Articles Posted in Frailty

An increase in the health of the elderly population has produced a spike in the number of elderly that undergo surgery at an older age. Elderly who are candidates for major surgery often run great risks that are increased when partnered with frailty. Frailty in s can increase the risk of complications during medical procedures and surgery, or with the prescription of medications. Yet, within the surgery population, frailty is believed to be seriously under recognized, leading to a lack of proper preparation of these patients. Diagnosing an elderly patient with frailty early on can seriously reduce the risk of unforeseen complications post medical procedures.

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One of the primary health issues in the United States that significantly affects the older adult population is diabetes mellitus. Not only is this disease related to premature aging, chronic diabetes is related to serious physical and cognitive problems as well, particularly among people with poor blood glucose metabolism.  Furthermore, the danger of uncontrolled diabetes is reduced quality of life and increased healthcare expenses.

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The prevalence of age-related frailty is high in older adults, ranging from 7% to 16.3%.  The prevention and treatment of frailty has long been a major concern in geriatrics, especially in the clinical medicine.  Frailty is the primary determinant of longevity and quality of life in the older adult population.  Frailty is defined as an age-related, biological syndrome that causes a reduction of biological reserves due to the dysfunction of various physiological systems, which increases an older adult’s vulnerability to minor stressors, and is related to adverse health outcomes (such as disability, hospital admission, and death).  Frailty is a stronger indicator for negative outcomes in older ages than chronic disease.  It is important to note that frailty is reversible in its early stages.  Importantly, a frail person can become nonfrail if frailty is identified and addressed at the onset.

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It is well known that the older adult population around the world is rapidly increasing. This fact implies that health care systems must make readjustments to better meet the needs of elderly people, no matter their socioeconomic background.  Multimorbidity and needing social support increase as one grows older.  Health issues and disabilities due to age create burden for the older adult, his or her loved ones, and public health care systems.  A strong association exists between the number of older adults in the population and health care costs in developed countries. Health care costs for the elderly population have grown at a faster rate than those for younger adults, primarily because of inadequate systems that are unable to meet the varied and complex needs of vulnerable, frail, and impaired older adults.  Such situations clearly pose a threat to the sustainability of social and health care frameworks.  Due to these reasons, in the past few years, the calls for the implementation of preventative measures against age-related and debilitating conditions in older adults have increased.

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It is well known that physical exercise is beneficial for the body, no matter one’s age.  Even an editorial published last year in the Journal of the American Medical Directors Association deemed exercise “the ultimate medicine.”  Now, research has shown even more evidence that exercise is crucial for the human body, especially in older ages, when adults become more vulnerable to frailty and sarcopenia.

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“Successful aging” is a term that is not well defined, but is constantly researched. The term immerged more than 20 years ago and constituted three primary domains: the avoidance of illness, physically and cognitively fit, and high engagement with life. Subsequent research placed strong emphasis on the absence or existence of disease, thereby classifying centenarians (older adults who live to 100 years of age or beyond) as “survivors,” “delayers,” and “escapers” according to the existence of diseases and the age at which the disease occurs preceding or following 80 years. Further studies addressed the importance of including elderly people’s perspectives so as to expand the primarily biomedical model to add social and psychological facets. Strong evidence showed that psychological factors of successful aging, including self-efficacy and resilience, were the sole indicators of future quality of life.

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Although there is no universally accepted method of classification, sarcopenia generally refers to the loss of muscle with age. One approach to measure sarcopenia uses the skeletal muscle index. Ways of measuring muscle mass include magnetic resonance imaging (MRI), dual-energy X-ray absorptiometry (DXA), and bio-electrical impedance (BIA). Sarcopenia isn’t the only issue that comes with age, however. Fat volume tends to increase with age and can contribute to sarcopenic obesity.

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As the older adult population in the United States continues to grow, falls continue to be a major concern in the healthcare industry. Frail elderly patients in nursing homes and assisted living facilities are especially vulnerable to fall events, which can greatly increase the risk of morbidity and mortality. Decline in functional status, the amount and kinds of medications, health conditions, impairments in vision and hearing, cognitive status, the reliance on adaptive equipment (such as canes, walkers, and wheelchairs), and restraints are all significant risk factors for falls in the care facility. Patients who are newly admitted into a nursing home are especially vulnerable to falls—an unfamiliar environment coupled with unfamiliar staff makes fall risk identification and management more difficult in this patient population. Moreover, these newly admitted patients have often suffered from a recent acute care event, thus increasing their risk of falls due to debilitated functional ability.

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Osteoporosis is a bone disease that is highly prevalent within the older adult population.  Often referred to as a silent disease due to its lack of clear outward symptoms, osteroporosis weakens bone structure and durability, increasing the risk of fractures.  The areas of the hip, spine, and wrists are the most vulnerable to bone fracture.  Some risk factors for osteoporosis are modifiable, such as poor diet and smoking, but others are non-modifiable, such as age.  The risk of the disease increases as one grows older, starting in the late-30s.

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Most of the older adult population worldwide experiences cognitive decline with age. Disability is often associated with cognitive impairment; thus, interventions for preventing cognitive decline are critically needed. Sarcopenia is the age-related deterioration of skeletal muscle mass that is highly prevalent and a crucial problem among the elderly. Studies have shown that sarcopenia and cognitive impairment are related to frailty. Thus, prevention of sarcopenia is imperative for mitigating age-related healthcare issues.
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