1. Frailty and Failure to Thrive Christopher Taylor, D.O. M.P.H. W. R. Bohon Senior Health Clinic R. J. Reynolds Elder Care Facility Bartlesville, Oklahoma

2. Frailty Frailty Multidimensional syndrome of loss of reserves – Energy – Physical Strength – Cognition – Health

3. Rockwood, K. et al. CMAJ 2005;173:489-495

4. Clinical Definitions 3 of 5 attributes – unintentional weight loss – muscle weakness – slow walking speed – exhaustion – low physical activity

5. Copyright ©2005 CMA Media Inc. or its licensors Rockwood, K. et al. CMAJ 2005;173:489-495

6. Frailty Incidence by Age Boyd CM - Am J Med - 01-NOV-2005; 118(11): 1225-31

7. Development of Dependency Boyd CM - Am J Med - 01-NOV-2005; 118(11): 1225-31 Percent developing dependence in activities of daily living at 18 months, stratified by hospitalization and frailty status.

8. Rockwood, K. et al. CMAJ 2005;173:489-495 Fig. 1: Kaplan-Meier curves, adjusted for age and sex, for study participants (n) over the medium term (5-6 years), according to their scores on the CSHA Clinical Frailty Scale

9. Failure to thrive Decrease in vitality – Progressive loss Physical Functioning Weight Lean Body Mass – Poor nutrition /Dehydration – Inactivity – Impaired immune response

10. Frailty and FTT Organic causes – Malignancy – Chronic Infectious Disease – Chronic Inflammatory Condition – Endocrine Disorder – Organ Failure

11. Frailty and FTT Nonorganic causes – Medication effects Anticholinergics Antiepileptics Benzodiazepines / Neuroleptics Beta Blockers and Central alpha blockers Diuretics Corticosteroids Opioids SSRIs / TCAs – Polypharmacy

12. Frailty and FTT Functional problems – Arthritis – Neuromuscular – Neurologic – Dental

13. Frailty and FTT Psychosocial – Depression – Alcohol / Substance Use – Poverty – Social Isolation

14. Frailty and FTT Evaluation – Medical evaluation – Laboratory / Radiographic Chemistry, CBC, ESR, CRP, TSH – Functional Evaluation ADL, IADL – Social History support systems, financial status

15. Treatment Frailty – Exercise Prescription – Hormonal Therapy? GHRH IGF-1 Androgens

16. Treatment Failure to Thrive – Manage Identified Clinical Illness – Aggressive Nutritional Support – Psychosocial Supports – End of Life Care Discussions