Frailty and Falls in Older Adults

Define frailty

state of vulnerability

person has reduced strength, energy and resilience

is frailty just seen in older adults?

most often seen in older adults, its not just about age

whats the pathophysiology of frailty about?

how multiple body systems gradually lose reserve and become dysregulated, making the person less able to cope with stressors

what are some of these systems that have a decline?

• muscle loss (sarcopenia)

• hormonal changes

• nervous system changes

• immune system dysfunction

explain sarcopenia?

1. his is loss of skeletal muscle mass and strength

2. leads to reduced power and mobility

= leads to weakness and slower movement

what does ageing do to skeletal muscle?

it reduces skeletal muscle mass and strength

explain hormonal changes?

1. decline in anabolic hormones, e.g. growth hormone

= reduces body’s ability to build and maintain muscle and tissue

explain nervous system changes?

1. reduced neuromuscular coordination

2. slower reaction times

= impaired balance (higher falls risk)

explain immune system dysfunction?

1. weakened immune response

2. increased vulnerability to infections

= poor recovery after illness

how does this impact an older adult?

impacts their ability to maintain an independent life and perform activities of daily living

whats meant by deconditioning?

physical decline that happens with inactivity or illness

what systems can be impacted by deconditioning?

• skeletal muscle

• vascular system

• bones

• metabolism

• cardiorespiratory system

consequences of deconditioning on skeletal muscle?

• atrophy

• decreased strength

• increased fatigability

• creased length

• decreased stiffness

• decreased oxidative ability

consequences of deconditioning on vascular system?

• arterial resistance

• decreased venous return

• decreased end diastolic volume

consequences of deconditioning on bones?

• negative bone synthesis

• decreased bone mass

• increased risk of bone damage

consequences of deconditioning on metabolism?

• decreased insulin sensitivity

• decreased total body protein

• decreased ability to recover

consequences of deconditioning on cardioresp?

• decreased stroke volume

• decreased blood volume

• decreased cardiac dimension

• decreased vo2 max

when is the rate of decrease the greatest?

first 3 weeks

what is deconditionng severity impacted by?

levels of activity/fitness pre event and levels of inactivity post event

whats meant by reconditioning?

process of restoring strength, fitness and function after someone has become deconditioned

how many times as long as the deconditioning phase is the reconditioning phase?

reconditioning phase is 3x longer

what is used to assess frailty (in older adults)?

the Comprehensive Geriatric Assessment (CGA)

what does CGA include?

• physical medical conditions

• mental health

• functioning (ADLs)

• social circumstances

• environment

• future wishes

How can we manage frailty?

• exercise

• caloric and protein support

• vitamin D

• reduction of polypharmacy

Definition of falls?

An unexpected event in which the participant comes to rest on the
ground, floor or lower level

what can falls be categorised as?

• explained

• unexplained

what are some causal factors for falls? (intrinsic)

• poor balance/posture

• visual impairments

• reduced muscle strength/flexibility

• impaired mobility

• previous falls

what are some causal factors for falls? (extrinsic)

• loose rugs/carpets

• poor fitting footwear

• poor fitting clothes

• poor lighting

• clutter

• slippery floors

what are the psychological effects of falling?

loss of confidence → fear of falling → reduced mobility → further weakness → falls

whats meant by a ‘long lie’?

Defined as a period of one hour or more lying on the floor
after a fall

what are possible outcomes after a ‘long lie’?

• decline in ADL for at least 3 days

• be hospitalised

• psychological problems

• increased risk of future falls

• death