Frailty is a multisystem clinical syndrome of decreased physiological reserve and resilience, making older adults vulnerable to stressors.
π It is not inevitable with ageing, but more common with increasing age and multimorbidity.
βοΈ Pathophysiology
- Frailty reflects dysregulation across multiple systems:
- πͺ Musculoskeletal: sarcopenia β reduced strength and mobility.
- π§ Neurological: impaired cognition, balance, reaction times.
- π« Cardiopulmonary: reduced reserve, poor tolerance to stress.
- π©Έ Immune / Endocrine: inflammageing, insulin resistance, reduced vitamin D.
- Result = homeostatic instability β small insults (infection, fall, new drug) β disproportionate decline.
π Models of Frailty
- π¬ Phenotype (Fried): frailty = β₯3 of 5 (weight loss, exhaustion, weakness, slow gait, low activity).
- π Deficit accumulation (Rockwood): frailty index = ratio of deficits present.
- π Clinical Frailty Scale (CFS): 1β9, quick bedside tool β widely used in UK (NHS, NICE, BGS).
π§Ύ Frailty Syndromes (the βGeriatric Giantsβ)
- πΆ Falls: impaired balance, weakness, home hazards.
- π§ Delirium: acute confusion, often with infection, pain, drugs.
- π½ Incontinence: bladder or bowel, loss of independence.
- π Polypharmacy: multiple medications β adverse events, interactions.
- π Immobility: pressure sores, deconditioning, pneumonia.
π Clinical Features
- General: fatigue, unintentional weight loss, frequent infections.
- Physical: slow walking speed, weak grip, recurrent falls.
- Cognitive: poor concentration, memory issues.
- Functional: dependence in ADLs/IADLs, poor recovery after illness.
π Consequences of Frailty
- β‘ Increased risk of falls, fractures, delirium, disability.
- π₯ More hospitalisations, longer stays, higher readmission rates.
- π§© Greater dependency on care homes and social care.
- β οΈ Increased mortality risk.
π§ͺ Assessment Tools
- π Clinical Frailty Scale (CFS) β quick bedside stratification.
- π Gait speed β <0.8 m/s = frailty marker.
- πͺ Grip strength β reduced = sarcopenia indicator.
- π Frailty Index β research/academic use.
- π Edmonton Frail Scale β broader screening (cognition, mood, meds, nutrition, continence).
βοΈ Management Principles
- π©Ί Comprehensive Geriatric Assessment (CGA) β holistic, MDT approach.
- π Medication optimisation β deprescribe where possible.
- π Exercise & rehab β resistance training, physio to improve strength/balance.
- π₯ Nutrition β protein, vitamin D, calcium supplementation.
- π§ Cognitive support β screen for delirium & dementia, optimise hearing/vision.
- πͺ Social support β carers, social worker, community resources.
- π Advance care planning β discuss goals of care, avoid burdensome treatments.
π UK Context
- π NICE: frailty is a long-term condition requiring proactive identification and management.
- π NHS England: CFS recommended for β₯65s in hospital/ICU to guide decisions.
- π BGS: promote frailty identification in community (GP, care homes).
- π QOF (primary care): practices incentivised to code frailty and undertake medication reviews & falls risk assessment.
π‘ Teaching pearl: Frailty is dynamic and potentially reversible β interventions like nutrition, exercise, and deprescribing can slow progression.
Think of frailty as a "red flag vital sign" in older adults.
References
The Rockwood Clinical Frailty Scale is often used to categorize levels of frailty in older adults.
Revisions
- Ensure updates and revisions based on emerging research and clinical guidelines for the management of frailty.