DECREASED VITALITY IN THE CONTEXT OF FRAILTY
Older adults frequently report decreased vitality, which has a host of underlying causes. This chapter outlines metabolic factors that may lead to decreased energy in the older adults: endocrine disease, anemia, poor nutrition, and infection. Lack of exercise is discussed in Chapter 5. Although the topic of frailty is outlined in Chapter 1, this chapter will provide some essential clinical points to assist primary care providers at the bedside.
When to consider the diagnosis of frailty
Older individuals should be considered for frailty at times of vulnerability or of an anticipated threat. Examples of such threat would be at the time of an injury or trauma. Likewise, the assessment should be made at the time of surgery or of elective surgery. Further, the assessment should be performed early in a hospital course or at the time of consideration for the start of chemotherapy. Finally, the assessment should be considered in the setting of weight loss, of falls, or in the setting of multiorgan system dysregulation. In short, one should consider the diagnosis of frailty during the time of an assessment of a vulnerable older patient.
How to make the diagnosis of frailty
The criteria for frailty has been defined by the frailty phenotype and the Canadian Study of Health and Aging Clinical Frailty Scale. Each of these tools is described in Chapter 1.
How to use frailty to help guide decision making
The frailty screening tools should lead to a more thorough assessment of the whole patient. Frailty frames the context of important decisions for older patients, but it is also the starting point for further evaluation of why the person has become frail. This evaluation should review the medical causes (including multiple comorbid illnesses, as well as many of the conditions described later in this chapter), their medications, the patient’s behavioral health needs, their social needs, and the meaning of the current situation to the individual. This biopsychosocial approach is the starting point for the assessment of a frail older patient.
Frailty should not preclude access to health care, but instead should guide the development of the most appropriate care plan to match with the patient’s needs. This plan should take into account the patient’s goals and preferences.
How to help a frail older patient
Several key points need to be made regarding the clinical management of frail older patients. First, look for the underlying medical problems that could be culminating in frailty. Second, carefully take into account unaddressed social and behavioral health needs of the individual. A social worker as part of your team can help fill in the details here. Next, review the medications for potential adverse drug events, including medications that have been prescribed for many years. In short, critically review the indications for these meds and whether the medication could be contributing to the patient’s current state. A clinical pharmacist as a part of ...