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Frailty in the elderly

Version: January 2017
Legacy ID: 31-1

Rationale

Frailty is a term that applies to some older adults who have varying degrees of weight loss and/or malnutrition, cognitive impairment, multiple medical comorbidities, decreased mobility, and/or psychosocial stressors, leading to decreased function (e.g., activities of daily living). A multidisciplinary approach in the form of a comprehensive geriatric assessment has been shown to decrease morbidity and maintain or improve function.

Causal Conditions

(list not exhaustive)

Often multi-factorial, including

  1. Medications
  2. Environmental/Social (e.g., isolation, poverty, elder abuse, neglect)
  3. Medical disease
  4. Malnutrition (e.g., from poor dentition, malabsorption, dysphagia)
  5. Psychiatric (e.g., mild cognitive impairment, dementia, depression, psychosis)
  6. Changes in visual acuity
  7. Changes in auditory acuity
  8. Decreased mobility

Key Objectives

Given a frail elderly patient, the candidate will diagnose the cause, severity, and complications, will conduct an assessment of function and cognition, and will initiate an appropriate management plan that demonstrates an awareness of the importance of a multidisciplinary approach.

Enabling Objectives

Given a frail elderly patient, the candidate will

  1. obtain and interpret critical clinical findings, including
    1. complete psychosocial history (e.g., social supports, financial status);
    2. symptoms of medical disease, weight loss, and malnutrition;
    3. comprehensive medication history;
    4. screen for elder abuse and neglect;
    5. assessment of the impact of symptoms on activities of daily living;
    6. physical examination findings of malnutrition;
    7. mental status examination and cognitive function using a validated scale;
  2. construct an appropriate plan for further investigation that is supported by the history and physical examination findings
  3. construct an effective initial multifactorial management plan, including but not limited to
    1. consultations (with medical specialists and other health professionals);
    2. non-pharmacological approaches to nutrition;
    3. pharmacological/medical;
      1. recommend interventions to target causes of morbidity;
      2. outline changes to medications to improve symptoms and minimize adverse effects;
    4. community support services;
      1. list services available to support elders in the community (e.g., home care services);
      2. determine if the patient needs to be referred for counseling about financial concerns or abuse.