4. Understanding Geriatric Syndrome

Front 1

Frailty: Formalised phenotype
(3 or more factors)

Back 1

1. Unintentional Wt loss: >4-5kg
2. Exhaustion fatigue: 3-4 times/week
3. Low energy Expenditure/activity
4. Slow gait speed/performance
5. Weak grip strength, Sarcopenia

Front 2

Frailty

Back 2

Involves declines in physiologic complexity or reserve in other systems, leading to loss of homeostatic capability to withstand stressors, thus resulting in vulnerabilities

Front 3

Disability vs Frailty

Back 3

Disability- inability to do ADL, IADL or difficulty in mobility.

Frailty- multisystem dysfunction, decreased reserve, unstable

Front 4

Frail older adults are less able to tolerate:

Back 4

–Stress of medical illnesses
–Hospitalizations
–Immobility

Front 5

Aging systems

Back 5

Brain- Hippocampus
Endocrine- Changes to HPA axis: reduce GH, IGF-1, high cortisol- wt loss,reduce muscle mass, anorexia, reduce energy
Immune- reduce immune cells, abnormal inflammatory response
Muscularskelatal- Sarcopenia, IL-6 & TNF-alpha: breaksdwn muscle; reduce testosterone & DHEA

Front 6

Screening & Assessment

Back 6

Comprehensive Geriatric Assessment
Screening Letter
Functional Assessment Screening Package
Strawbridge Questionnaire
The Bright Tool

Front 7

Management of Frailty

Back 7

Goals: Treat underlying causes
Non-Pharm: Increase nutrition + exercise
Pharm: Appetite stimulant (Megestrol, Dronabinol), Hormone replacement (Testosterone, DHEA, GH)