Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Frailty

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Frailty is a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death’.

Frailty Phenotype Template

Frailty Phenotype Template
Frailty Phenotype Template
Frailty Phenotype Template

384 KB

Frailty Phenotype

Assessment of presence of frailty

5 min.

Edmonton Frailty Scale

Edmonton Frail Scae
Edmonton Frail Scae
Edmonton Frail Scae

84 KB

Edmonton Frail Scale

Assessment of severity frailty

20 min.

Rockwood Clinical Frailty Scale

Rockwood Clinical Frailty Scal
Rockwood Clinical Frailty Scal
Rockwood Clinical Frailty Scal

250 KB

Rockwood Clinical Frailty Scale

Frailty evaluation tool

5 min.

Gait Speed Test

Gait Speed Test
Gait Speed Test
Gait Speed Test

98 KB

Gait Speed test

Frailty evaluation tool

5 min.

PRISMA-7

PRISMA-7
PRISMA-7
PRISMA-7

52 KB

PRISMA7

Frailty evaluation tool

5 min.

DEFINITION


‘A medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death’ (Morley JE, 2013).

 

Frailty is discrete from disease and disability and it may be reversible (Rodríguez-Mañas L, 2013)

 

The integration of frailty measures in clinical practice is crucial for the development of interventions against age-related conditions (in particular, disability) in older persons (Subra J, 2012) .

 

Multiple instruments have been developed over the last years in order to capture this geriatric ‘multidimensional syndrome characterized by decreased reserve and diminished resistance to stressors’ and render it objectively measurable (Rodríguez-Mañas L, 2013).

RISK FACTORS

 

Epidemiologic research to date have led to the identification of a number of risk factors for frailty, including:

 

(a) chronic diseases, such as cardiovascular disease, diabetes, chronic kidney disease, depression, and cognitive impairment (Fried LP, 2004).

 

(b) physiologic impairments, such as activation of inflammation and coagulation systems (Walston J, 2002), anemia (Roy CN, 2011), atherosclerosis(Chaves PH, 2008), autonomic dysfunction (Varadhan R, 2009), hormonal abnormalities (Cappola AR, 2009), obesity (Blaum, CS 2005),  hypovitaminosis D in men (Shardell M, 2009), and environment-related factors such as life space and neighbourhood characteristics (Xue QL,2008).

Possible warning signs :

-  Low levels of activity

-  Exhaustion
-  Unintentional weight loss

-  Atypical mood swings

BIOLOGICAL BASIS


The biological underpinnings of frailty are multifactorial, involving dysregulation across many physiological systems (Fried LP, 2009).

 

A proinflammatory state (Walston J, 2002), sarcopenia (Ferrucci L, 2002), anemia (Chaves PH, 2005), relative deficiencies in anabolic hormones (androgens and growth hormone) (Cappola AR, 2009), excess exposure to catabolic hormones (cortisol) (Varadhan R), insulin resistance (Barzilay JI, 2007), compromised altered immune function (Yao X, 2011), micronutrient deficiencies and oxidative stress (Semba RD, 2007), are each individually associated with a higher likelihood of frailty.

 

The risk of frailty increases with the number of dysregulated physiological systems in a nonlinear pattern, independent of chronic diseases and chronologic age, suggesting synergistic effects of individual abnormalities that on their own may be relatively mild (Fried LP, 2009).

The clinical implication of this is that interventions that affect multiple systems may yield greater, synergistic benefits in prevention and treatment of frailty than interventions that affect only one system.

Red Flags :

-  Slowness when walkibg

-  Sarcopenia

-  New onset depression

-  Five or more chronic medications

FRAILTY PHENOTYPE and FRAILTY INDEX

 

Two main theoretical constructs have come to dominate the conversation.
 

Fried et al.'s phenotypic model defines a constellation of five possible components (weight loss, exhaustion, weakness, slowness and reduced physical activity), which indicate an underlying physiological state of multisystem dysregulation (Fried LP, 2004)

Read More about Frailty Phenotype
Read More about Frailty Phenotype
Read More about Frailty Phenotype

Read more about Frailty Phenotype

Rockwood and Mitnitski's accumulation of deficits model, which counts the number of impairments and conditions in an individual patient to create a Frailty Index (Rockwood K, 2011).

Read More about Frailty IndexEOL Care
Read More about Frailty IndexEOL Care
Read More about Frailty IndexEOL Care

Read more about Frailty Index

It is inappropriate to consider the frailty phenotype and the Frailty Index as alternatives and/or substitutable. These two instruments are different and should rather be considered as complementary (Cesari M, 2014)

Other tools which are useful for routine screening and evaluation of frailty  are :

  • Rockwood Clinical Frailty Scale

  • Gait Speed Test

  • Prisma-7

Young at heart

Tips about diet, excercise, sleep, staying connected, and maintaining a healthy mind as we grow older.

A practical guide to healthy ageing (UK)

The advice in this booklet will help improve the health and general fitness of people of any age, but it is written to be particularly relevant for people who are about 70 years or older.

A practical guide to healthy caring (UK)

The advice in this booklet will help you if you look after a friend or family member or have any form of caring responsibilities, but it is written to be particularly relevant for those who are about 65 years or older and are new to caring.

The 2017/18 NHS General Practice Contract

sets out the requirements in England for frailty as follows: 

 

Identification and management of patients with frailty 
Summary of requirements

Information and links to resources about the 2017/18 NHS General Practice conotract requirements in England for Frailty

View/access   (219 KB)

Janet's Story

RightCare scenario : The variation between standard and optimal pathways.

Excercises for older people - Balance

NHS Choices UK.

Excercises for older people - Flexibility

NHS Choices UK.

Excercises for older people - Strength

NHS Choices UK.

Excercises for older people - Sitting

NHS Choices UK.