Overview for Frailty in the Community Setting

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)
  • 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 

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

Issue/Condition - Problème / état: 
Sector of Care - Secteur des soins: 
Resource Type - Type de Ressources: 
Author/Publisher - Auteur/Éditeur: 
Centre for Studies in Aging and Health
Date Published: 
2014-01