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Disability, Frailty and Co-Morbidity L. Fried et al. Gero 302 Jan 2012. Caring for the Elderly. - PowerPoint PPT Presentation
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Disability, Frailty and Co-MorbidityL. Fried et al.
Gero 302Jan 2012
Caring for the Elderly
• The frail are the most vulnerable older adults. They have the most complex and challenging problems. They have multiple chronic conditions and co-morbidities. They are frequently disabled and dependent.
• Definitions: Disability-difficulty or dependency in carrying out ADL, self-care, living independently and maintaining a QOL. Physical disability is task oriented based on standardized screens-See Table One. 20-30% of over 70 report disability in mobility
Cont.
• Frequency rises steadily with age. It general causes are disease, physiological alterations of ageing, social and economic factors, behavioral and access to care.
• Co-Morbidity-muscle weakness and balance, decreased exercise tolerance and self-care and cognitive impairment, hip fracture and morbidity
• Disability is an adverse health outcome it is also a risk factor for other adverse events and a predictor of other problems with ADL’s and IADL’s
Frailty
• 40% of adults over 80 are frail• The majority of residents in nursing homes are frail• Frailty can be a prime cause of disability• Frailty is defined as a physiologic state of increased
vulnerability to stressors that result from decreased physiologic reserves and dysregulation of multiple physiologic systems. These include: neuromuscular, osteopenia, immune system dysfunction. Loss of reserves results in aggregate thresholds being reached and breaking down in clinical functioning.
Frailty
• Multiple systems are involved. For example-weight loss, muscle wasting, loss of endurance, decreased balance and mobility, slowed performance, relative inactivity, and possible decrease cognitive function.
• Associated with frailty are: under-nutrition, prolonged bed rest, pressure sores, generalized weakness, anorexia, falls, delirium, confusion, polypharmacy.
• Frailty therefore is a distinct entity, with multiple manifestations which can then be used to predict further disability
Co-Morbidity
• Concurrent presence of two or more medically diagnosed diseases in the same individual with each contributing to the other. Examine the rates of arthritis, hypertension, heart disease, diabetes, stroke.
• Co-morbidity contributes to high health care costs and utilization. It heightens the risk of disability and mortality and the effects of a single disease entity.
Health Care issues
• Co-morbidity, frailty and disability each have special needs for care.
• They require complex coordination of multiple providers and incremental service increases.
• Treatment regimes may be hard to tolerate or too complex to understand and can limit compliance and understanding.
• The treatment of one disease can adversely affect the treatment of others-the use of anti-depressants and diet. NSAID’s and Gastic disturbances.
Cont.
• Review Fig two • Social issues include-isolation, dependency, and the
need for in-home and long term care• Frailty is a treatment challenge due to wide
fluctuations in health status and high risk complications.
• It is important to examine the subset of community dwellers with those in care
Implications
• Increased health care costs• Increased health utilization for the treatment of
chronic conditions (Two to five times as much)• The aggregate effects issue
Prevention
• Screening, diagnosis, treatment for those at high risk, and for those with reversible risk factors.
• Identify those who would benefit from specific interventions and this would reduce co-morbidity
• Introduction of resistance exercises to increase lean body mass at the pre-clinical stage.
• Early detection and prevention