Geriatric Syndromes

Learning Outcomes

  • Identify the etiology and risk factors for frailty
  • Recognize atypical presentations of disease as signs of frailty in older adults and their linkage between organs
  • Understand the relationship between assessment, interventions and prevention of frailty
  • Diagnose frailty using e-learning modules, complete a nutrition assessment, and review medications with adverse effects for those living with frailty

Key Concepts

  • Frailty is a geriatric syndrome that is difficult to reverse
  • It's a consequence of the interplay between aging processes and chronic diseases
  • Frailty involves multiple risk factors, including:
    • Pathophysiological factors
    • Psycho-social factors

Five Key Clinical Features of Frailty

  1. Low level of physical activity
  2. Self-reported exhaustion
  3. Generalized weakness
  4. Impaired physical function
  5. Unintentional weight loss

Dynamic Interaction of Frailty

  • Components:
    • Individual capacity
    • External resources
    • Stressors (illness, surgery, medication, social support)
  • This interaction contributes to difficulty in reversing frailty.

Subcategories of Frailty

  • Physical Frailty

    • Not all individuals with disabilities are frail
    • Multifaceted and defined by geriatrics
    • Distinct from sarcopenia and multimorbidity

  • Cognitive Frailty

    • Presence of both physical frailty and cognitive impairment
    • Excludes dementias and may be reversible

Risk Factors for Frailty

  • Medical Factors:

    • Incontinence,
    • Unintentional weight loss

  • Functional Factors:

    • Declining status,
    • Immobility,
    • Falls,
    • Sarcopenia

  • Psychological Factors:

    • Delirium,
    • Dementia

  • Medications and Alcohol:

    • Polypharmacy impacts pharmacokinetics and pharmacodynamics

  • Social and Environmental Indicators:

    • Social isolation,
    • Transition periods,
    • Caregiver stress

Atypical Presentations of Disease

  • Signs include:

    • Loss of attention,
    • Stability decline,
    • Involuntary loss of urine,
    • Loss of independence,
    • Aspiration,
    • Behavioral changes,
    • Weight changes

  • Consequences:

    • Organ failures can lead to a significant impact on overall health, disrupting basic homeostatic functions and causing acute geriatric syndromes such as dementia, incontinence, and falls.

Diagnosing Frailty

Fried Frailty Index (FFI)
  • Five essential criteria to assess frailty:
    1. Unintentional weight loss (>5% over past year)
    2. Self-reported exhaustion
    3. Low physical activity
    4. Slow walking speed
    5. Weakness (grip strength)
CSHA Frailty Index Scale
  • Evaluates physical, psychological, and social aspects
  • Levels of fitness or frailty from 1 to 9
Edmonton Frail Scale
  • Multidimensional, assesses 9 domains including cognition, health status, independence, support, medication use, nutrition, mood, continence, and mobility
  • Scoring ranges:
    • 0-5: Not frail
    • 6-7: Vulnerable
    • 8-9: Mild frailty
    • 10-11: Moderate frailty
    • 12-17: Severe frailty
Laboratory Biomarkers
  • Includes inflammatory response, hormone levels, free radicals, antioxidants, and nutritional status.

Management of Frailty

  • Comprehensive Geriatric Assessment (CGA)

    • Gold standard in managing frailty
    • Holistic approach focusing on:
    • Quality of life
    • Social resources
    • Psycho-behavioral conditions

  • Interprofessional Teams are essential for a thorough assessment,

  • Continuous rolling assessment including:

    • Medication reviews
    • Development of care plans
    • Addressing chronic illness treatment

Prevention Strategies

  • Focus on physical health and psycho-social aspects of life.
  • Early interventions in:
    • Physical
    • Psychological
    • Social and Environmental factors
  • Promote healthy aging through prevention of frailty onset and reduction of adverse outcomes.

References

  • Include foundational texts and recent studies surrounding frailty in geriatric care, such as works by Angulo et al. (2020) and Fried et al. (2009).
  • Note: Access through respective DOIs and institutional resources for full texts where necessary.