FrailtyPED 488

Special PopulationsLena Lutz

Overview

The frailty syndrome is a collection of symptoms or markers, primarily due to the aging-related loss and dysfunction of skeletal muscle and bone, that place (mostly) older adults at increased levels of risk for disability, dependency, falls, need for long term care, and mortality

The normal aging process and presence of multiple chronic medical disorders can contribute to increased physical decline; this may place an individual at a greater risk of becoming frail

http://www.youtube.com/watch?v=FEqZgOFVm6Y

Key components/ factors of topic

Overlapping concepts of frailty, disability, and comorbidity

Frailty includes both physical and functional decline

Frailty always implies multisystem dysfuntion

The cardiovascular, respiratory, nervous, musculoskeletal, renal and metabolic systems all see physiological changes associated with the aging process

Frail health can be found in people of any age but it is most commonly linked with the elderly

Signs/ Symptoms

Weight loss

Fatigue

Muscle weakness

Slow or unsteady gait declines in activity

Fried’s Phenotype for Frailty

The presence of three or more components indentifies a person as being frail

0=robust; 1-2=intermediate or pre-frail; 3=frail◦Shrinking: unintentional weight loss of 10 lbs or

more in the past year◦Exhaustion: lack of energy or vigor, or the presence

of fatigue and tiredness◦Strength: loss of physical robustness, skeletal

muscle soundness◦Slowness: a lethargic, unsteady, and unbalanced

gait◦Low physical activity: inactivity or sedentariness

Causes

Normal aging

Disease

Disuse

Common Medical Disorders That Contribute to Frailty

HypertensionCoronary artery

diseaseAsthmaPneumoniaArthritisOsteoporosisDiabetes

MalnutritionCancerAnemiaAlzheimer’s diseaseCataractsHearing disordersAnxiety disordersDepression

Medications

Elderly and frail individuals are usually on more medication than individuals of any other population

Types Side Effects

Sedatives, Hypnotics Dizziness

Antidepressants, Diuretics, Antihypertensives

Confusion and/or depression

Beta blockers, Antihistamines Fatigue and weakness

Anti-glaucoma agents/miotics, Bronchodilators/anti-asthmatic agents

Increases in heart rate

Benefit From Exercise

Exercise including resistance, strength, and physical movement training can help improve gait and balance issues

Minimize further weight loss and/or loss of muscle mass and strength◦Resistance training can help increase lean body

mass and improve strength, exercise tolerance and walking speed

Reduce risk of fallingIncreased socialization and self-esteem

◦Promote independence in daily living activities

Risk With Exercise

Increased risk of injury due to balance difficulties

Prone to fractures caused by osteoporosisLow tolerance for hot and cold

environments◦Susceptible to heat cramps, exhaustion, stroke,

and dehydrationIncreased risk of cardiovascular diseases

How it relates to your area of interest

Group Exercise Instruction◦Need to understand individual ability levels to

assess appropriate intensity◦Those who are frail have impaired balance

which would put them at higher risk for injury in an aerobic class (STEP)

◦Older frail individuals are susceptible to dehydration

◦Exercise session duration cannot be too long; frail individuals fatigue easily

References

ConsultGeriRN.org◦http://consultgerirn.org/topics/frailty_and_its_im

plications_for_care_new/want_to_know_moreDurstine, J.L., & Moore, G. (2003). ACSM’s

exercise management for persons with chronic disease and disabilities. (2nd ed.). Champaign, IL: Human Kinetics