Frailty andFrailty andFailure to ThriveFailure to Thrive

Christopher Taylor, D.O. M.P.H.

W. R. Bohon Senior Health Clinic

R. J. Reynolds Elder Care Facility

Bartlesville, Oklahoma

  FrailtyFrailty

Multidimensional syndrome of loss of reserves– Energy – Physical Strength– Cognition– Health

Rockwood, K. et al. CMAJ 2005;173:489-495

Clinical DefinitionsClinical Definitions

3 of 5 attributes– unintentional weight loss– muscle weakness– slow walking speed– exhaustion– low physical activity

Copyright ©2005 CMA Media Inc. or its licensors

Rockwood, K. et al. CMAJ 2005;173:489-495

Frailty Incidence by AgeFrailty Incidence by Age

Boyd CM - Am J Med - 01-NOV-2005; 118(11): 1225-31

Development of DependencyDevelopment of Dependency

Boyd CM - Am J Med - 01-NOV-2005; 118(11): 1225-31

Percent developing dependence in activities of daily living at 18 months, stratified by hospitalization and frailty status.

Rockwood, K. et al. CMAJ 2005;173:489-495

Fig. 1: Kaplan-Meier curves, adjusted for

age and sex, for study participants

(n) over the medium term (5-6 years),

according to their scores on the CSHA

Clinical Frailty Scale

Failure to thriveFailure to thrive

Decrease in vitality– Progressive loss

Physical Functioning Weight Lean Body Mass

– Poor nutrition /Dehydration– Inactivity– Impaired immune response

Frailty and FTTFrailty and FTT

Organic causes– Malignancy– Chronic Infectious Disease– Chronic Inflammatory Condition– Endocrine Disorder– Organ Failure

Frailty and FTT Frailty and FTT Nonorganic causes

– Medication effects Anticholinergics Antiepileptics Benzodiazepines / Neuroleptics Beta Blockers and Central alpha blockers Diuretics Corticosteroids Opioids SSRIs / TCAs

– Polypharmacy

Frailty and FTT Frailty and FTT

Functional problems – Arthritis– Neuromuscular– Neurologic– Dental

Frailty and FTTFrailty and FTT

Psychosocial – Depression– Alcohol / Substance Use– Poverty– Social Isolation

Frailty and FTTFrailty and FTT

Evaluation – Medical evaluation– Laboratory / Radiographic

Chemistry, CBC, ESR, CRP, TSH

– Functional Evaluation ADL, IADL

– Social History support systems, financial status

Treatment Treatment

Frailty– Exercise Prescription– Hormonal Therapy?

GHRH IGF-1 Androgens

TreatmentTreatment

Failure to Thrive– Manage Identified Clinical Illness– Aggressive Nutritional Support– Psychosocial Supports– End of Life Care Discussions