Factors of Frailty
Frail adults have been found to eat diets that are lacking in this macronutrient
Protein.
A diet lacking in protein can lead to decreased muscle mass and function.
This gender is at higher risk of being frail
Women (8% over 5%)
NOTE: Women live longer than men but are more likely to be frail. This might be due to long-term diseases that slow someone down like arthritis where men are likely to have diseases that shorten their life.
I can go outside and I regularly exercise. What level of frailty is the patient? (1-9)
1 - Very Fit
When asking patients about symptoms of depression, anxiety, or hopelessness you are assessing this category of the Frailty checklist.
Feelings
NOTE: Because many older adults have long-term health problems and many live alone this makes them at a higher risk of depression. Using the geriatric depression scale is a good tool. 8-16% of older adults are experiencing sadness to depression.
This is the best prevention of frailty
A combination of walking and weight training exercises are effective in preventing movement issues and improving frailty.
NOTE: Guideline recommendations are 30 minutes of moderate physical activity most days of the week (150-210 minutes). Best intervention is a mix between walking, strength training, and yoga. Also helps to promote mood and mental health.
Frail adults have been found to have an increase in labs values that signify high activity of this body system
Immune system.
Stress hormones, inflammatory cytokines, IL-6, and CRP damage the muscle cells and are often elevated in frail older adults
The percentage of adults over 80 that are considered frail
25%
Note: Prevalence of frailty ranges from 4% to 16% in community-dwelling men and women aged 65 and older. Almost 50% of adults over 65 are at risk of becoming frail.
I cannot go outside and am approaching the end of my life. What level of frailty is the patient? (1-9)
9 - Terminally Ill
An 80-year-old woman with many episodes of urinary leakages or urinary infections should be assessed for this “F” in the checklist?
Flow
NOTE: Almost 50% of adults older than 80 have constipation. Common symptoms are fainting, not eating, nausea, pain, and low quality of life. 70% of women older than 70 have some form of urinary incontinence. Common symptoms are dry, itchy skin, burning with peeing, falling, and not wanting to go in public. It is second only to dementia to having to go to long-term care.
A patient on multiple medications for their conditions is called this
Polypharmacy
NOTE: There is a large relationship between medications and the frailty of patients. Reducing medications helps stop and manage frailty.
The muscle in frail older adults are less sensitive to this important building block
Amino Acids.
Because their muscles are less sensitive to amino acids, they underutilize the protein in their diet for muscle building.
This percentage of nursing home residents are frail
52%
Note: Many things affect this such as other illnesses, they rely on others for help, and weight loss are seen in long-term care. Studies have shown that frailty is more common in people living in nursing homes compared to community-dwelling people in the same age groups.
I cannot go outside, I am completely dependent on others and I am bedbound. What level of frailty is the patient?
8 - Very Severely Ill
Talking to a patient to see if they are able to brush their teeth, eat their food, comb their hair, etc or manage their finances, transportation, buying groceries, etc. as well as any recent injuries both must be discussed for this category.
Function and Falls
NOTE: Older adults should be asked whether they have fallen in the past year, as falls are the number one cause of injury in older adults. A study to stop falls found exercise lowered the number of falls. It was lowered even more when the patient's eyes, bones, and home were fixed. A home can be looked at through a local agency.
How often should an older adult be making contact with other individuals (via phone, retirement club, sewing club, etc)
Weekly
NOTE: Not having weekly phone calls patients had a large functional decline and mortality. It is protective against dementia, depression, death, and helps overall well-being.
This hormone worsen the burden of frailty in older adults
Cortisol
This race is twice as likely to become frail
African Americans are twice as likely to become frail than Caucasian and Hispanic Americans.
Note: Studies have found this to be an independent risk factor, and not explained by health or income.
I cannot go outside, I need a walker to get around and I sometimes help at home. What level of frailty is the patient? (1-9)
6 - Moderately Frail
Documenting patient’s substitute decision-makers, knowing their advanced care directives, and talking with them about their end-of-life goals sooner than later are all major parts of the last category in our checklist.
Future and Family
NOTE: Frailty is associated with increased illness and death. However, only 2% to 29% of frail older adults have discussed end-of-life care with a health care professional, despite most of them wanting to discuss this sooner rather than later.
Eating more of this is decreases the risk of frailty
Protein
NOTE: Older adults should have 1 g/kg of body weight per day. It plays a big role in continuing to build muscle and high-calorie snacks should be interventions for underfed older adults.
A decrease in this physiologic trait leaves an older adult vulnerable to becoming frail after a physiologic stressor.
Resilience
As older adults combat illnesses and stressors, they use up their functional and physiologic reserve which decreases their resilience. Protecting resilience and rebuilding functional and physiologic reserves can help combat frailty
These three diseases are associated with a high risk of frailty
Cancer (42%)
End-Stage Renal Disease (37%)
Chronic Heart Failure (45%)
NOTE: These conditions often go to the hospital more, less movement, more medications, and not eating as much.
I can go outside but I do not exercise, I am independent and slow and occasionally need a walking stick. What level of frailty is the patient? (1-9)
4 - Vulnerable
Checking pill bottles, dosages, interactions, and reviewing how to take their medication are a part of the 4th “F?”
Farmacy
NOTE: You should review how they take their medication by asking patients how often they forget to take each medication. Talk to the patient about what the medication is and why they are taking it, weigh the benefit and risks of the medication and help the patient decide. Before starting any new drug make sure it reflects the patient's wants.
“Use it or lose it” is a popular slogan that is true with regard to frailty. What two body parts is this in regard to.
Musculoskeletal and Brain
NOTE: Keeping up with physical activities and brain games reduces frailty. If you do not use muscles they will get weak, if you do not use your mind it begins to fail. It helps older adults keep independence, improving mental abilities may also reduce the direct costs of the impact of older adults mental frailty