frailty

Introduction

frailty is the accumulation of deficits with ageing resulting in mobility issues, loss of independence
the level of frailty is an important factor in:
- falls risk
- depression due to mobility issues, loss of independence
- need for emergency department attendance - 20-40% of ED attendances are said to be for those who are frail
- impaired ability to return to prior baseline levels after an acute illness or even following ED processes - each episode likely to further increase long term frailty
- mortality risk

there appear to be genetic risk factors
- a 2025 study suggested there were many genes that affect how our immune system, brain and metabolism work which contribute to risk of frailty ¹⁾
ageing
cognitive deterioration
psychological deterioration
- falls result in increased risk of falls partly due to loss of confidence, possibly depression leading to inattention
physical deterioration
- musculoskeletal
  - chronic pain / disabiity
  - sarcopenia / generalised muscle wasting
    - reduced protein intake
    - alcohol
    - smoking
    - exercise
    - hormonal
    - pathologic
    - genetic factors account for ~50-60% of sarcopenia variability - see sarcopenia / generalised muscle wasting
- neurologic disabilities
- impaired vision/hearing may lead to increased risk of falls, social isolation, depression, etc

1. “very fit”
2. “well” - no active disease symptoms, occasionally very active or exercise
3. “managing well” - well controlled medical symptoms but are regularly active beyond regular walking
4. “vulnerable” - symptoms limit activities, “slowed up” or “tired during day” but not dependent upon others
5. “mildly frail” - more evident slowing and may need help with higher level IADLs (usually unable to walk outside alone or go shopping)
6. “moderately frail” - need help with all outdoor activities and with keeping house. Have problems with stairs and bathing.
7. “severely frail” - completely dependent for personal care
8. “very severely frail” - approaching end of life - may not recover from a minor illness.
9. “terminally ill” - end of life with life expectancy < 6 months even if not otherwise evidence of frailty

score: 0 = robust; 1-2 = prefail; 3-5 = frail

What doesn't kill you makes you stronger is a MYTH
- this may be useful in some psychologic situations but in general most trauma, especially if it involves articular surfaces of joints, leaves long term sequelae which may limit activities life long and this may be severe enough to create a vicious downward spiral of poor health, frailty, obesity, depression.
- frailty tends to beget further frailty
PREVENTION is MUCH BETTER THAN CURE!

regular aerobic and muscle bulk maintenance exercises
risk mitigation to prevent trauma and its associated long term disabilities which lead to frailty
- risk assess activities and manage appropriately even when young adults
  - don't be stupid
  - take extra care in high risk situations
- falls risk prevention
maintenance of social networks
healthy lifestyle to reduce cardiovascular, stroke, obesity, diabetes and osteoporosis risks in particular
no smoking
adequate protein in diet - the body does not store protein except in muscles - you don't want these wasting away

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