Frailty
Frailty

Frailty

Frailty refers to the distinctive state relating the ageing process in which multiple body systems lose their in-built reserves. It is important to distinguish between frailty and disability. Many people with disability do not have frailty, and frailty may be the cause of disabilities in others.

Pathophysiology

There are innumerable things that can cause frailty, however, we can very simply break it down into 3 things:

  1. Disability
  2. Co-morbidities
  3. Advancing age - however, it is important to remember that one can be young and frail too.
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Frailty can then lead to further illness and ultimately be the cause of death.

😷 Presentation

One is considered to have the frailty phenotype if they have >3 or more of the following:

  1. Sarcopenia and reduced muscle strength
  2. Unintentional weight loss
  3. Self-reported exhaustion
  4. Reduced gait speed
  5. Low levels of physical activity

🔢 Classification

We can use the Clinical Frailty Scale to classify patients on the scale which ranges from very fit to terminally ill:

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🔍 Investigations

Clinical assessment is usually sufficient to deem someone frail.

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Physiological markers:

Elevated inflammatory markers (CRP) ⬆️

Elevated insulin and glucose levels in fasting state ⬆️

Raised D-dimer ⬆️

Low vitamin D ⬇️

Low albumin ⬇️

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Other assessments
  1. Electronic frailty index
  2. PRISMA 7 Questionnaire - 7 item questionnaire and can aid identification of the frailty. A score >3 is positive.
  3. TUGT (Timed up and go test) - measures time taken to stand up from a chair and walk 3 metres, turn back and walk to the chair and sit down again.
  4. Gait speed

🧰 Management

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Managing frailty

Comprehensive Geriatric Assessment (CGA) - is the gold standard for managing frailty in the community. It involves 4 components:

  1. Physical assessment
  2. Functional, social and environmental assessment
  3. Psychological components
  4. Medication review
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Medications to consider:
  • Antimuscarinics - can cause cognitive impairment, constipation, urinary retention, blurred vision → making the patient more dependent.
  • BDZs, sulphonylureas, sedatives, hypnotics - increase risk of falls.
  • Opioids - cause confusion, delirium, constipation.
  • NSAIDs - may cause severe renal impairment in frail patients.

It is also important to try and prevent frailty, through physical activity, protein supplementation, vitamin D supplementation, reducing polypharmacy.

🚨 Complications

  • Falls
  • Immobility
  • Delirium
  • Incontinence
  • Susceptibility to side effects of medications