Frailty Assessment

Dr Zoe Wyrko

Consultant Geriatrician, Queen Elizabeth

Hospital Birmingham

@geri_baby

• What is frailty?

• How can we find and measure frailty?

• What can be done about it?

“a clinically recognizable state of increased

vulnerability resulting from aging-associated

decline in reserve and function across multiple

physiologic systems such that the ability to cope

with everyday or acute stressors is comprised”

Aged >85 years

Frailty

Frail

Not frail

MODELS, SCALES, SCORES, INDEXES

AND SCREENING

Frailty Models

Phenotype theory

• Freid

– Low grip strength

– Low energy

– Slow walking speed

– Low physical activity

– Unintentional weight loss

Deficit Accumulation

• Rockwood

– Symptoms

– Signs

– Diseases

– Disabilities

– Leading to a frailty index

The eFI

• Based on Rockwood’s frailty index

• 36 variables

• READ codes on GP systems

• Robust predictive validity for

– Mortality

– NH admission

– Hospitalisation

• Ability to focus resources

Five-year Kaplan–Meier survival curve for the outcome of mortality for categories of fit, mild frailty, moderate frailty and severe frailty (internal validation cohort).

Andrew Clegg et al. Age Ageing 2016;ageing.afw039

© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

Even easier …

• Slow walking speed - >5 seconds to walk 4

metres

• Timed up-and-go test (TUG) - >10 seconds to

stand from a chair, walk 3 metres, turn round

and sit down again

Frailsafe screening questions

• Reduced mobility?

• Impaired cognition?

• From a care home?

INTERVENTIONS FOR FRAILTY

Comprehensive Geriatric Assessment

(CGA)

• Gold standard intervention for frailty

• An older person who receives CGA by a

multidisciplinary team in a specialist

environment is more likely to be alive and

living in their own home 6 months after an

acute illness

But what is CGA?

• A process not an event

• Interdisciplinary

• Multidimensional

• Produces problem lists

• Integrated plan for treatment, rehabilitation,

support and long term care

Key learning points

• Frailty is a long term condition

• Not all older people are frail

• Frailty scores have a role, but screening in

acute care is important

• The intervention is CGA, an interdisciplinary

process

QUESTIONS?

Resources

• Fit for Frailty http://www.bgs.org.uk/index.php/resources-

6/bgscampaigns/fit-for-frailty

• Clegg A, Young J. Frailty in elderly people. The Lancet 2013; 381:752-76

• Clegg et al. Development and validation of an electronic frailty index using

routine primary care electronic health record data. Age and Ageing 2016;

0: 1–8

• https://www.rcplondon.ac.uk/guidelines-policy/acute-care-toolkit-3-

acute-medical-care-frail-older-people

• Ellis G et al. Comprehensive geriatric assessment for older adults admitted

to hospital. Cochrane Database of Systematic Reviews 2011, Issue 7

• Welsh T. Comprehensive geriatric assessment – a guide for the non

specialist. Int J Clin Pract, March 2014, 68, 3, 290–293

• Wyrko Z. Frailty at the front door. Clinical Medicine 2015 Vol 15, No 4:

377–81