Frailty is a dynamic condition experienced by many older adults.  It is a vulnerability to adverse outcomes resulting from an interaction of physical, socio-economic and co-morbidity factors: major adverse events are more common among frail patients in comparison to non-frail patients. ⁽¹⁾

Why is it important?

• Prevalence of frailty is higher in women and increases with age
• Many residents in LTC would be considered “frail” although there may be reversible components
• Social vulnerability, aging, and chronic disease lends to development of frail elderly individuals
• When an individual is frail the impact of an “illness” further impairs function and ability to cope
• Frailty causes increased risk of other diseases
• In-hospital mortality is higher among frail patients than among non-frail patients ⁽¹⁾
• Frail survivors are more likely to become functionally dependent, had a lower quality of life, and more often re-admitted to hospitals than the non-frail survivors ⁽¹⁾
• Frailty increases the risk for adverse health outcomes such as falls, hospitalization, increased length of stay, increased costs, with worsening of outcomes including mortality and need for long term placement ^{(1) (3)}

Common Causes

• Physical: extreme age, weight loss, slow gait, fatigue, inactivity, poor grip strength
• Socio-economic:  isolation, caregiver gaps, poverty, gender, immigration status
• Co-morbidity factors:  impaired cognition/mood, poly-pharmacy, multiple chronic diseases

Key Considerations

• CSHA Clinical Frailty Scale widely used to describe and classify the severity of frailty: based on function for Activities of Daily Living and Instrumental Activities of Daily Living ⁽²⁾
  http://geriatricresearch.medicine.dal.ca/pdf/Clinical%20Faily%20Scale.pdf
• Align goals and preferences of the patient and family
• Focus should be on:
  • • Early identification of onset and acute illness, optimizing sensory inputs, assessing cognition/mood,reviewing medications, and promoting regular exercise and nutrition supplementation.
    • Optimizing chronic disease management strategies and modify geriatric syndromes (e.g. falls, immobility, confusion, depression, incontinence)
    • Implementing  necessary environmental changes/adaptations and maximization of community and socio-economic supports
    • Encouraging activity and socialization in order to help prevent advancing frailty
    • Consult physiotherapist, occupational therapist, recreationist as feasible

References

1.   Bagshaw, S.M., et al (2014). Association between frailty and short and long-term outcomes among
      critically ill patients: a multicenter prospective cohort study.  CMAJ, 186 (2), doi: 10.1503/cmaj.
      130639.  Retrieved Feb. 2014 from:
      http://www.cmaj.ca/content/186/2/E95

2.   B.C. Ministry of Health. (2012). Frailty in Older Adults- Early Identification and Management. 
      Retrieved February 2014 from:
      http://www.bcguidelines.ca/guideline_frailty.html

3.   Fried, L.P., et al (2001). Frailty in Older Adults: Evidence for a Phenotype. Journal of Gerontology:
      MEDICAL SCIENCES, 56A(3), M146-M156.  Retrieved Feb. 2014 from:
      https://rds185.epi-ucsf.org/ticr/syllabus/courses/83/2012/02/15/Lecture/readings/fried%20frailty
      %202001.pdf