FRAILTY
Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults.
Frailty is a condition associated with ageing, and it has been recognized for centuries.
Causes
Sarcopenia
Sarcopenia is the degenerative loss of skeletal muscle mass, quality, and strength associated with aging.
The rate of muscle loss is dependent on exercise level, co-morbidities, nutrition and other factors.
Sarcopenia can lead to reduction in functional status and cause significant disability from increased weakness.
Osteoporosis
Osteoporosis is an age-related disease of bone that leads to an increased risk of fracture.
In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered.
Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture.
Muscle weakness
Muscle weakness, also known as muscle fatigue, (or "lack of strength") refers to the inability to exert force with one's skeletal muscles.
Weakness often follows muscle atrophy and a decrease in activity, such as after a long bout of bedrest as a result of an illness.
There is also a gradual onset of muscle weakness as a result of sarcopenia – the age-related loss of skeletal muscle.
Mechanism
It has been suggested that the biological underpinnings of frailty are multifactorial, involving dysregulation across many physiological systems.
A proinflammatory state, sarcopenia, anemia, relative deficiencies in anabolic hormones (androgens and growth hormone and excess exposure to catabolic hormones (cortisol), insulin resistance,glucose levels,compromised altered immune function, micronutrient deficiencies and oxidative stress are each individually associated with a higher likelihood of frailty.
Diagnosis
The most widely used frailty scale consists of five items:
Unintentional weight loss >4.5 kg in the past year
Self-reported exhaustion
Less than 20th population percentile for grip strength
Slowed walking speed, defined as lowest population quartile on 4-minute walking test
Low physical activity such that persons would only rarely undertake a short walk
A healthy person scores 0; a very frail person scores 5.
Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes.
Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
Linda Fried / Johns Hopkins Frailty Criteria
A popular approach to the assessment of geriatric frailty encompasses the assessment of five dimensions that are hypothesized to reflect systems whose impaired regulation underlies the syndrome. These five dimensions are:
Unintentional weight loss,
Exhaustion,
Muscle weakness,
Slowness while walking, and
Low levels of activity.
Rockwood Frailty Index
Another notable approach to the assessment of geriatric frailty is Rockwood Frailty Index ,in which frailty is viewed in terms of the number of health "deficits" that are manifest in the individual, leading to a continuous measure of frailty. This approach was developed by Dr. Rockwood and colleagues at Dalhousie University.
Surgical outcomes
Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Frailty more than doubles the risk of morbidity and mortality from surgery and cardiovascular conditions.
Assessment of older patients before elective surgeries can accurately predict the patients' recovery outcomes
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