Learning to Spot Frailty

By JUDITH GRAHAM

Doctors should screen all adults over age 70 for frailty, a medical syndrome that affects 5 percent to 10 percent of people in this age group, according to a new consensus statement from six international medical organizations.

Frail seniors are tired, weak, thin and listless, with a reduced ability to bounce back from physical challenges and a greater risk of becoming disabled, dependent and dying earlier than others of their age. This was first identified as a condition worthy of attention in the medical community in the 1990s by Dr. Linda Fried, now dean of the Columbia University Mailman School of Public Health.

Since then, researchers have been debating how to define frailty and what interventions are called for. A previous international medical conference on frailty failed to produce a recommendation in favor of routine screening for older adults, the position advanced for the first time in this new statement.

Although there are several reliable tests for frailty, very few physicians other than geriatricians routinely evaluate older patients for this condition, said Dr. John Morley, a professor of geriatrics at St. Louis University and an author of the statement, published this month in The Journal of the American Medical Directors Association.

 

That ought to change, Dr. Morley said, because several factors that can contribute to frailty are easily treated. For instance, fatigue — a signature characteristic of this condition — can be caused by depression, anemia, thyroid or adrenal disorders, or vitamin B12 deficiency, all of which can be addressed with prescription drugs and other interventions.

Similarly, muscle weakness, another characteristic, can be improved with aerobic exercise and resistance training. “I tell my patients, ‘Walk for 10 to 15 minutes faster than a dog walks, and find a couple of bean cans and lift them up and down for five minutes each day in any direction,’” Dr. Morley said. “That’s roughly what people need to do.”

Even the most vulnerable, physically challenged older adults can benefit from exercise, which “conferred its greatest benefits to improvements in health status to those who were more frail at baseline,” according to a 2009 study by Canadian researchers published in the journal PLoS One.

Yet another cardinal sign of frailty is weight loss. Supplements like Ensure shakes can help elderly people maintain or put on weight. Frail seniors with multiple chronic medical conditions and symptoms like fatigue, dizziness or mental confusion can benefit when their medications are adjusted.

Caregivers can help identify frailty by asking five questions from the screening test below, Dr. Morley said. Arrange an evaluation by a physician when an older person answers “yes” to at least three.

Are you fatigued?
• Do you have difficulty walking up one flight of steps?
• Are you unable to walk more than one block?
• Do you have more than five illnesses?
• Have you lost more than 5 percent of your weight in the last six months?

Other tests recommended in the consensus statement include questions about walking speed (slow walking can be a sign of frailty), grip strength (a weaker grip is an indication), the extent of physical activity, and memory complaints.

Organizations that have signed on to the new consensus statement on frailty include the International Association of Gerontology and Geriatrics; the Society on Sarcopenia, Cachexia and Wasting Disorders; the European Union Geriatric Medicine Society; the American Medical Directors Association; the American Federation for Aging Research; and the International Academy on Nutrition and Aging.

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Filed under adult children of aging parents, aging drivers, Aging In Place, Alzheimer's Disease, care giving, dementia, elder care raleigh nc, Geriatric Care Management, long term care planning, NC, Raleigh

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