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Doctors urged to use 5-question tool to screen for frailty


American Medical News, Health (amednews.com)

June 20, 2013  

Physicians should take steps to help their older patients prevent physical frailty, said a committee of U.S. and international gerontology experts, because the condition is preventable and not a natural part of aging.

The experts recommend that primary care doctors and specialists screen all patients older than 70 once a year for frailty.

When the condition is identified, physicians should provide treatment, which could include prescribing aerobic and resistance exercise, caloric and protein supplements, vitamin D and reduced medications, the committee said in the June issue of the Journal of the American Medical Directors Assn.

The expert group that developed the guidance consisted of six major medical organizations and convened in Orlando, Fla., in December 2012 to develop a definition of frailty, as well as guidance for screening and treating the condition. The two participating U.S. organizations were the American Medical Directors Assn. and American Federation for Aging Research.

"Over a period of time, frailty leads to increased death rates, poor function and increased hospitalizations," said lead author Dr. John E. Morley.

"It's treatable, and we're asking doctors to spend 15 seconds to conduct a screening that could prevent bad outcomes," said Dr. Morley, director of the Division of Geriatric Medicine at Saint Louis University.

Such negative outcomes could include reduced endurance, independence and physical strength, as well as weight loss and difficulty carrying out daily activities, he said. Common health problems such as a fractured hip or influenza are more likely to lead to disability or death among frail individuals than in those who are healthy, geriatric experts say.

The committee, made up of experts in aging, geriatrics and nutrition, encourages physicians to use the five-question FRAIL questionnaire screening tool to identify patients with the condition.

The tool inquires about whether patients have more than five illnesses, lost more than 5% of body weight in the past six months, are fatigued, and unable to climb a flight of stairs or walk one block.

Patients who respond "yes" to three or more questions are considered frail and should receive treatment, the article said.

Frailty affects between 5% and 10% of adults who are older than 70 and is more common among elderly women than men, Dr. Morley said.

Specific neuroendocrine and hormonal factors, such as testosterone, might make men less likely to develop frailty than women by providing advantages in muscle mass maintenance, said a September 1999 study in the journal Medical Clinics of North America.

Surge expected in elderly population

The 2012 conference described in the JAMDA article was prompted, in part, by the challenges past groups had in developing a definition of frailty with which they all agreed.

That group defined physical frailty as a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance and reduced physiologic function. They said frailty increases an individual's vulnerability for increased dependency or even death.

The guidance in the JAMDA article comes as the medical community prepares for an expected surge in older patients due largely to the aging baby boomers. Experts project that the nation's population of adults 65 and older could balloon from 40.3 million today to 72.1 million by 2030, said the Administration on Aging.

"With the aging of our population, we cannot wait and must implement the screening and management of frailty into clinical practice worldwide," Dr. Morley said.

Some gerontologists, however, disagree with the article's conclusion. There's a lack of evidence that treating cases of frailty detected by screening will rectify or improve the problem, said James Pacala, MD, chair of the American Geriatrics Society board of directors and immediate past president of the organization.

Dr. Pacala, a Minneapolis gerontologist, said physicians and the public should pay more attention to the negative consequences of frailty, but he doesn't support universal screening of elderly patients for the condition. He described it as a premature recommendation.

"One of the requirements of a good screening test is that finding the condition early will change the outcome," he said. "I don't think we have enough evidence to justify that" with frailty.

 

"Frailty Consensus: A Call to Action," Journal of the American Medical Directors Assn., June (link)

"Frailty and the Older Man," Medical Clinics of North America, September 1999 (link)

"A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans," The Journal of Nutrition, Health and Aging, July 2012 (link)

 

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