Frailty
An aging-related syndrome of physiological decline, characterised by marked vulnerability to adverse health outcomes.
Prevalence
[edit | edit source]- About 4-16% in patients >65yo
- Pre-frailty - 28-44% in >65yo
Definitions
[edit | edit source]- Physical frailty - encompasses representative signs and symptoms
- Deficit accumulation frailty/index frailty - a conceptual framework that identifies frail and vulnerable people through cumulative comorbidities and illnesses
Pathophysiology
[edit | edit source]- Related to dysregulated stress responses and energy response systems, along with age-related molecular changes, chronic environmental exposures, and specific disease states
- Sarcopenia
Diagnosis and classification
[edit | edit source]- Dalhousie Clinical Frailty Scale
- FRAIL scale (1 point for each, and frail = 3 or more)
- F atigue (most/all of the past month)
- R esistance (to climbing a flight of stairs)
- A mbulation (difficulty walking one block)
- I llnesses (HTN, T2DM, cancer, MI, CCF, angina, arthritis, stroke, CKD)
- L oss of weight (>5% in past year)
Differential diagnosis
[edit | edit source]- Depression
- Malignancy - lymphoma, MM, occult solid tumours
- Rheumatologic disease
- Endocrine - thyroid, DM
- Cardiovascular - HTN, CCF, IHD, PVD
- CKD
- Haematologic - myelodysplasia, iron deficiency, pernicious anaemia
- Nutritional deficiencies
- Neurologic disease - PD, vascular dementia, serial lacunar infarcts'
Investigation
[edit | edit source]- FBE
- UEC
- LFT
- B12
- Vitamin D
- TSH
- HbA1c
Management considerations
[edit | edit source]- Establish goals of care
- Exercise programs
- Geriatrician involvement
- OT
- Nutritional supplementation
- Medication review
- Palliative care
Risk calculators (emergency laparotomy)
[edit | edit source]- NELA
- Estimated 30-day mortality risk
- Created using data entered in the UK National Emergency Laparotomy Audit between 2016 and 2019
- Originally released 2020, with 2023 update
- More accurate than P-POSSUM in the UK
- Available on app or https://data.nela.org.uk/riskcalculator/
- NSQIP (National Surgical Quality Improvement Program)
- Based on American data
- Granular information on risk of specific complications and predicted length of stay
- Emergency or elective, and procedure-specific
- https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp
- P-POSSUM
- Now a bit outdated, and not as good as NELA/NSQIP
- Tends to overestimate mortality