Clinical Resources - Frailty

The elderly population is projected to make up 20% of the total United States population by the year 2030. In addition, epidemiological data suggests increasing prevalence of chronic pain and frailty with advancing age. Pain, being a subjective symptom, is challenging to manage effectively. This is more so in elderly populations with age-specific physiological changes that affect drug action and metabolism. Elderly patients are also more likely to have multiple chronic health pathologies, declining function and frailty.

This research article describes the results of a survey given to family physicians to determine their practice of, knowledge about and attitudes toward delivering preventative care during periodic health exams (PHE's). 8 Pages.

The study tested the IADL Profile tool developed incorporating executive function to better estimate independence of IADL's for individuals with TBI (Traumatic Brain Injury). The researchers reported the study provided strong preliminary evidence for the IADL's Profile reliability when administered by occupational therapists who participated in a 3 day workshop and adds to previous studies of the tool's validity and generalizability for clinical use. 11 pages.

The author of this descriptive research paper concludes that the PHE is a valuable tool in outpatient clinical practice and may reveal numerous important diagnoses or risk factors not always identified through routine screening. 8 Pages.

The author reviews what is known about frailty, including its definition, epidemiology, and pathophysiology, and examines potential areas of future research. 7 pages.

Clinical Care - Frailty Assessment Tools

This 5-Item Geriatric Depression Scale (GDS) screening / assessment tool is used for identifying depression in older adults. Applicable for a wide range of settings and can be used with older adults including those with mild to moderate cognitive impairment. 1 page.

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 study shows that the level of frailty was distributed along the socioeconomic gradient in both higher and lower income countries such that those individuals with less education and income were more likely to be frail. 

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.

Clinical Care - 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. 

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.

A flowchart algorithm which recommends the approach and steps to take when performing the Geriatric Periodic Health exam. 1 page.

This document provides a complete health check up list for clinicians to use with adults, based on recommendations from the Canadian Task Force on Preventative Health Care (CTFPHC) It includes evidence and non evidence based components. 5 pages.

Clinical Care - Frailty Management Handouts

This reading list includes links to and summaries of a variety of open source resources related to a variety of eating disorders and nutritional considerations. Topics include:
  • anorexia of aging
  • anorexia nervosa and frailty
  • reduced appetite in older age
  • recommendations for optimal nutrition
  • malnutrition
  • dysphagia
  • special considerations for those with brain injury and degenerative diseases
  • obesity
  • diabetes

6 pages. Last reviewed January 2019.

This reading list includes links to and summaries of a variety of open source resources. Topics related to Indigenous Elders include:
  • dementia
  • palliative care
  • end-of-life
  • disparities and inequalities
  • successful aging
  • culturally sensitive care
  • nutrition
  • diabetes
  • cancer
  • frailty
  • LGBTQ
  • abuse and trauma

6 pages. Last reviewed November 2018.

This reading list includes links to and summaries of a variety of open source resources related to osteoporosis. Topics include:

  • the relationship between Alzheimer's Disease and osteoporosis
  • diabetes and lower bone mineral density
  • falls and fractures
  • exercise interventions
  • frailty and osteoporosis
  • osteoporosis in men
  • osteoporosis in women
  • glucocorticoid-induced osteoporosis
  • nutrition

5 pages. Last reviewed September 2018.

This month's reading list includes links to and summaries of a variety of open source resources on the importance of resilience and how to support resilience in older adults. Themes include:

  • resilience in the presence of disease
  • social and community supports and considerations
  • family and caregiver resilience
  • measuring resilience

6 pages. Last reviewed June 2018.

This reading list provides links to and summaries of a variety of open source resources related to delirium in older adults. Topics include risk factors related to hip fracture, the HELP program, delirium at the end-of-life, delirium in dementia, non-pharmacological interventions, nutrition and frailty. 3 pages.