Exam

Frailty

search

Frailty, Sarcopenia

  • Definitions
  1. Frailty
    1. Physiologic decline with advancing age, with associated increased risk of adverse health outcomes
    2. Findings include slow gait, Unintentional Weight Loss, sedentary
  2. Sarcopenia
    1. Catabolic age-related loss of Muscle mass and strength
    2. Findings include reduced grip strength, gait speed and Muscle mass
  • Pathophysiology
  1. Frailty is a Constellation of progressive physiologic decline inadequately compensated by physiologic reserve
  • Risk Factors
  1. Older age
  2. Female gender (although frail men have higher mortality)
  3. Lower socioeconomic status and less well educated
  4. Tobacco Abuse and other unhealthy behaviors
  5. Social isolation
  6. Comorbidities
    1. Diabetes Mellitus
    2. Respiratory disease (e.g. COPD)
    3. Cerebrovascular Accident
    4. Dementia
    5. Multiple Sclerosis
    6. Connective Tissue Disease
    7. Osteoarthritis
    8. Chronic Fatigue Syndrome
  • Symptoms
  1. Early
    1. Generalized weakness
    2. Fatigue or exhaustion
  2. Later
    1. Slow gait
    2. Decreased balance
    3. Decreased Physical Activity
    4. Decreased Motor Strength
    5. Cognitive Impairment
  3. Late
    1. Weight loss
  • Diagnosis
  • Frailty (Three or more of the following criteria)
  1. Unintentional Weight Loss of at least 10 lb (4.5 kg) in the last year
  2. Self-reported exhaustion
  3. Weakness (decreased grip strength)
  4. Slow walking speed
  5. Low Physical Activity
  • Differential Diagnosis
  1. See Unintentional Weight Loss (Geriatric Failure to Thrive) and Unintentional Weight Loss Causes
  2. See Generalized Muscle Weakness and Muscle Weakness Causes
  3. See Fatigue and Fatigue Causes
  4. Major Depression
  5. Anemia
  6. Hypotension
  7. Hypothyroidism
  8. Vitamin B12 Deficiency
  • Grading
  • CSHA Clinical Frailty Scale
  1. Category 1: Very Fit
    1. Energetic, active and well motivated
    2. Exercises regularly and most fit for age
  2. Category 2: Well
    1. Less fit than category 1, but no active disease
  3. Category 3: Well with Treated Comorbidity
    1. Well controlled comorbidity
  4. Category 4: Apparently Vulnerable
    1. Disease limits patient by self report
    2. Not dependent on others
  5. Category 5: Mildly Frail
    1. Limited dependence on others for Instrumental Activities of Daily Living
  6. Category 6: Moderately Frail
    1. Assistance needed for Activities of Daily Living (including Instrumental Activities of Daily Living)
  7. Category 7: Severe Frailty
    1. Complete dependence on others for Activities of Daily Living
  8. Category 8: Very Severe Frailty
    1. Approaching end of life
    2. Even minor illness might be difficult to survive
  9. Category 9: Terminally Ill (end of life)
    1. Life Expectancy <6 months
  10. References
    1. Rockwood (2005) CMAJ 173(5): 489-95 [PubMed]
    2. Dalhousie University
      1. https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html
  • Evaluation
  1. Comprehensive Geriatric Assessment
    1. See Geriatric Assessment
    2. Multidimensional older adult evaluation (e.g. Polypharmacy, ADL Scale, Fall Risk, Hearing, Vision, mood, cognition)
  2. Frailty Assessment Tools
    1. Fried Frailty Phenotype Criteria
    2. Rockwood Frailty Index
  • Management
  1. Exercise program
    1. See Exercise in the Elderly
    2. See Geriatric Balance Training
    3. See Geriatric Strength Training
    4. Offer multicomponent Physical Activity program (referral)
      1. Should include Progressive Resistance Training component
  2. Other measures
    1. Additional interventions based on Comprehensive Geriatric Assessment
    2. May consider social support services
    3. Consider geriatrician Consultation
    4. Consider Nutritional Supplementation (e.g. Protein Supplementation) esp. in Unintentional Weight Loss
  • Complications
  1. Fall Risk
  2. Overall Disability requiring assistance for ADLs
  3. Polypharmacy
  4. Increased hospitalization rates
  5. Longterm Care admission (e.g. Nursing Home)
  6. Increased mortality
  • Prognosis
  1. Frailty is dynamic and can be improved with interventions
  2. Positive prognostic factors (more likely to reduce Frailty)
    1. Women
    2. Better socioeconomic conditions
  • References
  1. Allison (2021) Am Fam Physician 103(4): 219-26 [PubMed]
  2. Chodzko-Zajko (2009) Med Sci Sports Exerc 41(7): 1510-30 [PubMed]
  3. Fried (2001) J Gerontol A Biol Sci Med Sci 56(3): M146-56 +PMID:11253156 [PubMed]
  4. Ng (2015) Am J Med 128(11): 1225-36 [PubMed]