Frailty Assessment and Management
Introduction
As we are getting older, we accumulate health deficits that are eventually manifested as frailty, disease or disability. Older adults with frailty has loss of physiologic reserve and increased vulnerability to adverse health outcome such as disability, falls, delirium, hospitalization, nursing home admission and death.
Studies show ¾ - ½ of elderly over 85 years old are estimated to be frail and have a substantially increased risk of adverse health outcome.
Failure to detect frailty potentially exposes elderly patients to interventions/treatments from which they might not benefit and could be harmful.
The development of frailty often leads to a spiral decline of increasing frailty. Worsening frailty is also highly associated with an increased risk of death.
Frailty Index Lab – What We Do : Comprehensive Geriatric Assessment
We use the cumulative deficit model of frailty index to identify frailty as accumulating evidence showed the risk of mortality increases monotonically with the total burden of health deficits rather than specific deficit types. (Reference 1, 2)
We use a standardized, evidence-based frailty index calculator based on comprehensive geriatric assessment in order to assess frailty. We use the online Frailty Index (FI) calculator developed by the Gerontology research team at Beth Israel Deaconess Medical Center ( PI : Dae Hyun Kim, MD, MPH, PHD) . The Frailty index calculator covers medical history, functional status, cognitive function, gait speed/hand grip strength and nutritional status. (BIDMC FI calculator link here)
Our frailty assessment can give patients/providers a deeper insight into the complex frailty and help them to develop interventions to improve outcome.
From our consistent and accurate assessment, we generate long term frailty index data for each patient, which can be used for personal health progress evaluation and mortality & morbidity prediction. It can also be used as an evaluation tool to check if the interventions are working.
The frailty index data can provide better risk discrimination and can inform clinicians of patient’s vulnerability and need for additional perioperative management, which leads to reduction of post-surgical complications. (Reference 3)
For elderly with higher frailty index, we can facilitate goal-directed care such as palliative care, hospice care and alternative treatment.
Guided Geriatric Care / Coordinated Care – What Can Be Done : Better Healthcare Solution
With our Frailty assessment, we connect people with frailty to geriatric specialists for more comprehensive care, patient-centered care and coordinate care.
We teach people the skill/knowledge to improve adaptive capacity and guide them for better self-management.
With Frailty data, we can guide people to set individualized and goal-directed care
We aid medical professionals to develop pattern recognition for better management of frailty and facilitate efficient care planning
Reference
Rockwood K and Mitnitski A. Frailty Defined by Deficit Accumulation and Geriatric Medicine Defined by Frailty. Clin Geriatr Med 2011; 27: 17-26.
Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A Standard Procedure for Creating a Frailty Index. BMC Geriatrics 2008; 8: 24.
Kim DH, Afilalo J, Shi SM, Popma JJ, Khabbaz KR, Laham RJ, Grodstein F, Guibone K, Lux E, Lipsitz LA. Evaluation of Changes in Functional Status in the Year Following Aortic Valve Replacement. JAMA Intern Med. 2019; 179: 383-391.