Measuring Frailty Research

The WHOQOL surveys were developed by the World Health Organization (WHO) to assess population groups in a variety of situations in an effort to evaluate quality of life across various cultures (University of Washington, 2016). WHOQOL-OLD is one such measure for older adults, which was created in part because other QOL scales like WHOQOL-100 and WHOQOL-BREF did not address some of the more pertinent issues that individuals face in the latter portion of their lives (University of Washington, 2016). Similar to the other quality of life assessment tools created by WHO, WHOQOL-OLD includes basic, yet important quality of life indicators that touch upon the physical, psychological and environmental states of individuals as well as the quality of

(helpguide, 2012) Effective care for older patients requires an accurate assessment of the elderly's health status. Physical, psychological, social, and behavioral and health system factors may influence their health status. Functional health status includes: a) basic activities of daily living; dressing, feeding, bathing, toileting, transfer-moving inside and round the house, b) instrumental activities of daily living; shopping, laundry, cooking, housekeeping, taking medication, managing money, c) advanced activities of daily living; social activity, occupation, recreation. Cognitive function assessment includes: attention span, concentration, intelligence, judgment, learning ability, memory, orientation, perception, problem solving, psychomotor ability, reaction time, social intactness. (ispub, 2012)

Suzman, R., Beard, J. R., Boerma, T., & Chatterji, S.Health in an ageing world—what do we know? The Lancet, 385(9967), 484-486. doi:10.1016/S0140-6736(14)61597-X

The patient’s previous function should always be considered so as to know how far the patient has deteriorated and thus be able to consider the decline as either normal or abnormal. Nevertheless, Nathan also mentioned this, saying that older people are not afforded the same history and investigation as younger ones, thus driving basically the same point home. Older patients are discharged quickly without even being properly treated, consequently making their ailment become worse as time passes. We cannot just assume that what a patient is going through is normal and thus unimportant, rather the authors make it clear that we should give older people the same options, care, and patience that we offer to the younger

‘Frailty thy name is woman' emotionally refers to his mother 'Hamlet' (Act 1, Scene 2). While the term “frailty” has been around for a while, the use of it in a medical literature has only been evolving in the past 30 years. However, condition with similar meaning, was described back in 1914 in a publication “The Diseases of Old Age and their Treatment” (Nascher, 1914). In this publication Nascher describes a condition of his elderly patients as “senile disability” or “senile cachexia” manifesting in general physical weakness and mental impairments as a result of the aging process. Later, several authors use term “Failure to Thrive” while describing a multifactorial state of decline in elderly (Kimball et al., 1995; Robertson et al., 2004; Sarkisian et al., 1996). The search term “frail elderly” in PubMed.gov generated 8384 results indicating great interest by clinicians and researchers in this topic. However, despite the interest there is considerable uncertainty regarding the concept and definition of frailty (Bergman et al., 2007). Frailty is “one of those complex terms – like independence, life satisfaction, and continuity – that trouble gerontologists with multiple and slippery meanings” (Kaufman, 1994).

Frailty is a common clinical syndrome in older persons that carries an increased risk of poor health outcomes. Frailty has been described as “a physiologic state of increased vulnerability to stressors that decrease physiologic reservoirs, resulting from aging and decrease function of multiple physiologic organs (1). The overall prevalence of frailty in USA community dwelling aged 65 or older in the United States ranges 7-12%. The prevalence of frailty increased with age from 3.9% in the 65-74 age group to 25% in the 85+group, and was greater in women than men (8% vs. 5%) (2).

This questionnaire has several subdomain scores including Vitality, Physical Functioning or Emotional Role Functioning and two component scores Physical (SF-PCS) respectively Mental (SF-MCS), the scores ranging from 0 (worst possible) to 100 (best possible) [10]. In this study, SF-36 was used to compare HRQoL in both populations and in particular, to detect the presence of the clinically significant fatigue: this is defined with scores for Vitality subdomain of 50 or less. This cut-off being validated in other autoimmune debilitating diseases such as multiple sclerosis or rheumatoid arthritis [11-13].

The aims of those studies were to estimate the prevalence of frailty, and its ability to predict outcomes in older patients as short-term outcomes in

Sarcopenia results in unfavorable and detrimental effects on an older person’s physical function. Muscle mass decrease is probably the single most frequent cause of late-life disability among older people. It is directly responsible for functional impairment with loss of strength, and increased likelihood of falls and fractures, as muscles account for 60% of the body protein stores, the reduction in lean body mass has other health effects independent of its functional consequences (Rolland et al., 2008).

Figure 1. The effect of gender on the mean forced vital capacity in college aged students. The data reported as the mean ± standard deviation with n = 127, 59 respectively. The asterisk signified the male mean FVC is significantly different than the female mean FVC.

An ICU patient’s functional status is a crucial factor when physical therapists recommend a discharge location. Early physical interventions and effective discharge planning can reduce a patient’s length of stay therefore, reducing rates of ICU-acquired weakness as well as readmission rates.1 Prolonged inactivity results in decreased functional ability which in turn effects quality of life. Therefore, it’s imperative that functional outcome measures are implemented in the ICU to reduce the likelihood of adverse effects from occurring as well as determine appropriate discharge destinations as soon as possible.2 This being said, there are currently 26 different outcome measures that can be used to assess ICU patient’s functional abilities.3 However, there is no consensus about which outcome measure is most appropriate to use in the ICU to determine discharge

From our review, there are a few studies of frailty in orthopedic clinical settings. Also, frailty is complex with multidimensional components; there is not enough robust evidence to justify which frailty instrument has the edge over others in clinical settings. However, the reasons to consider for selecting clinical frailty instruments should be concerned with: clinical contexts, conceptual or theoretical framework, validity and reliability of frailty instruments, and predictability of health outcomes. Based on reasons as mentioned, the CHS (Fried’s Frailty Phenotype) and FI (Frailty Index) have more advantage than others. The FI has a strong predictability of the adverse health outcomes, but the cut points vary. Moreover, the comorbidity

As stated above elderly are at risk of vulnerability due to mental, physical, economic, and social issues. These issues influence their lives predisposing them of developing several health problems. Health risk factors increase with age, the U.S Centers for Disease control and Prevention (CDC) identified heart disease as the leading killer among individuals older than 65 years old. The (CDC) described that 37 percent of men including 26 percent women age 65 and older are affected by this chronic disease (Vann, M. R., 2015). This study demonstrates that elderly are one of the vulnerable category, they are challenged by many health conditions, resources are available to provide them with adequate assistance, and healthy people 2020 objectives meet their

As individuals age changes occur physiologically that are part of normal aging. These changes occur in all organ systems and can impact an individual’s quality of life. The changes related to aging can be attributed to an individual’s genetic make up, lifestyle, physical activity, and dietary lifestyle. Being able to differentiate between normal changes in aging against disease process is important because it can help clinicians develop a plan of care (Boltz, Capezuti, Fulmer, & Zwicker, 2012). Creating an accurate plan of care for older adults will greatly impact their quality of life.

The other challenging for healthcare providers and researchers in assessing frailty is that detecting the truly frail person based on specific context. Evidence from the Global Burden Diseases (GBD) report revealed that the dissimilar context or geographical areas show the different outcomes (GBD). Thus, the cultural sensitive frailty screening is needed in clinical settings. The existing frailty instruments concern multidimensional of frail person; evidently, the individuals’ difference plays the important roles in distinguishing frailty. Therefore, many studies focus on the individual factors–genetic/epigenetic, metabolic factors, environment, and lifestyle–to delineate frailty.(Aunan et al., 2016; Fulop et al., 2015; Morikawa et al., 2013;