Frailty in the Older Adult - PowerPoint PPT Presentation

Loading...

PPT – Frailty in the Older Adult PowerPoint presentation | free to download - id: 6c0c99-NjEwM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Frailty in the Older Adult

Description:

Title: Powerpoint Templates Subject: The University of Alabama at Birmingham Author: UAB Public Relations & Marketing Last modified by: Channing Ford – PowerPoint PPT presentation

Number of Views:25
Avg rating:3.0/5.0
Date added: 22 August 2019
Slides: 36
Provided by: UABPu
Learn more at: http://www.lhl.uab.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Frailty in the Older Adult


1
Frailty in the Older Adult
  • Cynthia J. Brown, MD, MSPH
  • Associate Professor
  • Director, Geriatric Medicine Section
  • Birmingham/Atlanta VA GRECC
  • University of Alabama at Birmingham

2
Learning Objectives
  • Identify key features of frailty as currently
    defined
  • Define sarcopenia
  • Understand changes in body composition associated
    with aging
  • Describe how a multidisciplinary team might
    approach frailty in the older adult

3
Case Presentation
  • Case 1 An 82-year old man with a history of
    heart failure, knee osteoarthritis, and
    hypertension presented for elective knee
    replacement.
  • Case 2 An 82-year-old man with a history of
    heart failure, knee osteoarthritis, and
    hypertension presented for elective knee
    replacement.
  • Case 3 An 82-year-old man with a history of
    heart failure, knee osteoarthritis, and
    hypertension presented to the ED after being
    found by a neighbor on the floor.

4
  • These three patients demonstrate different levels
    of susceptibility and clinical stability, which
    strongly affected clinical outcomes.
  • There appears to be a spectrum of resilience,
    from highly independent and robust to the most
    frail and vulnerable.

5
Defining Frailty
  • Break into your small groups and answer the
    following questions
  • How would you define the term frail?
  • What makes a person frail?
  • Are there key components to frailty?

6
Frailty Definitions
  • A variety of definitions have been used defining
    frailty as synonymous with
  • Disability
  • Comorbidity
  • Advanced Old Age
  • However, while there is some overlap, frailty
    appears to encompass more than disability or
    comorbidity.

7
Overlap of Frailty with ADL Disability and
Comorbidity
N67
5.7
21.5
26.6 N98
N2131
46.2
Fried LP, J Gerontol Med Sci, 2001
8
Frailty Definition
  • Clinicians have begun to define frailty as
  • a syndrome of decreased reserve and resistance
    to stressors, that result in cumulative declines
    across multiple physiologic systems, causing
    vulnerability to adverse outcomes.
  • It has been postulated that there are key
    components of frailty, and multiple components
    must be present to constitute frailty.

Fried LP, J Gerontol Med Sci, 2001
9
Frieds Model of Frailty
10
Frieds Model of Frailty
11
Definitions of Components of Frailty
  • Shrinking
  • gt 10 pounds lost unintentionally in past year
  • Self-reported exhaustion
  • Self-report of exhaustion on CES-D questions
  • Weakness (grip strength)
  • Grip strength lowest 20 adjusted for gender
    BMI
  • Slow walking speed
  • Slowest 20 to walk 15 feet
  • Low physical activity
  • Lowest quintile of weighted kilocalorie expended
    per week

12
Sarcopenia in the Older Adult
13
Sarcopenia
  • Sarcopenia age-related loss of muscle mass and
    strength.
  • Changes in the muscle fiber itself, and an
    increase in infiltration of fat into the muscle
    (myosteatosis) also common with aging.
  • Changes all lead to a decline in muscle function.

14
Sarcopenia and Myosteatosis
Petrella et al. Eur J Appl Physiol 2007
Top Young Male, age 25 Bottom Older Male, age
63 Height and weight matched
Top Young Female, age 27 Bottom Older Female,
age 65 Height and weight matched
15
(No Transcript)
16
Age-related Loss of Muscle Mass
N211




Values are mean SE. Main age group effects,
Plt0.001. Different from 25 y, Plt0.05.
Different from 37 y, Plt0.05. DXA-determined
limb muscle mass. MM
Bamman, et al.
17
Functional Consequences
18
Evaluation of Function
  • Walking fundamental mobility task.
  • Variables that influence walking speed include
  • Musculoskeletal status
  • Sensory function
  • Motor control
  • Cognitive status
  • Walk speed a general summary indicator could be
    useful single-item screening tool

19
Gait Speed
20
(No Transcript)
21
Predicted Median Life Expectancy by Age and Gait
Speed
Studenski S, et al. JAMA. 2011305(1)50-58.
22
Timed Chair Stands
  • Used to evaluate lower body strength and
    endurance
  • Instruct to stand from chair without using arms 5
    times while being timed.
  • Normative values available, can identify which
    older persons may have problems with strength.

23
(No Transcript)
24
Get Up and Go Test
  • The get up and go test asks a person to
  • stand from a chair without using their arms
  • walk 10 feet
  • turn around and walk back
  • and sit in the chair
  • Can be timed with a time of 20 seconds
    indicating risk for adverse outcomes.
  • Can also observe for unsteady gait.

25
(No Transcript)
26
(No Transcript)
27
Now it is your turn to try these easy clinical
assessments
28
Health Literacy in Older Adults
29
Contributing Factors in Older Adults
  • Fewer years of schooling, poorerfixed incomes
  • gt 50 do not take meds as directed
  • 68 cannot interpret blood sugar value
  • 76 cannot follow Upper GI instructions
  • 100 could not understand Medicaid rights in one
    study

30
Related Cultural/Language Barriers
  • Non-English speaking
  • Immigrant status
  • Ethnic interpretation of illness
  • Spiritual and religious beliefs
  • Default answers
  • Lack of insurance/transportation

31
Testing in a Busy Practice
  • Always assume and ask in sensitive way
  • How do you get your information?
  • What things do you like to read?
  • How satisfied are you with how you read?
  • Eyes wandering over page, very slow to finish,
    sounding out words, look confused
  • Remember the pill bottle prop
  • Ask questions about the dosage and frequency

32
Nutrition Problems in the Older Adult
33
Changes in Body Composition
  • There is a net decrease in
  • Bone mass
  • Lean muscle mass
  • Water content
  • There is a net increase in
  • Total body fat
  • Especially intra-abdominal (fat located inside
    the belly area/abdominal cavity)

34
Physiological Changes Accounting for Nutrition
Risk in Elderly
  • Changes in taste, and smell
  • Changes in the gastrointestinal system
  • Impaired thirst sensation
  • Atrophic gastritis (chronic inflammation of
    stomach with reduced stomach secretions.

35
Pathologic Changes Common in Aging
  • Chronic diseases and restrictive diets
  • Dental problems
  • Depression
  • Alcohol abuse
  • Medication side effects
About PowerShow.com