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