Frailty

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What defines a geriatric patient?

“Geriatrics” is best described as promoting the health of seniors. There is no specific age at which a patient is prescribed geriatric treatments. The United Nations uses 60+ as the numerical criterion, and most developed countries use 65 years. Currently, 15% of the US population is age 65+; an age group that consumes approximately 40% of healthcare resources.

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How do geriatric patients differ physiologically?

Older adults have less physiologic reserve and less ability to maintain homeostasis after stressors. This intrinsic vulnerability is sometimes termed frailty .

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What is the life expectancy by age?

Life expectancy is longer as age increases, and tends to be 0–3 years longer for females. Fiftieth percentile life expectancy at age 65 is 17 years for men and 20 years for women. At age 80, life expectancy is 8 years for men and 10 years for women.

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What are common causes of death in the geriatric population?

Frailty, cancer, organ failure, and advanced dementia.

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What is frailty?

Frailty is an age-related, multidimensional state of decreased physiologic reserves that results in diminished resiliency, loss of adaptive capacity, and increased vulnerability to stressors. By definition, frailty is associated with poor healthcare outcomes and disability.

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What is the pathophysiology of frailty and human aging?

Biologic hallmarks clinically express themselves as frailty and include genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication.

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Why does frailty matter?

Frailty is one of the most critical issues facing healthcare because it is closely related to poor healthcare outcomes. Frail older adults are at highest risk for falls, disability, delirium, cognitive decline, iatrogenic complications, social withdrawal, and death following an operation.

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What is the comprehensive geriatric assessment?

A comprehensive geriatric assessment describes a multidisciplinary, multidimensional evaluation aimed to define high-risk health characteristics of older adults, which will allow individualized intervention plans. Common clinical characteristics assessed by a comprehensive geriatric assessment include functional status, mobility, comorbid medical conditions, cognition, psychologic state, social support, nutritional status, and a review of the patient’s medications. The interventions recommended following a comprehensive geriatric assessment are typically carried out by a multidisciplinary team.

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How can you assess for frailty?

There is no single tool that measures frailty. Instead, a variety of measurements have been described, which should be chosen for use based on the clinical situation. Examples of frailty measurement tools include:

• a.

  Deficit accumulation frailty assessment describes summing abnormal characteristics found in evaluations like the comprehensive geriatric assessment and equating a higher number of abdominal characteristics to increased health risk.

• b.

  The FRAIL scale is performed by assessing f atigue, r esilience, a mbulation, i llnesses, and l oss of weight.

• c.

  Biologic, or “phenotypic,” frailty is measured by assessing walking speed, grip strength, fatigue, weight loss, and activity level.

• d.

  Brief single item assessment can rapidly and accurately screen for frailty, including the timed up-and-go score (time to get up and walk 10 feet, return to sitting) and gait speed.

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What is the significance of frailty in the perioperative period?

Frailty predicts poor postoperative outcomes in elderly patients. Adverse outcomes related to baseline frailty include 30-day mortality, 1-year mortality, serious complications, prolonged length of stay, and need for postdischarge institutionalization.

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