1. Disability, Frailty and Co-Morbidity L. Fried et al. Gero 302 Jan 2012

2. Caring for the Elderly The frail are the most vulnerable older adults. They have the most complex and challenging problems. They have multiple chronic conditions and co- morbidities. They are frequently disabled and dependent. Definitions: Disability-difficulty or dependency in carrying out ADL, self-care, living independently and maintaining a QOL. Physical disability is task oriented based on standardized screens-See Table One. 20- 30% of over 70 report disability in mobility

3. Cont. Frequency rises steadily with age. It general causes are disease, physiological alterations of ageing, social and economic factors, behavioral and access to care. Co-Morbidity-muscle weakness and balance, decreased exercise tolerance and self-care and cognitive impairment, hip fracture and morbidity Disability is an adverse health outcome it is also a risk factor for other adverse events and a predictor of other problems with ADL’s and IADL’s

4. Frailty 40% of adults over 80 are frail The majority of residents in nursing homes are frail Frailty can be a prime cause of disability Frailty is defined as a physiologic state of increased vulnerability to stressors that result from decreased physiologic reserves and dysregulation of multiple physiologic systems. These include: neuromuscular, osteopenia, immune system dysfunction. Loss of reserves results in aggregate thresholds being reached and breaking down in clinical functioning.

5. Frailty Multiple systems are involved. For example-weight loss, muscle wasting, loss of endurance, decreased balance and mobility, slowed performance, relative inactivity, and possible decrease cognitive function. Associated with frailty are: under-nutrition, prolonged bed rest, pressure sores, generalized weakness, anorexia, falls, delirium, confusion, polypharmacy. Frailty therefore is a distinct entity, with multiple manifestations which can then be used to predict further disability

6. Co-Morbidity Concurrent presence of two or more medically diagnosed diseases in the same individual with each contributing to the other. Examine the rates of arthritis, hypertension, heart disease, diabetes, stroke. Co-morbidity contributes to high health care costs and utilization. It heightens the risk of disability and mortality and the effects of a single disease entity.

7. Health Care issues Co-morbidity, frailty and disability each have special needs for care. They require complex coordination of multiple providers and incremental service increases. Treatment regimes may be hard to tolerate or too complex to understand and can limit compliance and understanding. The treatment of one disease can adversely affect the treatment of others-the use of anti-depressants and diet. NSAID’s and Gastic disturbances.

8. Cont. Review Fig two Social issues include-isolation, dependency, and the need for in-home and long term care Frailty is a treatment challenge due to wide fluctuations in health status and high risk complications. It is important to examine the subset of community dwellers with those in care

9. Implications Increased health care costs Increased health utilization for the treatment of chronic conditions (Two to five times as much) The aggregate effects issue

10. Prevention Screening, diagnosis, treatment for those at high risk, and for those with reversible risk factors. Identify those who would benefit from specific interventions and this would reduce co-morbidity Introduction of resistance exercises to increase lean body mass at the pre-clinical stage. Early detection and prevention