pathology: frailty / frailty syndrome / frailty of old age / fraility

yogabook / pathology / frailty syndrome – frailty syndrome

Definition

Frailty is a multifactorial geriatric syndrome that describes reduced resilience to external stressors, increased vulnerability, increased dependency and reduced life expectancy. Frailty generally results not only from physiological ageing processes, which entail functional limitations, but also from additional pathologies. Frailty is an important factor that increases the risk of disability, hospitalisation and mortality and increases the likelihood of complications during and after surgery. Prehabilitation is therefore particularly suitable for these patients, as recommended by the AWMF guideline on perioperative care. Frailty regularly results in an increased need for diagnostic, nursing and therapeutic measures. Falls, hospitalisation, impaired consciousness, disabilities and the need for care become more likely and more frequent. Frailty is not a disease but a multifactorial syndrome that becomes more likely and more pronounced with age, but is not correlated with age or causally attributable to ageing. The prevalence in over 80-year-olds is estimated at 30%.

In frail patients, increased levels of various interleukins such as IL-1 and IL-6 are often measured, as well as TNF(alpha) and CRP or hCRP, in addition to reduced levels of the hormones testosterone, oestrogen, corticosteroids and somatotropin. In most cases, frailty is characterised by above-average levels of sarcopenia, osteoporosis and loss of maximum strength. An important risk is the increased risk of falling due to gait instability, which often leads to femoral neck fractures. In addition to osteoporosis, sarcopenia also plays a role in the damage caused by the fall, in that the lower mass of the vastus lateralis worsens the tension of the femur. Some conditions cause frailty quite regularly, including hypertension, stroke, heart attack and diabetes mellitus.

Conversely, frailty is a risk factor for dementia. Frailty can not only lead to difficulties in coping with everyday life, but can also reduce social contacts due to a perceived lack of ability to cope with the associated tasks, which often begins with travelling to contacts or meeting places. This in turn reduces the amount of exercise undertaken, which has an aggravating effect on dementia processes, as does the reduced mental activity that reduced social contact usually entails. In this way, dementia and frailty reinforce each other. Frailty is treated with strength training, endurance sports, coordination exercises and an adapted diet. In addition, existing illnesses are adjusted in the best possible way.

Ursache

Predisposing

  1. Polymorbidity
  2. Biological age

Diagnosis

  1. Frailty criteria according to Fried
    • Exhaustion, subjectively perceived
    • Involuntary weight loss (depending on the criteria catalogue at least 5 kg/ a or 5% in 3 months or 10% in 6 months)
    • reduction in gross physical strength by at least 20% compared to the average population of the same age
    • reduced gait speed
    • generally reduced activity
  2. The FRAIL scale is similar, in which 3 criteria must be met for the diagnosis of trailty, with 1-2 criteria the diagnosis of pre-trailty is made:
    • Fatigue (tiredness/exhaustion)
    • Resistance (muscle strength), based on the ability to climb one flight of stairs at a time
    • Ambulation (walking ability), the ability to walk 100 metres at a time
    • Illness (diseases): Presence of at least 5 illnesses
    • Loss of weight (weight loss) of at least 5 kg in the last 6 months

Symptoms

  1. Increased susceptibility to infections (immunosenescence)
  2. Balance disorders
  3. Reduction of vital capacity
  4. Impaired consciousness, confusion
  5. Need for care

Complications

  1. Increase in the incidence and severity of intra- and postoperative complications
  2. Increased risk of care dependency
  3. Increased risk of dementia and other disorders of consciousness
  4. Increased risk of disability
  5. Increased risk of hospitalisation
  6. Increased risk of falling
  7. Increased mortality

Therapy

  1. Strength training
  2. Endurance sports
  3. Coordination exercises
  4. Adapted nutrition
  5. Gait safety training
  6. Training in coping with everyday life
  7. Best possible medication for existing illnesses

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