Diagnose Frailty to Help Vulnerable Elderly
Abstract & commentary
By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.
Synopsis: Strong evidence was found that slow gait speed, low physical activity, and weight loss are key indicators of frailty, which is associated with chronic disability, long-term nursing home stays, injurious falls, and death.
Source: Rothman MD, et al. Prognostic significance of frailty criteria. J Am Geriatr Soc 2008;56:2211-2216.
A prospective cohort study followed 754 non-disabled community-dwelling persons in New Haven, CT, aged 70 and older for 6-9 years to determine the prognostic value of 7 potential frailty criteria: gait speed, physical activity, weight loss, exhaustion, weakness, cognitive impairment, and depressive symptoms. Outcomes were the occurrence of chronic disability, long-term nursing home stays, injurious falls, and death. Data were collected from comprehensive home assessments every 18 months for 6 years, followed by telephone contact for a further 3 years to determine outcomes, to give at least 7.5 years of follow-up for all participants.
The study criteria came from information obtainable in most offices: Slow gait speed was defined as > 10 seconds to walk both directions as quickly as possible on a 10-foot course. Weight loss was defined as > 10 lbs in the past year, and weakness by grip strength was measured on a hand-held dynamometer and compared to established norms. Cognitive impairment was defined as a score < 24 on Folstein Mini-Mental Status Exam, and physical activity and depression were established using standardized questionnaires. Exhaustion was established for the answer "much or most of the time" to either of the following statements, "I felt that everything I did was an effort," or "I could not get going."
Results indicated that slow gait speed, low physical activity, and weight loss were most strongly associated with chronic disability, long-term nursing home stays, and death, even after adjusting for age, sex, race, education, and other chronic conditions. Low physical activity was most associated with death, and slow gait speed was the only criteria that predicted injurious falls.
Commentary
Frailty is used in geriatric medicine to describe a potentially modifiable syndrome of vulnerability to functional decline, institutionalization, and falls.1 It would be useful to identify which of our older patients are in this group and which might benefit from medical interventions to avoid these adverse outcomes, as opposed to those patients with permanent disabilities that are best treated with palliative measures.
Previous literature has suggested that self-reported weakness and exhaustion could also be used in a frailty determination2 (along with physical measures), but this proved weak in the current study followed over a longer time. Another approach is to use deficit accumulation models, which do show increased adverse outcomes as the elderly acquire more problems, but are more difficult to record and quantify.
For now the most practical frailty assessment includes assessment of gait, physical activity, and weight lossadd them together with other deficits to evaluate those elderly most at risk for potentially modifiable adverse outcomes. This research gives us hope that our attempts to correct these issues may make a difference for our geriatric patients.
References
1. Abellan van Kan G, et al. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 2008;12:29-37.
2. Fried LP, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56: M146-M156.
Strong evidence was found that slow gait speed, low physical activity, and weight loss are key indicators of frailty, which is associated with chronic disability, long-term nursing home stays, injurious falls, and death.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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