Frailty andFrailty andFailure to ThriveFailure to Thrive
Christopher Taylor, D.O. M.P.H.
W. R. Bohon Senior Health Clinic
R. J. Reynolds Elder Care Facility
Bartlesville, Oklahoma
FrailtyFrailty
Multidimensional syndrome of loss of reserves– Energy – Physical Strength– Cognition– Health
Clinical DefinitionsClinical Definitions
3 of 5 attributes– unintentional weight loss– muscle weakness– slow walking speed– exhaustion– low physical activity
Development of DependencyDevelopment of Dependency
Boyd CM - Am J Med - 01-NOV-2005; 118(11): 1225-31
Percent developing dependence in activities of daily living at 18 months, stratified by hospitalization and frailty status.
Rockwood, K. et al. CMAJ 2005;173:489-495
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
Failure to thriveFailure to thrive
Decrease in vitality– Progressive loss
Physical Functioning Weight Lean Body Mass
– Poor nutrition /Dehydration– Inactivity– Impaired immune response
Frailty and FTTFrailty and FTT
Organic causes– Malignancy– Chronic Infectious Disease– Chronic Inflammatory Condition– Endocrine Disorder– Organ Failure
Frailty and FTT Frailty and FTT Nonorganic causes
– Medication effects Anticholinergics Antiepileptics Benzodiazepines / Neuroleptics Beta Blockers and Central alpha blockers Diuretics Corticosteroids Opioids SSRIs / TCAs
– Polypharmacy
Frailty and FTTFrailty and FTT
Psychosocial – Depression– Alcohol / Substance Use– Poverty– Social Isolation
Frailty and FTTFrailty and FTT
Evaluation – Medical evaluation– Laboratory / Radiographic
Chemistry, CBC, ESR, CRP, TSH
– Functional Evaluation ADL, IADL
– Social History support systems, financial status