Frailty Assessment

Dr Zoe Wyrko
Consultant Geriatrician, Queen Elizabeth
Hospital Birmingham
@geri_baby
• What is frailty?

• How can we find and measure frailty?

• What can be done about it?

“a clinically recognizable state of increased
vulnerability resulting from aging-associated
decline in reserve and function across multiple
physiologic systems such that the ability to cope
with everyday or acute stressors is comprised”
 Aged >85 years
Frailty

Frail
Not frail
MODELS, SCALES, SCORES, INDEXES
AND SCREENING
 Frailty Models
Phenotype theory Deficit Accumulation
• Freid • Rockwood
– Low grip strength – Symptoms
– Low energy – Signs
– Slow walking speed – Diseases
– Low physical activity – Disabilities
– Unintentional weight loss
– Leading to a frailty index
 The eFI
• Based on Rockwood’s frailty index
• 36 variables
• READ codes on GP systems
• Robust predictive validity for
– Mortality
– NH admission
– Hospitalisation
• Ability to focus resources
 Five-year Kaplan–Meier survival curve for the outcome of mortality for categories of fit, mild
frailty, moderate frailty and severe frailty (internal validation cohort).

Andrew Clegg et al. Age Ageing 2016;ageing.afw039

© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics
Society.
 Even easier …
• Slow walking speed - >5 seconds to walk 4
metres
• Timed up-and-go test (TUG) - >10 seconds to
stand from a chair, walk 3 metres, turn round
and sit down again
 Frailsafe screening questions
• Reduced mobility?
• Impaired cognition?
• From a care home?
INTERVENTIONS FOR FRAILTY
 Comprehensive Geriatric Assessment
(CGA)
• Gold standard intervention for frailty

• An older person who receives CGA by a

multidisciplinary team in a specialist
environment is more likely to be alive and
living in their own home 6 months after an
acute illness
 But what is CGA?
• A process not an event
• Interdisciplinary
• Multidimensional
• Produces problem lists

• Integrated plan for treatment, rehabilitation,

support and long term care
 Key learning points
• Frailty is a long term condition
• Not all older people are frail
• Frailty scores have a role, but screening in
acute care is important
• The intervention is CGA, an interdisciplinary
process
QUESTIONS?
 Resources
• Fit for Frailty http://www.bgs.org.uk/index.php/resources-
6/bgscampaigns/fit-for-frailty
• Clegg A, Young J. Frailty in elderly people. The Lancet 2013; 381:752-76
• Clegg et al. Development and validation of an electronic frailty index using
routine primary care electronic health record data. Age and Ageing 2016;
0: 1–8
• https://www.rcplondon.ac.uk/guidelines-policy/acute-care-toolkit-3-
acute-medical-care-frail-older-people
• Ellis G et al. Comprehensive geriatric assessment for older adults admitted
to hospital. Cochrane Database of Systematic Reviews 2011, Issue 7
• Welsh T. Comprehensive geriatric assessment – a guide for the non
specialist. Int J Clin Pract, March 2014, 68, 3, 290–293
• Wyrko Z. Frailty at the front door. Clinical Medicine 2015 Vol 15, No 4:
377–81