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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.
Dementia and physical health
Published in Graham A. Jackson, Debbie Tolson, Textbook of Dementia Care, 2019
Understanding and describing this state of increased vulnerability to a poor outcome is useful in helping target treatments to avoid loss of function, dependence or nursing home admission. Although frailty is largely a physical illness concept it is recognised that dementia and frailty overlap significantly. Dementia patients are more at risk of sudden decline in physical health and loss of function when affected by illness. In that sense dementia is a significant potential component of the frailty syndrome.
Interventions in frailty care and enhancing independence
Published in Shibley Rahman, Living with frailty, 2018
Disability prevention for older persons, in contrast to disease prevention, has recently been addressed by the Dutch Health Council as function-oriented prevention. The Dutch Health Council emphasises the necessity for development and evaluation of tailor-made interventions that focus on promoting independent functioning in daily life for (vulnerable) older persons with an important role for primary care, screening of vulnerable groups and multidisciplinary cooperation (Daniels et al., 2011). Possibly disability in daily living is a key point of the frailty syndrome and may be the first step for frailty in promoting a substrate for disease and its chronic course (Ahmed et al., 2007).
Dementia, Frailty and Triage in a Pandemic
Published in The American Journal of Bioethics, 2021
The Clinical Frailty Scale equates the degree of frailty with dementia. However, as Vinay et al. note, patients with greater degrees of dementia may or may not have other features of the frailty syndrome (loss of biological reserve, failure of homeostasis, vulnerability to intercurrent illness). It may be difficult to know Max’s chance of survival if he required mechanical ventilation. There are reports of high mortality among patients with dementia who have had COVID (Hariyanto 2021), and more than 80% 1 year mortality for patients with advanced dementia receiving mechanical ventilation for pneumonia or septicemia (Sharma 2020). But it is often difficult to separate out other confounding factors (such as comorbidity and age), as well as the impact of treatment limitation decisions (and self-fulfilling prophecies).
Depression Severity, but Not Cognitive Impairment or Frailty, is Associated with Disability in Late-Life Depression
Published in Clinical Gerontologist, 2020
Ruth T. Morin, Philip Insel, David Bickford, Craig Nelson, R. Scott Mackin
When looking at CI and its relation to disability in the LLD population, it is also important to consider the potential role of frailty. Frailty is conceptualized as “a biologic syndrome of decreased reserve and resistance to stressors, resulting from cumulative declines across multiple physiologic systems and causing vulnerability to adverse outcomes (Fried & Mor, 1997).” The risk of frailty increases proportionately with age (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013), with associated falls and hospitalizations increasing the proportion of disability and risk of death (Ahmed, Mandel, & Fain, 2007). The frailty syndrome, which may include weakness, slowness, weight loss, or low levels of activity, overlaps significantly with symptoms of LLD (Brown et al., 2016). Additionally, depressive symptoms have been found to increase the risk for physical frailty, especially in the presence of medical comorbidities and impaired cognition (Vaughan, Corbin, & Goveas, 2015). However, frailty as a contributing factor to disability in LLD has been understudied, particularly in the context of concurrent CI.
Perioperative care of geriatric patients
Published in Hospital Practice, 2020
Aditya P. Devalapalli, Deanne T. Kashiwagi
Frail individuals are more susceptible to physiologic disturbances which can lead to poor health outcomes, including increased falls, functional dependence, hospitalization, institutionalization, and mortality [53,54]. One study of 125 older patients (mean age 77.4) who were identified by positive frailty screening using the Edmonton Frail Scale, most of whom underwent orthopedic procedures (82%), showed that there was a higher likelihood of postoperative complications, increased length of stay, and reduced chance of being discharged home [54]. A prospective study of 594 patients pursuing elective surgery evaluated phenotypic frailty using Fried criteria found that frailty was an independent predictor of postoperative complications within 30 days, longer hospital length of stay, and chance of discharge to skilled or assisted living facility; the predictive power of traditional risk stratification scores was significantly improved with the addition of the frailty index [55]. A systematic review of 32 studies demonstrated that the degree of preoperative frailty has been shown to correlate closely with postoperative mortality as well as various postoperative complications [53]. There is a growing body of evidence that highlights the significant relationship between the frailty syndrome and surgical outcomes, and that frailty should be a standard component of the preoperative assessment.