Management of Frailty and Functional Decline in Older People

Introduction

Frailty is a geriatric syndrome where older adults become more vulnerable to multiple health issues that can lead to several complications. 5 to 17 percent of older adults are affected by frailty and experience low energy and poor strength associated with it. Hip fractures are the most common condition in frailty syndrome. Frailty and disability are not the same, even though people with frailty may develop a disability. Frailty results in low physical activity, exhaustion, slow walking speed, and so on.

Functional decline refers to the impairment in physical and mental functions. Some of the age-related functional declines are:

• Vision problems.

• Difficulty in hearing.

• Memory impairment.

• Weakness in bones and muscles.

• Balance problems.

Besides, older people experience other functional declines as well. They can occur due to many chronic or long-term disorders.

What Are the Risk Factors for Frailty in Older People?

Based on various studies, it was found that numerous factors are responsible for frailty in older people.

• Lower Weight: Weight loss can cause a reduction in muscle mass and bone strength that results in the deterioration of overall health. Malnutrition, depression, lack of sleep, etc. are the common causes of unexplained weight loss in older people.

• Female Sex: Studies found that females are more prone to frailty even though women tend to live longer than men. Hence, females are considered both frailer and less frail. Post-menopausal women are more prone to frailty as they are at high risk for developing bone-related diseases such as osteoarthritis and osteoporosis.

• Smoking: Older adults who smoke regularly or are chain smokers tend to be frailer than people who stopped smoking or never smoked.

• Alcoholism: Increased intake of alcohol during old age can worsen existing health issues or can interact with medications resulting in severe complications. Alcoholism can cause balance issues which in turn may lead to fractures.

• Diabetes: Insulin depletion or resistance in diabetic patients can lead to frailty because insulin is an anabolic hormone that can enhance metabolism in the body.

• History of Fall or Injury: Fall or injury during old age may cause many problems, including mobility issues that can result in frailty.

What Are the Causes of Functional Decline in Older People?

The functional decline can occur due to many social conditions and diseases. Hospitalization is considered the most common cause of the functional decline in older adults. Following are the problems caused by hospitalization that may result in a functional decline in older people:

• Malnutrition and dehydration.

• Decreased mobility or difficulty in walking.

• Skin integrity problems like pressure sores or ulcers.

• Frequent falls due to loss of balance, confusion, and physical impairment.

• Medication errors like wrong dosage, timings, or side effects.

• Mental health problems such as depression, anxiety, or panic attacks.

Cognitive decline or impairment in functions like memory, thinking, problem-solving, decision-making, etc. are experienced by many adults as they approach late adulthood. However, in people with diseases like Alzheimer’s and Parkinson’s disease, it is critically impaired and affects their daily activities.

Floaters, glaucoma, macular degeneration, cataracts, etc. are some of the common age-related eye diseases that can cause visual impairment. Age-related hearing loss or presbycusis can occur due to long-term exposure to loud music, sounds of fireworks, guns, motor vehicles, etc. Conditions such as diabetes and hypertension in the elderly may also predispose hearing loss.

The common diseases that affect bones in the elderly are rheumatoid arthritis, osteoporosis, Paget’s disease, and osteoarthritis.

How Is Frailty Assessed in Older People?

The five items specified by frailty phenotype are:

1. Slowness.

2. Weight loss.

3. Impaired strength.

4. Exhaustion.

5. Low physical activity.

In the frailty index, 40 or more items are counted and combined to get a score. An individual's frailty index is measured by dividing the number of deficits they have by the total number of deficits or health declines considered. If the value received is 0.25 or more, then the individual is considered frail. Basic activities of daily living (BADL) such as feeding, bathing, toileting, dressing, and ambulation are assessed along with instrumental activities of daily living (IADL) such as banking, transportation, cooking, cleaning, managing medications, and shopping are assessed with the help of questionnaire or direct observation. In addition, there are diagnostic tools to assess patients in rehabilitation, long-term care residents, and community-dwelling older adults, and also to assess dementia.

How to Manage Frailty and Functional Decline in Older People?

When the exact underlying cause of frailty or functional decline is diagnosed, the initial step is to treat it. Some diseases require only medications and lifestyle changes, while others require surgical procedures. Cataract surgery, cochlear implant surgery, knee arthroplasty, hip replacement surgery, spinal surgery, pacemaker implantation, colorectal excision, etc., are common surgeries performed on the elderly.

Sound amplifiers are advised for people with hearing problems, while for those with a low voice, such as those with Parkinson’s disease, voice amplifier devices can be used.

Many assisted devices are available nowadays to make life easier for people with frailty or functional decline. Smart devices like Alexa or Google Nest that work on voice commands can help people with mobility problems switch lights, fans, or other electrical devices, change television channels, or play songs. Pill organizers or reminders can be used by people who forget to take medications on time. Canes or walkers can be used to walk independently. People with severe mobility problems can use electric mobility scooters to cover more distance. Safety rails and a non-slip bath mat in the bathroom can prevent falls while bathing. Assisted eating devices such as a feeding tray and suction cup cutlery are great choices for older people with difficulty holding things. Bed rails are a good option to prevent falls while sleeping that may result in severe injuries. Medical alert systems or safety alarms that detect trips or falls are helpful in emergencies.

Conclusion

Aging is an inevitable process that causes many changes in the body. Frailty and functional decline are experienced by many people above 65 years due to many degenerative or lifestyle diseases. Older people suffer more when their mobility gets affected as it helps them with independence and physical and mental well-being. However, mobility aids like canes, walkers, electric scooters, etc. can help them to move around without anyone's help. Even though frailty and functional decline are inevitable changes, their severity can be reduced by following a healthy lifestyle. Doctors recommend purchasing stand up rolling walker with seat to prevent falls in elderly.