LTC Resources - Frailty

LTC - Frailty Overview

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

LTC - Frailty Guidelines & Protocols

The European Society for Clinical Nutrition and Metabolism developed these guidelines with special considerations of older adults.  The authors point out that studies have shown an inverse relationship between nutritional status and complication rates, length of stay in hospital, etc.  Nutrition should be an integral part of an older adults overall care plan.  6 pages.  Last reviewed January 2017.

The 2010 clinical practice guideline for the diagnosis and management of osteoporosis in Canada focused on the care of adults living in the community. However, the fracture rate for adults living in long-term care (residents) is two to four times that of adults of similar age living in the community, and one third of older adults who experience hip fracture are residents in long-term care. 

LTC - Frailty Assessment Tools

This form describes how to use the 5-Item Geriatric Depression Scale (GDS) screening tool. 1 Page.

Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty—slow walking speed, weakness, inactivity, exhaustion, and shrinking—as measured by physical performance tests and questionnaires.

The FRAX® tool has been developed by WHO to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. Desktop and paper versions available.  This webpage includes an interactive fracture risk calculation tool with instructions.

Pre-frailty and frailty is an example of an elder care issue that, when identified and treated, may negatively impact quality metrics for the simple reasons that older adults don’t respond as well to treatment as younger cohorts.

This scoring assessment tool helps the clinician determine a client's ability to perform 8 instrumental activities of daily living: meal preparation, ordinary housework, managing finances and medications, stairs, phone use, shopping, and transportation.
1 page.

LTC - Frailty Management Strategies

This checklist identifies environmental adaptations for seniors that could help prevent accidents and enhance independent living at home. Guidelines on how to hire a reputable contractor are included.

LTC - Frailty Management Handouts

This reading list provides links to and summaries of a variety of open source resources related to frailty and older adults.  4 pages.

Frailty has important implications for the care needs of older adults and how those needs are met. By recognizing frailty and measuring it objectively, clinicians can better engage patients and their loved ones in difficult discussions about treatment plans and prognosis, and ultimately deliver better palliative care.

LTC - Frailty Clinical Education

The authors of this article discuss the close associations of frailty and physical and functional impairment with mild cognitive impairment (MCI) and the implications for improving diagnostic acuity of MCI and targetting interventions among cognitively frail individuals to prevent dementia and disability. 

The majority of cancer incidence and mortality occurs in individuals aged older than 65 years, and the number of older adults with cancer is projected to significantly increase secondary to the aging of the US population. As such, understanding the changes accompanying age in the context of the cancer patient is of critical importance.

Frailty assessment provides a means of identifying older adults most vulnerable to adverse outcomes. Attention to frailty in clinical practice is more likely with better understanding of its prevalence and associations with patient characteristics. We sought to provide national estimates of frailty in older people.

Dr. John Puxty, Geriatrician & Director of the Centre for Studies in Aging & Health at Providence Care, gave an overview of Frailty & Common Comorbidities  in an online presentation to health care professionals in South East Ontario via the Ontario Telemedicine Network on January 17th, 2017.  A copy of the event flyer and link to the presentation recording are available.

There is emerging evidence of the role of certain nutrients as risk factors for frailty. However, people eat food, rather than nutrients, and no previous study has examined the association between dietary patterns empirically derived from food consumption and the risk of frailty in older adults.

LTC - Frailty CoP/CoI

We are identifying and evaluating the resources for this area and encourage you to check back. If you have a suggestion for a resource appropriate to this sector, resource type and issue, we welcome you to email info@sagelink.ca and provide us with some information about the resource.