Frailty
Anatomy & Risks
Assessment of functional ability - Fried’s phenotype of frailty
- Activity levels
- Walking speed
- Fatigue
- Grip strength
- Weight loss
Total score can be simplified to Frailty Scale
Symptoms & Complications
Clinical Frailty Scale (can also use PRISMA-7 self-reporting questionnaire)
1. Very fit – regular exercise; among 6. Moderate frailty – help with all
fittest for their age outside activities, keeping house
2. Fit – no active disease symptoms; and bathing
active occasionally 7. Severe frailty – completely
3. Managing well – medical problems dependent for personal care but
well controlled but not regularly not high risk of dying
active 8. Very severe frailty – completely
4. Very mild frailty – not dependent dependent, approaching end of life
on others; symptoms limit activities 9. Terminally ill – life expectancy
5. Mild frailty – more evident slowing; <6mths otherwise not living with
help needed with high order ADLs severe frailty
e.g., finance, transport
Degree of frailty generally corresponds to degree of dementia
Walking speed – TUG test (assesses risk of falls at home and frailty)
Timed Up and Go test
- <10s = normal
- 11-20 = normal for elderly and disabled
- >20s = assistance outside needed; further examination required
ASA Classification (Prefix ‘E’ used for emergency surgery)
I. Normal healthy patient – non- poorly controlled DM/HTN;
smoking, minimal alcohol alcohol abuse
II. Mild systemic disease – without IV. Severe systemic disease
functional limitations; current (constant threat to life) – e.g.,
smoker; social alcohol drinker; MI/CVA ≤3mths ago, sepsis,
pregnancy; obesity BMI 30-40; DIC, ESRD without dialysis
well-controlled DM/HTN, mild V. Moribund not expected to
lung disease survive without operation –
III. Severe systemic disease - ≥1 e.g., ruptures/perforations,
moderate-severe diseases; BMI cranial bleeds with mass effect
>40; ESRD on dialysis; MI/CVA VI. Brain dead for donation
≥3mths ago; pacemaker; COPD;
, Falls
Anatomy & Risks
DAME
Drugs - Impaired peripheral sensation
- Nitrates / BB / ACEi - Reduced postural sway (balance)
- Diuretics - Sarcopenia
- Anticholinergics - Slower reflexes
- Antidepressants / Anticonvulsants / Medical
L-dopa - Cardiac
- Benzos / Opiates / Codeine / - Neurological
Sedatives Environmental
- Digoxin - Walking aids
- Polypharmacy (>4 drugs) - Footwear
Ageing related - Home hazards
- Presbyopia - Glasses (esp. varifocals)
Symptoms & Complications
Complications
- Fractures
Investigations
Urine dip unreliable in the elderly
- Fracture risk assessment
- Cardiovascular risk assessment for stenosis/arrhythmias
- A-E for infection risk
- Neurological examination for stroke/visual impairment
Treatment/Management & Side effects
1. Gait (physiotherapy) 6. Cognitive impairment (referral as
2. Visual problems (eye test; glasses) necessary)
3. Hearing difficulties (remove 7. Postural hypotension
earwax; hearing assessment) 8. Continence (infection risk)
4. Medications review 9. Footwear
5. Alcohol intake 10. Environmental hazards (turn on
lights; take up rugs)
Elder Abuse
Anatomy & Risks
Factors relating to victim - Drug/alcohol dependency
- Cognitive impairment - Caregiver burden and stress
- Shared living Relationship between them
- Functional dependency - Family problems
- Low income - Conflicted relationships
Relating to abuser Environmental factors
- Cognitive impairment incl. - Low social support
dementia - Shared living
Anatomy & Risks
Assessment of functional ability - Fried’s phenotype of frailty
- Activity levels
- Walking speed
- Fatigue
- Grip strength
- Weight loss
Total score can be simplified to Frailty Scale
Symptoms & Complications
Clinical Frailty Scale (can also use PRISMA-7 self-reporting questionnaire)
1. Very fit – regular exercise; among 6. Moderate frailty – help with all
fittest for their age outside activities, keeping house
2. Fit – no active disease symptoms; and bathing
active occasionally 7. Severe frailty – completely
3. Managing well – medical problems dependent for personal care but
well controlled but not regularly not high risk of dying
active 8. Very severe frailty – completely
4. Very mild frailty – not dependent dependent, approaching end of life
on others; symptoms limit activities 9. Terminally ill – life expectancy
5. Mild frailty – more evident slowing; <6mths otherwise not living with
help needed with high order ADLs severe frailty
e.g., finance, transport
Degree of frailty generally corresponds to degree of dementia
Walking speed – TUG test (assesses risk of falls at home and frailty)
Timed Up and Go test
- <10s = normal
- 11-20 = normal for elderly and disabled
- >20s = assistance outside needed; further examination required
ASA Classification (Prefix ‘E’ used for emergency surgery)
I. Normal healthy patient – non- poorly controlled DM/HTN;
smoking, minimal alcohol alcohol abuse
II. Mild systemic disease – without IV. Severe systemic disease
functional limitations; current (constant threat to life) – e.g.,
smoker; social alcohol drinker; MI/CVA ≤3mths ago, sepsis,
pregnancy; obesity BMI 30-40; DIC, ESRD without dialysis
well-controlled DM/HTN, mild V. Moribund not expected to
lung disease survive without operation –
III. Severe systemic disease - ≥1 e.g., ruptures/perforations,
moderate-severe diseases; BMI cranial bleeds with mass effect
>40; ESRD on dialysis; MI/CVA VI. Brain dead for donation
≥3mths ago; pacemaker; COPD;
, Falls
Anatomy & Risks
DAME
Drugs - Impaired peripheral sensation
- Nitrates / BB / ACEi - Reduced postural sway (balance)
- Diuretics - Sarcopenia
- Anticholinergics - Slower reflexes
- Antidepressants / Anticonvulsants / Medical
L-dopa - Cardiac
- Benzos / Opiates / Codeine / - Neurological
Sedatives Environmental
- Digoxin - Walking aids
- Polypharmacy (>4 drugs) - Footwear
Ageing related - Home hazards
- Presbyopia - Glasses (esp. varifocals)
Symptoms & Complications
Complications
- Fractures
Investigations
Urine dip unreliable in the elderly
- Fracture risk assessment
- Cardiovascular risk assessment for stenosis/arrhythmias
- A-E for infection risk
- Neurological examination for stroke/visual impairment
Treatment/Management & Side effects
1. Gait (physiotherapy) 6. Cognitive impairment (referral as
2. Visual problems (eye test; glasses) necessary)
3. Hearing difficulties (remove 7. Postural hypotension
earwax; hearing assessment) 8. Continence (infection risk)
4. Medications review 9. Footwear
5. Alcohol intake 10. Environmental hazards (turn on
lights; take up rugs)
Elder Abuse
Anatomy & Risks
Factors relating to victim - Drug/alcohol dependency
- Cognitive impairment - Caregiver burden and stress
- Shared living Relationship between them
- Functional dependency - Family problems
- Low income - Conflicted relationships
Relating to abuser Environmental factors
- Cognitive impairment incl. - Low social support
dementia - Shared living
