Frailty affects up to 20 percent of individuals over the age of 70 years of age.
Frailty is a geriatric, older adult syndrome that is recognized as a risk for further decline and should be screened for by all clinicians who care for the elderly. Statistics vary, but the literature suggests that frailty affects up to 20 percent of individuals over the age of 70 years of age. Frailty is more common in women and in lower socio-economic populations. Frailty increases with age and multiple illnesses. Seniors living at home are less likely to be considered frail than those who reside in assisted living or nursing facilities. Frailty or complications of frailty are often the reason that a senior requires admission to a facility.
Senior Frailty is manifested in a number of ways
Frailty can be manifested in a variety of complex signs and symptoms. The five criteria that are used to diagnose frailty include: Weight loss; Exhaustion; Weakness; Slowness and; Low levels of activity. If a senior meets at least three of these criteria, they are considered to be frail. Less than three deserves monitoring and intervention and more than three increases the risk of adverse outcome for the senior significantly. Frailty can lead to increased risk for falls, and their complications–fractures, disability, hospitalization, premature death and institutionalization.
As a caregiver, you are the most effective and efficient monitor of the onset of frailty. Watch the way the senior walks observing for sway in the gait, pace of ambulation, grabbing on to walls, doors or chairs.
As mentioned above, weight loss may occur in spite of adequate intake. The senior may not want to participate in outings or meetings with friends and family because it is too tiring. The senior may want to sleep excessively during the day and still expect to sleep well at night. These are all changes to be monitored for and reported to the healthcare practitioner.
Another contributing factor is Polypharmacy, referring to taking many medications prescribed by multiple clinicians.
Testing for frailty
Testing for frailty can be as simple as asking questions concerning the signs and symptoms. If the senior is unable to respond to the questions, the healthcare clinician can test and observe for changes. Physiological factors that need to be assessed include anemia, thyroid disease and diseases that include inflammation. Diagnoses that can lead to a greater risk of frailty include heart disease, diabetes, and kidney disease.
Medications are chemicals which the body must metabolize and dispose of, and have side effects that may exacerbate frailty or mimic frailty symptoms. As a result, the senior may have diminished liver, kidney and heart function if these medications are not detoxified or excreted efficiently. When this occurs the medication may accumulate causing other difficulty.
Frailty is sometimes hard to diagnose. In fact The Journal of the American Medical Directors Association found that although there are several reliable tests for frailty, this syndrome is often overlooked by healthcare providers. The individual symptoms are recognized, but they are not correlated as a treatable condition.
A New York Times story quoted Dr. John Morley, a professor of geriatrics at St. Louis University, as saying “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.”
Exercise can help restore strength
Even the most vulnerable, physically challenged older adults can benefit from some simple exercises. This includes walking for 10 to 15 minutes and lifting cans of food for five minutes each day. Even those with cognitive impairment can be encouraged to exercise with direction and cuing. Exercise in a chair while sitting, water aerobics and isometric exercises can lead to improvement in function.
How caregivers can assess frailty
Dr. Morley recommended that caregivers can help identify frailty by asking or assessing the five issues from the screening test below.
• 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?
If an older person answers “yes” to at least three, an evaluation by a healthcare provider is recommended.
Don’t overlook frailty
Frailty is not something to be overlooked due to the potential adverse outcomes that can occur with its onset. As a caregiver, look for the onset of the symptoms as the senior under your care experiences these changes. Report these to your healthcare provider for assessment and identification of treatable or reversible conditions. Be the best advocate you can be to help protect the senior under your care.
If for any reason you are not able to advocate for the senior under your care, seek out an eldercare or senior expert for assistance.
Mardy Chizek, RN, FNP, BSN, MBA, AAS
President, Charism Eldercare Services, Westmont, Illinois