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Death wishes of the very old 1
Published in Govert den Hartogh, What Kind of Death, 2023
Not only the individual conditions by themselves are to be considered medically classifiable diseases or ailments. What as a result of the process of ageing understood in the way I described is most characteristic of old age is the plurality of health deficits, interacting with each other, and creating a decreased resistance to environmental stressors. This condition is by now known as ‘frailty’ or the ‘frailty syndrome’ and it is increasingly measured by means of a ‘frailty index’.21 The concept of frailty presents itself as an important new medical classification, because at the dawn of the ‘fourth age’ it has both predictive value for incomplete recovery from acute ailments, falling down, loss of control, hospitalization and death, as well as a guiding value for medical efforts, e.g. as regards nutrition and physical activity, and in particular for adapted treatment of the component diseases.
Neurointensive care: Postoperative management
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Frailty is defined as a state of vulnerability with reduced physiological reserves affecting the capacity to maintain or regain homeostasis when exposed to stressors, such as surgery, that place patients at increased risk of adverse health outcomes (57). Frailty has multiple causes, such as physical, psychological, social, or any combination of these. It may include loss of muscle mass and strength, reduced energy and exercise tolerance, cognitive impairment, decreased physiological reserve, and reduced ability to recover from acute stress. Risk factors for frailty are advanced age, functional decline, poor nutrition and/or weight loss, polypharmacy, poverty and/or isolation, and medical and/or psychiatric comorbidity (58). Frailty is associated with an increased risk of adverse outcome (59). A recent meta-analysis found that frailty was associated with increased risk for negative health outcomes such as hospitalization, loss of activities of daily living, premature mortality, physical limitation, and falls and fractures (60). A higher modified frailty index (mFI) has been associated with a higher risk of postoperative complications in patients undergoing spine and cranial neurosurgeries (61,62). The frailty index may provide an additional tool to improve perioperative risk stratification (63,64).
General principles on caring for older adults
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Frailty assessment can be useful in individualizing cardiovascular therapy, since older adults with CVD and severe frailty have a shorter remaining life expectancy and increased risk for treatment-related harms. There are a number of validated instruments to measure frailty (36). The frailty phenotype is the most widely used assessment that is based on unintentional weight loss, weak grip strength, exhaustion, slow gait, and physical inactivity (37). It classifies individuals into robust (0 of 5 components), pre-frail (1–2 components), and frail state (≥3 components). Each component of frailty phenotype can be targeted by interventions. The deficit-accumulation frailty index is an alternative measure that quantifies frailty as a proportion of deficits (e.g., symptoms, signs, diseases, diagnostic test abnormalities, functional limitations) in medical, physical, cognitive, emotional, and sensory domains from a survey, medical record, or comprehensive geriatric assessment (38,39). Although the frailty index can take a value between 0 and 1, very few people have a frailty index greater than 0.6, suggesting that an individual with more than 60% of deficits has very high mortality risk (40). In other words, a patient whose frailty index is close to 0.6 has little reserve to withstand additional stress from adverse drug reactions, invasive procedures, or hospitalizations. Compared with frailty phenotype, the frailty index offers better prediction of adverse health outcomes (41).
Older Adults’ Views on Social Interactions and Online Socializing Games – A Qualitative Study
Published in Journal of Gerontological Social Work, 2023
Jeroen H. M. Janssen, Evi M. Kremers, Minke S. Nieuwboer, Bas D. L. Châtel, Rense Corten, Marcel G. M. Olde Rikkert, G. M. E. E. (Geeske) Peeters
Quantitative data were predominantly collected for description of the sample. The questionnaire consisted primarily of the Older Persons and Informal Caregiver Survey-Short Form (TOPICS-SF) (Santoso et al., 2018), which provides information on demographics, physical and mental well-being, daily living activities, and morbidity. The TOPICS-SF was used to compute a frailty index (range 0–1, higher scores indicating higher levels of frailty), and a cutoff of 0.2 was used to classify someone as frail (Lutomski et al., 2013). The term ‘frailty’ refers to a state of vulnerability to adverse health outcomes (Clegg et al., 2013; Lutomski et al., 2013), and the frailty index is a way to quantify this vulnerability. Loneliness was measured with the 6-item De Jong-Gierveld Loneliness scale (range 0–6), categorized as not lonely (scores 0–1), moderately lonely (scores 2–4), and severely lonely (scores 5–6) (De Jong Gierveld & Van Tilburg, 2006, 2008). Network size was measured by asking the number of people the participants had regular and important contact with (response options: 2 to 5, 6 to 10, 11 to 15, 16 to 20, more than 20) (Kuiper et al., 2019). Lastly, fear of falling was administered by asking people whether they have been afraid of falling in the last twelve months. Fear of falling can decrease social activities, increase social isolation (Scheffer et al., 2008), and might therefore be positively associated with loneliness.
Conceptualization of frailty in rehabilitation interventions with adults: a scoping review
Published in Disability and Rehabilitation, 2023
Kristina M. Kokorelias, Shawna M. Cronin, Sarah E. P. Munce, Parvin Eftekhar, Katherine S. McGilton, Shirin Vellani, Tracey J. F. Colella, Pia Kontos, Alisa Grigorovich, Andrea Furlan, Nancy M. Salbach, Susan Jaglal, Brian Chan, Jill I. Cameron
Recently, existing definitions of frailty have been scrutinized. Rather than simply defining a patient as frail or not frail, Searle and Rockwood [12] suggest definitions of frailty should distinguish between different severities of frailty. The Clinical Frailty Scale (CFS) is evaluated by a health care provider and provides a summary of frailty in an individual [13]. Recently, the CFS has been expanded to a classification tree to help healthcare providers further understand frailty [14]. The frailty index considers accumulated deficits (symptoms, signs, functional impairments, and laboratory abnormalities) to measure the health status of individuals [15]. In addition to the challenges associated with defining frailty, there is no standard assessment of frailty for use in clinical practice or research [16]. A comprehensive assessment of frailty should have content validity (e.g., is dynamic and includes multiple determinants), construct validity (e.g., advancing age and related to disability), and criterion validity (e.g., predicts adverse outcomes) [17]. Frailty measurements could inform eligibility to participate in rehabilitation programs and serve as an outcome in rehabilitation intervention research. Thus, despite rehabilitation having the potential to improve outcomes for adults with frailty, there is limited understanding of frailty in rehabilitation intervention research [18].
Frailty and Nutrition Risk Predict Falls and Emergency Department Visits in Home-Delivered Meal Clients
Published in Journal of Nutrition in Gerontology and Geriatrics, 2023
Heather Hutchins-Wiese, Grigoris Argeros, Sarah E. Walsh
Frailty assessment may provide a more holistic approach to screening and assessment of older adults than nutrition risk alone. Frailty assessment is a way to identify older adults with increased vulnerability due to age-associated declines in function and resilience that cross multiple physiologic symptoms.12 A myriad of tools have been identified to assess frailty; regardless of the tool used, frailty is associated with greater health care use, multiple comorbid conditions, and increased mortality.13–17 One such tool, the Frailty Index (FI), was identified as a pragmatic approach to assessing frailty in community dwelling older adults receiving MOW services.18 Both frailty and nutrition risk are associated with health outcomes for older adults including falls, ED visits, and hospitalizations.15,19–23 However, systematic identification and associations between health risk and outcomes have not been studied in the MOW population.