Transcript Doing the Right Thing - Oklahoma State University Center for Health

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
Frailty
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Multidimensional syndrome of loss of
reserves
– Energy
– Physical Strength
– Cognition
– Health
Rockwood, K. et al. CMAJ 2005;173:489-495
Clinical Definitions

3 of 5 attributes
– unintentional weight loss
– muscle weakness
– slow walking speed
– exhaustion
– low physical activity
Rockwood, K. et al. CMAJ 2005;173:489-495
Copyright ©2005 CMA Media Inc. or its licensors
Frailty Incidence by Age
Boyd CM - Am J Med - 01-NOV-2005; 118(11): 1225-31
Development of Dependency
Percent developing
dependence in activities
of daily living at 18
months, stratified by
hospitalization and
frailty status.
Boyd CM - Am J Med - 01-NOV-2005; 118(11): 1225-31
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
Rockwood, K. et al. CMAJ 2005;173:489-495
Failure to thrive

Decrease in vitality
– Progressive loss
 Physical Functioning
 Weight
 Lean Body Mass
– Poor nutrition /Dehydration
– Inactivity
– Impaired immune response
Frailty and FTT

Organic causes
– Malignancy
– Chronic Infectious Disease
– Chronic Inflammatory Condition
– Endocrine Disorder
– Organ Failure
Frailty and FTT

Nonorganic causes
– Medication effects
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Anticholinergics
Antiepileptics
Benzodiazepines / Neuroleptics
Beta Blockers and Central alpha blockers
Diuretics
Corticosteroids
Opioids
SSRIs / TCAs
– Polypharmacy
Frailty and FTT
Functional problems
– Arthritis
– Neuromuscular
– Neurologic
– Dental
Frailty and FTT

Psychosocial
– Depression
– Alcohol / Substance Use
– Poverty
– Social Isolation
Frailty and FTT

Evaluation
– Medical evaluation
– Laboratory / Radiographic
 Chemistry, CBC, ESR, CRP, TSH
– Functional Evaluation
 ADL, IADL
– Social History
 support systems, financial status
Treatment
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Frailty
– Exercise Prescription
– Hormonal Therapy?
 GHRH
 IGF-1
 Androgens
Treatment
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Failure to Thrive
– Manage Identified Clinical Illness
– Aggressive Nutritional Support
– Psychosocial Supports
– End of Life Care Discussions