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Doctors focus on frailty to keep elderly in balance - Ogden Clinic provided source, Standard-Examiner 06/10/2013

(Standard-Examiner) If you’re older than 70, you should be checked for frailty. Not doing so could cost you your life.

Over time, frailty leads to increased death rates, poor function and increased hospitalizations, according to an article in this month’s Journal of the American Medical Directors Association.

The condition is treatable, and the article’s authors say it takes doctors just 15 seconds or so to conduct a screening that could prevent bad outcomes.

“Frailty is extraordinarily common, affecting between 5 and 10 percent of those who are older than 70,” said Dr. John Morley, director of the division of geriatric medicine at Saint Louis University and lead author of the article.

Most people who are frail function pretty well, he said. However, there are those who are too tired to get out and do things or are afraid of falling, and many times, they aren’t interested in eating.

“If they walk into a doctor’s office, the doctor is likely to say, ‘You look fine.’ Yet, their frail condition is highly predictive of a bad outcome and many times can be fixed if doctors and patients are aware of the problem,” Morley said.

Dr. J. David Schmitz, a family physician with the Ogden Clinic, said frailty can be caused by poor nutrition, lack of exercise and multiple medical problems such as heart disease, diabetes, arthritis and chronic obstructive pulmonary disease.

These things can lead to such weakness that people can no longer take care of themselves effectively and become dependent on others.

“All too often, we tend as physicians to focus just on the symptoms of disease the patient is presenting to us in the office and forget to ask the most important question: ‘How are you getting along?’ ” Schmitz said.

The article, he said, reinforces the importance of having a personal connection with patients and encourages doctors not just to treat patients’ disease but to treat their life.

Representatives from international and national medical societies who have explored the characteristics of physical frailty have established treatment guidelines, the article states.

Because older adults prefer to stay in their own homes as long as possible, it’s important for them to recognize the signs of frailty and for their doctors to conduct a screening.

“Patients who can maintain their independence and dignity are happier even when dealing with horrific medical problems,” Schmitz said.

Patients who lose their independence because of frailty are among the saddest people on Earth because they have lost their identity as a functional member of society, so it’s important for doctors to investigate those issues, he said.

A family physician is uniquely positioned to help deal with the problems.

The recommendation in the article includes a FRAIL questionnaire that addresses Fatigue, Resistance, Aerobic endurance, Illness and Loss of weight.

The questionnaire takes less than 15 seconds to administer, the article’s authors say.

Bonnie Jacklin, chief nursing officer at McKay-Dee Hospital, said all patients of the Ogden hospital are subject to a functional assessment that consists of an in-depth questionnaire that includes all of the FRAIL screening questions.

Once patients are assessed, she said, they are treated with nutritional supplements, vitamin D, exercise and, if needed, a reduction in medications.