Frailness

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Pathology 5 Clinical-manifestations 6 Laboratory 7 Complications 8 Management 9 More General Terms 10 Additional Terms 11 References

Introduction

• Fragility, or weakness in physical or mental health, with decreased reserves in multiple organ systems.

Etiology

• secondary to acute event
• end-stage of chronic disease(s)
• old age
• idiopathic

Epidemiology

• 3-7% of individuals 65-75 years of age [4]
• 20-40% of individuals > 80 years of age

Pathology

• decline in neuromuscular function
• sarcopenia
• osteoporosis
• diminished ability to respond to stress ( homeostenosis)

• decline in maximal oxygen consumption [3]

• fatigue, easy exhaustion

• psychomotor slowing

• slow walking speed if ambulatory

• comorbidities

• 7% of frail elderly have no known comorbidity
• 25% of frail elderly have 1 comorbidity

• inflammation may play role

Clinical-manifestations

• presents with multiple aspects of functional decline [7]
• weight loss, unintentional
• muscle weakness
• fatigue
• bradykinesia
• dyspnea on exertion
• loss of mobility
• anorexia
• develops in slow, stepwise process [4]

Laboratory

• serum 25-hydroxyvitamin D:

• both low & high levels associated with increased likelihood of frailty

Complications

• inability to perform activities of daily living, disability
• falls
• spiraling decline in vitality
• hospitalization

• has not been associated with nursing home placement [7]

• death

Management

• exercise may be of benefit

• stretching
• resistance training
• tai chi [4]
• aerobic exercise

• hormone replacement of little benefit

• testosterone replacement may benefit elderly men with low serum testosterone
• growth hormone of no benefit
• DHEA of no benefit

• calcium & vitamin D may improve sarcopenia
• no proven role of antioxidants
• increased caloric intake of no benefit
• increased protein intake of no benefit [7]
• positive attitude attenuates physical & mental decline associated with frailty [4]

More General Terms

• syndrome

Additional Terms

• osteoporosis
• sarcopenia

References

1. url>http://www.freedictionary.org</url>
2. Hirsch, Calvin, UC Davis grand rounds, Sept 14, 2006
3. Hollenberg M, Yang J, Haight TJ, Tager IB. Longitudinal changes in aerobic capacity: implications for concepts of aging. J Gerontol A Biol Sci Med Sci. 2006 Aug;61(8):851-8. PMID: [1]
4. Ahmed N et al, Frailty: An emerging geriatrics syndrome Am J Med 2007, 120:748 PMID: [2]
5. Morley J et al, Frailty and hormones Rev Endocr Metab Disord 2005, 6:101 PMID: [3]
6. Ensrud KE et al. Circulating 25-hydroxyvitamin D levels and frailty status in older women. J Clin Endocrinol Metab 2010 Dec; 95:5266. PMID: [4]
7. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010

frailness