Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Frailty
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
Assessment of presence of frailty
5 min.
PRISMA-7
Program of Research to Integrate Services for the Maintenance of Autonomy - 7
Assessment of presence of frailty
5 min.
Edmonton Frailty Scale
Edmonton Frail Scale
Assessment of severity frailty
20 min.
Clinical Frailty Scale - Rockwood
Rockwood Clinical Frailty Scale
Frailty evaluation tool
5 min.
GST-4
Gait Speed Test (4 metre)
Simple assessment of functional mobility
5 min.
TUG Test
Timed Up and Go Test
Assessment of mobility, balance, walking ability, and fall risk in older adults
10 min.
Clock Drawing Test
Clock Drawing Test
Quick screening test for cognitive dysfunction secondary to dementia, delirium, or a range of neurological and psychiatric illnesses
x min. variable
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
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 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 :
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Rockwood Clinical Frailty Scale
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Gait Speed Test
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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.
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.