Frailty

Question 1

What is the Fried Frailty Phenotype

Answer 1

unintentional weight loss (>10lb or 5% body wt)
weakness (grip strength)*
slow gait speed*
low physical activity
self-reports exhaustion

*low = lowest 20% by sex and BMI

Question 2

4 evidence based treatment of frailty?

Answer 2

ICFSR 2019
– A comprehensive care plan for frailty should systematically address polypharmacy, the management of sarcopenia, treatable causes of weight loss, and the causes of fatigue (depression, anaemia, hypotension, hypothyroidism, and vitamin B12 deficiency)
– Multicomponent physical activity program (resistance, balance)
– Protein /caloric supplementation
– Oral health
– Social supports (address unmet needs and encourage adherence to the Comprehensive Management Plan)
– NOT vit D, cognitive or problem-solving therapy, hormone therapy

In hospital…
Medication review optimization
Multidisciplinary CGA

Question 3

Key words associated with each category of the CFS?

Answer 3

1. very fit
2. fit
3. managing well: medical problems are well controlled, not regularly active
4. very mild frailty: symptoms limit activities
5. mild frailty: slowing down, high iADLs affected
6. mod frailty: help with bathing, all outside activities, keeping house
7. severe frailty: dependent for all personal care, not dying
8. very severe frailty: approaching end of life, can’t recover from minor illness
9. approaching end of life <6m

Question 4

Frailty can be time-consuming to assess. What 2 quick physical performance measures are independently predictive of mortality?

Answer 4

o Gait speed <0.8m/s
o 6MWT
o SPPB
—
maybe…
o Grip strength
o Chair rise time (slowest quartile compared to fastest quartile)

*Think Fried Frailty Phenotype

Question 5

2 different models of frailty

Answer 5

Frailty phenotype = describes group of physical characteristics. Frailty is conceptualized categorically as robust (0), pre-frail (1-2) or frail (3-5)

Frailty index (deficit accumulation index) = counts deficits. Frailty is conceptualized as a continuous accumulation of these deficits.

Question 6

4 frailty scales

Answer 6

Fried Frailty Phenotype (0-5)
– pro: predicts mortality
– con: time consuming, certain patients excluded

Frailty Index (>= 0.25)
– pro: easy to understand
– con: impossible to use clinically

CFS
– pro: used clinically
– con: doesn’t distinguish cause of frailty

Edmonton Frail Scale
– pro: social support domain
– con: time consuming

Question 7

6 predisposing factors for frailty

Answer 7

1) Advanced age
2) Female sex
3) Low education
4) Low SES
5) Multiple comorbidities
6) Smoking

Question 8

Define “compression of morbidity”

Answer 8

Hypothesis put forth by James Fried stating that lifetime burden of illness could be reduced if the onset of chronic illness could be postponed (comorbid illnesses can be compressed into a short time period at the end of life), resulting in a longer period of health life expectancy

Question 9

What is the prevalence of physical frailty for adults >65?

Answer 9

15% (ICFSR 2019)