Frailty Kathleen Pace Murphy, PhD, MS Assistant Professor, Division of Geriatric and Palliative Medicine Deputy Director, Consortium on Aging

Kathleen Pace Murphy, PhD, MS, GNP-BC Assistant Professor, UTHealth McGovern Medical School Division of Geriatrics and Palliative Medicine Deputy Director, Consortium on Aging Neither I nor members of my immediate family have any financial relationship with commercial entities that may be relevant to this presentation.

Frailty Age related alteration in physiology and pathology that leads to vulnerability, loss of physiological reserve, and a range of poor medical and functional outcomes (Bergman, Ferrucci, Gurainki, et al, 2007).

Statistics Prevalence is uncertain. Lekan (2009) reported a 3-7% prevalence in older adults aged 65 to 75 years. Newman Gottdiener, McBurnie, et al (2001) reported in the Cardiovascular Health Study a prevalence of 25% in adults over the age of 85 years.

Etiology Diseases such as malignancy, CHF, COPD, dementia, stroke, Parkinson’s disease, DM, hypothyroidism, depression, and rheumatic diseases. Inflammatory and immune responses – ↑pro-inflammatory biomarkers (IL-6, CRP) – clotting cascade activation (↑elevated levels of factor VIII, fibrinogen and D-dimer) – ↑ serum cortisol elevations – ↓vitamin D levels, growth and sex hormones (Espinoza & Walston, 2005).

Diagnosis The frailty index is one measurement used to assess this syndrome in the older adult (Fried, Tangen, Walston, et al, 2001). An older adult must have at least 3 of the 5 indices: Weight Loss: Unintentional weight loss (10 pounds or greater) in the past year. Exhaustion: Presence of fatigue and tiredness. Strength: Weakness of grip strength. Slowness: Slow walking speed. Low energy expenditure: Inactivity.

Intervention Syndrome - Interprofessional geriatric team approach and a comprehensive plan of care. Physical and occupational therapy to improve gait, muscle strength, and improve functional independence (i.e. activities of daily living). Dietician consult to provide a nutritional assessment and plan of care to address dehydration, inadequate caloric intake; dietary counseling. Speech therapy consult to evaluate swallowing problems which may contribute to diminishing weight. Dental consult will evaluate dental caries, poor fitting dentures and other dental disease which prevent the older adult from adequately eating. Social work consult - social assessment and plan of care as it relates to patient and family support, referrals to community agencies and financial resources. Prognostic indicator for poor clinical outcome - Palliative Care Team consult, Chaplain Services, home health nurses Resources:

References Bergman, H., Ferrucci, L. Gurainki, J., et al. (2007). Frailty: An emerging research and clinical paradigm-issues and controversies. Journals of Gerontology; 64A: Espinoza, S., & Walston, J.D. (2005). Frailty in older adults: Insights and interventions. Cleveland Clinic Journal of Medicine, 72(12): Fried, L.P., Tangen, C.M., Walston, J., et al. (2001). Frailty in older adults: Evidence for a phenotype. Journal of Gerontology; 56A: M1-M11. Lekan, D. (2009). Frailty and other emerging concepts in the care of the aged. Southern Online Journal of Nursing Research, 9:3. Newman, A.B., Gottdiener, J.S., McBurnie, M.A., et al. (2001). Associations of subclinical cardiovascular disease with frailty. Journal of Gerontology: Medical Sciences, 56A: M158-M166.