II. What Does Frailty Look Like?
Transcript:
Narrator: Imagine an individual, Ernesto, 75 years old, with a history of hypertension and more recently, falls.
Narrator: Ernesto visits his primary care practitioner Dr. Lee, and reports that he has experienced a couple of falls in the past six months. Dr. Lee asks Ernesto a few more questions and finds out that Ernesto is increasingly exhausted and has little energy. Concerned that Ernesto may be frail or becoming frail, Dr. Lee refers him to a geriatrics clinic for frailty assessment.
Narrator: The clinical assessment for frailty includes five measures: unintentional weight loss, exhaustion, activity levels, walking speed, and grip strength (needs citation). Ernesto’s assessment shows that he meets two criteria for frailty based on these measures: slow walking speed and low grip strength. Having one or two frailty criteria characterizes him as pre-frail. A score of three or more out of five criteria would characterize him as frail.
Further Reading
Frailty can be measured using Linda Fried’s Physical Frailty Phenotype (PFP), which is a measurement of fve distinct physical domains; walking speed, unintentional weight loss, exhaustion, activity levels, and grip strength (Fried et al, 2001). Having crossed the threshold for 1 or 2 out of 5 measures categorizes someone as prefrail. A score of 3 or more active measures out of 5 characterizes someone as frail.
Frailty syndrome and its measurable physical phenotype is of utmost importance to understand in all clinical settings because frailty, and its association with adverse outcomes following clinical procedures, cannot be ascertained by simply looking at the patient. There is no single way a frail patient can appear, and observing a patient’s physical appearance (also known as “the eyeball test”) does not give any indication of their underlying cellular function and health.
For example, frailty assessment by emergency care providers could facilitate referral to the more appropriate services and could assist with identifying patients who will not benefit from aggressive medical treatments (Theou, 2016). However, few clinics implement frailty measures and research into their care planning for older patients, and those that do are still in experimental phases (Vellas et al, 2012).
The understanding of the definition of frailty and its constantly changing multidimensional nature is still evolving, but there is some consensus on frailty and aging theory. Most importantly, a delineation of frailty from comorbidity and disability, which are characteristics that are often treated as synonymous with frailty (Fried et al, 2004). It is understood that frailty causes disability, independent of clinical and subclinical diseases.
Therefore, the syndrome of frailty may be a precursor to disability, due to its central features of weakness, decreased endurance, and slowed performance. Functions most likely to be affected by frailty are those dependent on energy level, muscle health, and speed of performance such as mobility. Fried et al reported that 27% of those who were disabled in activities of daily living (ADLs) tasks were frail, which suggests that frailty begins by affecting mobility tasks and energy production and storage before causing noticeable multisystem functional decline (Fried et al, 2001). For example, disability due to arthritis of the hands might very specifically affect ability to grasp or eat, without having any relationship to frailty. It is important to distinguish that frailty is not synonymous with either disability or comorbidity (Fried et al., 2001). Consequently, frailty is increasingly understood as a muscular and energy production and storage mechanism dysfunction that occurs in some vulnerable older adults.
Video Gallery
References
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