II. Definitions
- Frailty
- Physiologic decline with advancing age, with associated increased risk of adverse health outcomes
- Findings include slow gait, Unintentional Weight Loss, sedentary
- Sarcopenia
III. Pathophysiology
- Frailty is a Constellation of progressive physiologic decline inadequately compensated by physiologic reserve
IV. Risk Factors
- Older age
- Female gender (although frail men have higher mortality)
- Lower socioeconomic status and less well educated
- Tobacco Abuse and other unhealthy behaviors
- Social isolation
- Comorbidities
V. Symptoms
- Early
- Later
- Slow gait
- Decreased balance
- Decreased Physical Activity
- Decreased Motor Strength
- Cognitive Impairment
- Late
- Weight loss
VI. Diagnosis: Frailty (Three or more of the following criteria)
- Unintentional Weight Loss of at least 10 lb (4.5 kg) in the last year
- Self-reported exhaustion
- Weakness (decreased grip strength)
- Slow walking speed
- Low Physical Activity
VII. Differential Diagnosis
VIII. Grading: CSHA Clinical Frailty Scale
- Category 1: Very Fit
- Energetic, active and well motivated
- Exercises regularly and most fit for age
- Category 2: Well
- Less fit than category 1, but no active disease
- Category 3: Well with Treated Comorbidity
- Well controlled comorbidity
- Category 4: Apparently Vulnerable
- Disease limits patient by self report
- Not dependent on others
- Category 5: Mildly Frail
- Limited dependence on others for Instrumental Activities of Daily Living
- Category 6: Moderately Frail
- Assistance needed for Activities of Daily Living (including Instrumental Activities of Daily Living)
- Category 7: Severe Frailty
- Complete dependence on others for Activities of Daily Living
- Category 8: Very Severe Frailty
- Approaching end of life
- Even minor illness might be difficult to survive
- Category 9: Terminally Ill (end of life)
- Life Expectancy <6 months
- References
IX. Evaluation
-
Comprehensive Geriatric Assessment
- See Geriatric Assessment
- Multidimensional older adult evaluation (e.g. Polypharmacy, ADL Scale, Fall Risk, Hearing, Vision, mood, cognition)
- Frailty Assessment Tools
- Fried Frailty Phenotype Criteria
- Rockwood Frailty Index
X. Management
-
Exercise program
- See Exercise in the Elderly
- See Geriatric Balance Training
- See Geriatric Strength Training
- Offer multicomponent Physical Activity program (referral)
- Should include Progressive Resistance Training component
- Other measures
- Additional interventions based on Comprehensive Geriatric Assessment
- May consider social support services
- Consider geriatrician Consultation
- Consider Nutritional Supplementation (e.g. Protein Supplementation) esp. in Unintentional Weight Loss
XI. Complications
- Fall Risk
- Overall Disability requiring assistance for ADLs
- Polypharmacy
- Increased hospitalization rates
- Longterm Care admission (e.g. Nursing Home)
- Increased mortality
XII. Prognosis
- Frailty is dynamic and can be improved with interventions
- Positive prognostic factors (more likely to reduce Frailty)
- Women
- Better socioeconomic conditions