Conclusion – Geriatric Syndromes and Frailty
Geriatric syndromes are interconnected health states that, as a whole, differ from the individual health conditions in a younger person because they are accompanied by older age and cognitive, functional, and mobility impairment. Research is building to show that the development or progression of these syndromes can predict poor outcomes for older adults. Nurse practitioners (NPs) are in the unique position of being able to monitor for geriatric syndromes in various settings throughout the continuum of care.
Patient-centered care for older adults should include patient/family education about geriatric syndromes and their importance as indicators of risk for decline. Families can be encouraged to report findings of new or worsening syndromes. In return, such reported evidence should trigger provider investigation into possible reversible causes, such as polypharmacy or acute illness. Providers should be prepared to educate patients and their families or caregivers regarding preventive strategies. Throughout this book, examples of red flags/triggers and educational opportunities are offered in regard to geriatric syndromes and their association with health systems and treatments.
A.Frailty
Frailty may be seen as a stage in aging that follows multiple health and functional declines. One definition of frailty follows:
It is a state of vulnerability to poor resolution of homeostasis following a stress and is a consequence of cumulative decline in multiple physiological systems over a lifespan. Frailty results in a vulnerability to sudden health status changes triggered by minor stressor events (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013).
Other descriptions of frailty include biological loss of complexity, disuse, or homeostatic dysregulation. Frailty is commonly seen as a strong predictor of mortality. Weakness is the most common first manifestation, followed by slowness and low physical activity. These typically progress to exhaustion and weight loss, although there is a great deal of variability in the progression of frailty. The standardization of assessment and description of frailty are still in development. Among common screening tools are the following:
1.Fried et al. (2001) physical frailty phenotype:
•Weight loss (more than 10 lbs).
•Weakness (grip strength).
•Exhaustion (self-report).
•Walking speed (15 feet).
•Physical activity (kcals/wk).
2.FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) Scale has been validated in a number of studies (Morley et al, 2013):
•Fatigue (are you fatigued?).
•Resistance (can you climb a single flight of stairs?).
•Ambulation (can you walk one block?).
•Illnesses (more than five).
•Loss of weight (more than 5%).
3.Vulnerable Elder Survey (Min et al., 2009; download for free at Rand: www.rand.org/health/projects/acove/survey.html).
B.Sarcopenia.
The hallmark of age-related weakness is the clinical condition sarcopenia:
1.Age-related (as opposed to illness associated) decline in muscle mass and function, defined by the following three elements:
a.Presence of low muscle mass as measured commonly with dual-energy x-ray absorptiometry (DEXA), or bio-electrical impedance, using adjusted appendicular muscle mass for height: two standard deviations below the mean for healthy adults is diagnostic for sarcopenia.
b.Decreased muscle strength: Commonly measured with handgrip strength (grip strength can be measured using a dynamometer).
c.Reduced physical performance: Commonly measured using usual gait speed (Shafiee et al., 2017).
2.Prevalence in adults age 60 and older is equal in men and women at 10%. One study identified 53% to 57% of men and 43% to 60% of women over the age of 80 as having sarcopenia.
3.Research shows sarcopenia affects multiple ethnicities equally, with the exception of Asian ethnicity, which appears to carry a lower risk for sarcopenia.
4.Occurs in overweight, normal weight, and under-weight individuals.
5.Causes and contributors include the following:
a.Disuse/decreased physical activity.
b.Changing endocrine function (including reduced androgens).
c.Inflammation.
d.Chronic disease.
e.Reduced motor neurons in the spinal cord.
f.Suboptimal protein intake.
g.Increase insulin resistance.
6.Carries a high rate of adverse outcomes in older adults including disability, poor quality of life, falls, and increased risk of death.
7.Low serum albumin is a biomarker for sarcopenia.