Nothing is ever simple! A year ago, I would have never thought that a standard definition of frailty would come in useful. Isn’t the word, ‘frail’ self explanatory? As it turns out, it is not. The OASIS-C asks for frailty indicators giving weight loss as an example.
A colleague found a great article from The Journal of Gerontology Sciences which uses the symptoms of weakness, poor endurance, weight loss, low physical activity, and slow gait speed to assess frailty. The article states that more than one symptom is generally present. Conditions associated with frailty are those we see every day in home health. They are: undernutrition, functional dependence, prolonged bed rest, pressure sores, gait disorders, generalized weakness, aged .90 years, weight loss, anorexia, fear of falling, dementia, hip fracture, delirium, confusion, going outdoors infrequently, and polypharmacy.
If you are thinking that many of your patients meet this criteria for frailty, you are likely correct. Using the definition stated above, about seven percent of the population over age 65 is frail and a full 30% of persons over 80 are frail. Consider that our patients are the ‘active adults’ targeted by Florida’s condominium industry looking for a place to play golf and Mah Jong and it is easy to believe that our percentage of frail patients is much higher.
To assess your patient, look for some of the associated symptoms. Check your diagnoses for those that might contribute to frailty. Most importantly, assess your patient always being leery of those stoic patients who report being stronger and more capable than they actually are. Collaboration with home health aides and physical therapy may paint a much clearer assessment.
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Thanks to Lavonne for sharing the link with me.