This recording of a presentation by researcher Olga Theou, of Dalhousie University was about a review to identify and document the nature and extent of research evidence, policies and practice related to measuring frailty in pre-hospital and in-hospital settings.

This paper discusses engaging older adults living with frailty and their family caregivers. Frailty is a state that puts an individual at a higher risk for poor health outcomes and death. Understanding whether a person is frail is important because treatment and health care choices for someone living with frailty may be different from someone who is not (i.e., who is fit). In this review, the authors discuss strategies and hurdles for engaging older adults living with frailty across three settings: research, health and social care, and policy. The authors developed this review using published literature, expert opinion, and stakeholder input (including citizens). Engaging frail older individuals will be challenging because of their vulnerable health state - but it can be done.

This systematic literature review and narrative synthesis from the UK aimed to investigae the attitudes of the public and healthcare professionals to Advance Care Planning discussions with frail and older people.

The aim of this study was to determine the predictive power of the individual physical frailty indicators: gait speed, physical activity, hand grip strength, Body Mass Index (BMI), fatigue, and balance, for ADL and IADL disability. The sample consisted of 505 community-dwelling persons.  This study differs from previous studies in that it focuses on ADL and IADL disability and used a relatively short follow-up period.

Dr. John Puxty, Geriatrician & Director of the Centre for Studies in Aging & Health at Providence Care, gave an overview of Frailty and Falls in Long Term Care - Approach to High Risk Fallers in an online presentation to health care professionals in South East Ontario via the Ontario Telemedicine Network on December 8th, 2015.  A copy of the event flyer and presentation in PDF format are available.

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.

Care of the Frail Elderly: Navigating the Maze

CSAH Geriatric Education Conference • June 5, 2013 • Kingston, ON

On June 5, 2013, over 100 health professionals working in various settings including acute, community, primary and long-term care joined us at St. Lawrence College in Kingston for an exploration of new initiatives, community programs and clinical updates that addressed the realities of providing health care for the elderly with complex care issues.

Frailty is a health condition associated with a lessened capacity to recover from stressing experiences, such as a fall or hospitalization, which can lead to poorer health outcomes. Increasing age is a risk factor for frailty; about 4% of people aged 65 to 69 are living with frailty, compared to 26% of those aged 85 and above (1). These individuals can experience fatigue, unintentional weight loss, mobility issues (2) or delirium (3), and are likely to have two or more chronic diseases and use many medications (3).

Proper action and collaboration of patients, caregivers and medical professionals can reduce negative health outcomes associated with frailty (3). Eating a balanced diet, increasing physical activity and maintaining social interaction can lead to better health outcomes and quality of life for those affected by frailty. For more information on healthy living, please review the materials under the “Healthy Lifestyles” tab in Caregiver Resources. Additionally, regular checkups with a healthcare professional, medication reviews and staying informed on frailty, help ensure a state of good health. If frailty or pre-frailty is a concern, please schedule an appointment with your family physician to discuss a personalized care plan. 

References

(1)  Collard, R. M., Boter, H., Schoevers, R. A., & Oude Voshaar, R. C. (2012). Prevalence of frailty in community‐dwelling older persons: A systematic review. American Geriatrics Society, 60(8), 1487-1492. Retrieved from https://doi.org/10.1111/j.1532-5415.2012.04054.x

(2)  Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., . . . McBurnie, M.A. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology: Series A, 56(3), M146–M157. Retrieved from https://academic.oup.com/biomedgerontology/article/56/3/M146/545770

(3)  B.C. Ministry of Health. (2017). Frailty in older adults - Early identification and management. Retrieved from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/frailty

Public Information

We are currently developing 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 topic, we welcome you to email info@sagelink.ca with information about the resource.

 

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
  • 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 individuals are more likely to become functionally dependent; have a lower quality of life; and are more often re-admitted to hospital than non-frail individuals
  • 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 www.sagelink.ca/GPHE_intro_all_related_documents_2014_geriatric_periodic_health_exam
  • Components of the Comprehensive Geriatric Exam can be used to flag issues for further review with Geriatric Periodic Health Exam 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

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

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