Frailty: Ageing

Frailty in the Context of Ageing

Frailty defines age-related exhaustion of homeostatic reserves. An individual with frailty is exposed to enhanced vulnerability to stressors, and associated risk of negative health-related outcomes. This geriatric syndrome, comprising biological, psychological and social issues is more prevalent than expected in PLWH compared to HIV-negative matched controls [21].The most common instruments to measure frailty include the Frailty Phenotype [22] and Frailty Index [23]

Feature Frailty Phenotype Frailty Index
Clinical Definition Based on presence of signs, symptoms (pre-disability syndrome) Based on presence of diseases, disabilities (accumulation of deficits)
How to assess

Assessed by five specific features [22]:
1. self-reported weight loss (a)
2. self-reported exhaustion (b)
3. low levels of physical activity as measured by Minnesota Leisure physical activity questionnaire (c)
4. measured 4 m walk speed time (d)
5. measured grip strength (e)

A frailty index is calculated based on the number of health deficits out of > 30 assessed health deficits [23]

Health variables, including signs and symptoms of disease, laboratory measures, and self-reported data

Data routinely collected in medical records can be included if they characterise age-related, acquired health deficits which cover a range of physiologic systems

How to interpret Categorical variables
Total score of 5 items:
0 deficits = fit
1-2 deficits = pre-frail
3 + deficits = frail
Continuous variables
Index ranges from 0 to 1:
< 0.25 = fit
0.25 - 0.4 = frail
> 0.4 = most frail
How to address frailty [24] Promote Comprehensive Geriatric Assessment (CGA), aimed at personalising interventions according to benefits/priorities for a given person through a multidisciplinary diagnostic and treatment process, that identifies medical, psychosocial, and functional limitations aimed at maximising overall health with ageing and the improvement of quality of life
Recommendations [25], [26] In PLWH who are frail:
1. Sustain and recover physical function impairment and sarcopenia prescribing physical activity with a resistance training component
2. Address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications, see Prescribing in Elderly PLWH
3. Screen for, and address modifiable causes of fatigue
4. For PLWH exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation
5. Prescribe vitamin D for individuals deficient in vitamin D. See Vitamin D Deficiency: Diagnosis and Management

 

(a) Self-reported unintentional weight loss was considered present if exceeding 4.5 kg in the last year or 2.3 kg in the last 6 months

(b) Exhaustion is present if the participant answers ‘‘occasionally’’ or ‘‘most of the time’’ to either one of the following statements: During the last week, how often have you felt that (i) everything you did was an effort, or (ii) you could not ‘get going’

(c) Low physical activity was considered present if participant answered ‘yes, limited a lot’ when asked whether their health limits vigorous activities such as running, lifting heavy objects, participating in strenuous sports

(d) Walk speed time, is measured by a 4-meter walking test in usual pace, one trial) A deficit is assigned according to the following gender-specific criteria
    – Men:
        height ≤ 173 cm and speed ≤ 0.6531 m/s;
        height > 173 cm and speed ≤ 0.762 m/s
    – Women:
        height ≤ 159 cm and speed ≤ 0.6531 m/s;
        height > 159 cm and speed ≤ 0.762 m/s

(e) Maximum grip strength can be assessed using a handheld dynamometer the mean value of three consecutive measurements of the dominant hand (adjusted by sex and BMI quartile based on CHS population [23]):
    – Men:
        BMI ≤ 24 kg and strength < 29 kg;
        BMI 24.1–26 and strength < 30 kg;
        BMI 26.1–28 and strength < 30 kg;
        BMI > 28 and strength < 32 kg
    – Women:
        BMI ≤ 23 and strength < 17 kg;
        BMI 23.1–26 and strength < 17.3 kg;
        BMI 26.1–29 and strength < 18 kg;
        BMI > 29 and strength < 21 kg