1 / 22

Understanding frailty

Understanding frailty. Leicester Medical School. Simon Conroy Senior Lecturer/Geriatrician Prague 2009. Understanding frailty. The holy grail of geriatric medicine. Early identification of frailty Identification of ‘pre-frail’ Possibility of early interventions.

kimball
Download Presentation

Understanding frailty

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Understanding frailty Leicester Medical School Simon Conroy Senior Lecturer/Geriatrician Prague 2009

  2. Understanding frailty

  3. The holy grail of geriatric medicine • Early identification of frailty • Identification of ‘pre-frail’ • Possibility of early interventions

  4. Frailty according to Fried • Sarcopaenia • lowest quintile for hand-grip strength • Exhaustion • I felt that everything I did was an effort • I could not get going • Nutrient–energy imbalance • self-reported unintentional weight loss of ≥ 5kg in the previous year • Slowness • slowest quintile for the time required to walk 2.4 meters • Low physical activity • lowest quintile for energy expended per week in leisure-time physical activities 3/5 – frail 1-2/5 – pre-frail 0/5 – non-frail

  5. Frailty according to SOF • Study of Osteoporotic Fracture Index • Weight loss • Inability to rise from a chair five times without using the arms • Reduced energy (answer of “no” to the question “Do you feel full of energy?” on the Geriatric Depression Scale) 2/2 – frail 1/2 – pre-frail 0/2– non-frail

  6. Problems with frailty rating scales • Frailty is dynamic • Reliability • Test population: SOF only validated in women • Limited in scope • BUT, CHS scale has been used in biological studies • No interventional studies as yet1 1. Fairhall N, Aggar C, Kurrle SE, et al. Frailty Intervention Trial (FIT). BMC Geriatrics 2008;8:27.

  7. Frailty interventions • Screen – SOF/CHS • Assess – expanded frailty index • Intervene - ??

  8. Biology of Ageing

  9. Oxidative stress • Reactive oxygen species (ROS) damage to DNA, proteins and lipid within ageing muscle cells → sarcopaenia • ROS levels associated with low grip strength & mortality • Candidate modifiable risk factors • smoking • dietary intake of carotenoids, ascorbate, selenium, plant polyphenols • exercise

  10. Genetics • Few studies have looked at genetic determinants of frailty • Multiple genes known to affect ageing or single or multiple domains of frailty • DNA methylation/folate • Insulin/IGF1 • Vitamin D • WRN helicase and lamin A (premature ageing) • Sirtuin genes • Antioxidants (superoxide dismutase, glutathione peroxidases) • Cardiovascular modifiers e.g. NO, RAS • Neurocognitive ageing e.g. ApoE • May identify pathways amenable to intervention

  11. Vascular ageing Frailty

  12. Frailty & human geography • Links with neighbourhood deprivation • Access to services

  13. Some unanswered health services research questions • Frailty & quality of life (Sealy Centre on Aging, Texas) • Frailty, social networks & carer strain • Frailty & cognition • Frailty and access to services • Frailty and health service resource use • Frailty in ethnic minorities • Delivering coordinated health care to frail older people

  14. Operationalising frailty • Frail older people should receive integrated comprehensive geriatric assessment • Increased living at home (OR 1.7) • Reduce functional decline (RR 0.76) • Reduce NH admissions (RR 0.66) • Yet increasing primary & secondary health care split…

  15. Operationalising frailty • Aged 70+ • Patients with a fracture, who are medically unstable • Care home resident (nursing or residential) • Confusion (dementia or delirium) • Other patients scoring over 25 on the Waterlow Score

  16. Admission rates from ED N=534 AMU bed occupancy 31% 18% 63% 70+ 10% Frail 40% 74% medicine 26% other speciality 75% 76% medicine 19% EDU ED attendances N=1723 25% children 57% adults 15% aged 70+ 3% frail, 70+

  17. AFU discharge rate AFU mortality 90 day readmissions from AFU 25/171 15% 3/171 2% 13/25 52% AFU outcomes, 4/10/8-27/10/8, n=171 AMU discharge rate AMU mortality 30 day readmissions 90 day readmissions 496/2988 17% 2988/6317 47% 52/6317 <0.01% 691/2988 23% 196/5208 4% 949/5208 18% ~1035 admissions in total: 171/1035=17% 239/949 25% 166/949 17%

  18. Summary • Frailty core business • Not well understood • Large collaborative studies required • Translational aspects critical

  19. Děkuji!

More Related