
- increased residual volume
- increased presence of SOB
- increase risk of pneumonia
- increased complications in pts with lung problems
Physiologic changes with aging: vasculature
- increased peripheral resistance
- tendency toward hypertension
Frailty defined: Row and Kahn
- low probability of disease and disability
- high cognitive and physical/functional capacity
- active engagement with life
Frailty defined: the 90s
- biologic syndrome of decreased reserve and resistance to stressors
- cumulative declines across the lifespan
- not just a disability or comorbidities
Frailty defined: Fried
- cardiovascular health study in 2001
- geriatric syndrome with a distinct phenotype
Frailty defined: Ken Rockwood
- multidimensional syndrome of loss of reserves that give risk to vulnerability
- deficits are not uniform
- came up with clinical frailty scale that is based on judgement from doing exam
What is frailty?
- reduction in physiological reserve
- loss of biological reserve
- vulnerability to physiological decompensation
- wear and tear
- multisystem dysregulation
- loss of reserves (energy, physical health, cognition)
Frailty phenotype
- unintentional weight loss
- self reported exhaustion
- low energy expenditure
- slow gait speed
- weak grip strength
FRAIL >3
PRE FRAIL 1-2
NOT FRAIL 0
The frail scale (5 Qs)
- Fatigue: How much time during the previous 4 weeks did you feel tired?
- Resistance: Do you have any difficulty walking up 10 steps line without resting and without aids?
- Ambulation: Do you have difficulty walking several hundred meters aline without aids?
- Illness: How many illnesses do you have out of a list of 11?
- Loss of weight: Have you had weight loss of 5% or more?
Clinical frailty scale (Rockwood): score 1
very fit
People who are robust, active, energetic, and motivated. They tend to exercise regularly and are among the fittest for their age.
Clinical frailty scale (Rockwood): score 2
fit
People who have no active disease symptoms but are less fit than category 1. Often, they exercise or are very active occasionally
Clinical frailty scale (Rockwood): score 3
managing well
People whose medical problems are well controlled, even if occasionally symptomatic, but often are not regularly active beyond routine walking.
Clinical frailty scale (Rockwood): score 4
living with very mild frailty
Previously “vulnerable”, this category marks early transition from complete independence. While not dependent on others for daily help, often symptoms limit activities. A common complaint is being “slowed up” and/or being tired during the day.
Clinical frailty scale (Rockwood): score 5
living with mild frailty
People who often have more evident slowing, and need help with high order IADLs (finances, heavy housework). Typically, mild frailty progressively impairs shopping and walking outside alone, meal prep, medications, and begins to restrict light housework.
Clinical frailty scale (Rockwood): score 6
living with moderate frailty
People who need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing.
Clinical frailty scale (Rockwood): score 7
living with severe frailty
Completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not a high risk of dying (within 6 months)
Clinical frailty scale (Rockwood): score 8
living with very severe frailty
Completely dependent for personal care and approaching end of life. Typically, they could not recover even from a minor illness.
Clinical frailty scale (Rockwood): score 9
terminally ill
Approaching the end of life. This category applies to people with a life expectancy <6 months who are not otherwise living with severe frailty. (Many terminally ill people can still exercise until very close to death.)
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Foundations of Geriatrics25
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Theories of Aging23
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Eugeric and Psychosocial Changes of Aging61
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Cardiovascular Exercise Considerations for the Older Adult17
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Musculoskeletal Exercise Considerations for the Older Adult45
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Age Related Changes in Gait and Mobility30
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Frailty30
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Pharmacology and the Geriatric Client54
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Nutritional Considerations for the Elderly31
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Wellness for Older Adults26
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Facilitating Intentional Aging42
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Elder Learning17
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Non-Pharmacologic Pain Management36
