Frailty

Question 1

What is frailty

Answer 1

Condition characterised by loss of biological reserves and vulnerability to adverse outcomes

Question 2

How do simpl conditions affect frail people differently

Answer 2

For a given insult - more prfound deterioration and longer recovery than for a non frail person.eg falls, delirium, confusion - disproportional to insult. Accumulation of physiological systems not working.polypharmacy adds to it.

Question 3

What is the fragility index

Answer 3

Frailty Index score = Number of deficits in an individual/Total number of deficits measured

e.g. in a dataset with 50 health deficits, a person with 10 things wrong (10 deficits) has a frailty index score of 10/50 = 0.20.

Question 4

Why does frailty cccure

Answer 4

• Frailty is a multiply determined risk state manifest as not everyone of the same age having the same risk of death (or other adverse outcomes)
• It arises due to the stochasticity of age-related deficit accumulation across the life course
• People are frail when they have lots of things wrong with them
• What does this mean for treatment and care?

Question 5

What are non-specific presentations of frailty

Answer 5

• Falls, immobility, off legs, collapse ? cause
• Confusion (delirium and/or dementia)
• “Acopia” or “social admission” (phrases never to use!)
• Other diffuse or multiple statements related to disability

Question 6

What are the reasons behind non specific presentations

Answer 6

• Homeostatic failure
• Multiple pathology & polypharmacy
• Differential challenge

Question 7

Describe issues with homeostasis that can occur

Answer 7

• Balance, temperature, blood pressure, sodium, etc
• Biological systems usually robust: multiple feedback loops
• Failure either due to overwhelming single disease, or lesser disease with multiple co- morbidity

Question 8

What external factors can exacerbate Riley

Answer 8

Vulnerable homeostatic systems need protection from challenge…..but…
• Living alone • Poverty
• Poor housing • Ageism

Question 9

What should be done when a non specific presentation is found

Answer 9

• When found:
expect multiple pathology
look beyond the acute precipitant or consequence
• Medical intervention could be at the acute precipitant
at co-pathology • Rehabilitation

Question 10

What are implications orpractise in terms of frailty

Answer 10

• Use frailty to differentiate and prognosticate
• Tailor management accordingly
• Frailty complex, solutions will need to be complex… Comprehensive Geriatric Assessment