Post-Class Assignment 

• What is frailty and how is it defined? 

• What are the features of frailty? 
• What assessment tools are available to determine whether someone is frail or at risk for frailty? 
• Why is it important to identify these patients? 
• Which factors are potentially treatable to reverse frailty or prevent it? 

 

 

1. According to UptoDate, “frailty” is a syndrome occurring with increased age that makes one more susceptible to health issues, stressors, and poorer outcomes, as well as less responsive to treatment (1). 

1. According to BMC Geriatrics, the frailty phenotype by Fried, notes 5 main features: “weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity,” noting have three out of the five as being frail (2). 

1. The most common frailty screening tool is the Fried frailty phenotype as mentioned before (1-2/ 5 for pre-frailty, 3/5 for frailty). Others include: 

1. Index approach to frailty- based on the answer to 20 questions that evaluate “accumulation of illnesses, functional and cognitive declines, and social situations” (1).  

1. FRAIL Scale- A quick screening tool, asking about fatigue, resistance, ambulation, illnesses, and loss of weight. A score of 0 would be a negative screen, a score of 1-2 would be pre-frail, and 3-5 would be frail.  

1. Edmonson Frail scale- uses 14 questions to evaluate “cognition, general health, function, social support, and nutrition” (1). This tool is more to help identify areas of vulnerability that we should focus on as clinicians. 

1. It is important to identify these patients as frailty increases risk of other health issues, which can greatly impair functional status and overall health, such as “frequent falls, fractures, delirium, cognitive impairment, and incontinence” (1). By identifying these patients early, we can put measures in to decrease the risk (prevent) or treat many of these issues. For example, a frail patient may be at increased risk of falls and poor outcomes as a result, thus maybe we can make his or her home more safe to lower the risk of slips and falls. Furthermore, these patients need attention from many different fields and specialties, thus it is important to get these patients such treatment earlier rather than later. 

1. Some factors that can be addressed to prevent/ mitigate certain frailty components: 

1. Poor nutrition- referral to a dietitian; consider dentition/ lack of dentures, possible depression, medication side effects as potential causes; consider supplementation 

1. Mental health disorders- address possible depression, refer to a psychiatrist, try to avoid antidepressant use from the start because the elderly are more likely to experience adverse effects 

1. Lack of exercise- exercise programs specifically for the elderly, PT/OT 

1. Poorly controlled health conditions- appropriate coordination with specialists; patient education; frequent medication reconciliation 

1. Falls- ensure appropriate assistive device, address slippery areas, ensure good footwear, consider if living situation is still appropriate if patient is struggling with stairs etc.; ensure good eyesight, regular eye exams (3) (4) 

 

1. https://www-uptodate-com.york.ezproxy.cuny.edu/contents/frailty?search=frailty&source=search_result&selectedTitle=1~147&usage_type=default&display_rank=1#H1 

1. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-018-0967-0 

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146844/ 

1. https://www.todaysgeriatricmedicine.com/archive/012014p18.shtml