Frailty劉力幗 醫師

台北榮民總醫院 高齡醫學中心

總計 : 11.15% (2012) 11.53% (2013)

What happens when you start to age? Age as only a demographic

variable for adjustment? What really happens along

with aging? Diseases? Functional decline?

Things are more complicated if your concern is about all-cause mortality

What predicts mortality of older old?

Chen LK, et al. J Am Med Dir Assoc 2010;11:567-71

You could knock him/her

over with a feather.

Frailty is not just the same as ageing

By GINA KOLATAPublished: October 5, 2006

Frailty Syndrome

Frailty = (Dependency x vulnerability x co-morbidity)

+(Environmental x Social factors)

apparently MINOR insult

disease or disabilityAdverse outcomes

increased vulnerability to diseaseDecrease reserves

Common pathway of terminal aging

Martinez Martin, et al. Rev Esp Geriatr Gerontol 2007;42:357-60

Frailty, a progressive physiologic decline in multiple body systems, is marked by loss of function, loss of physiologic reserve, and increased vulnerability to disease and death. Frailty increases susceptibility to acute illness, falls, disability, institutionalization, and death.

Fried LP, et al. J Gerontol 2001; 56A:M1–M11

Frailty

Frailty predicts mortality of older adults

3 out of 5 conditions slow walking speed poor hand grip exhaustion weight loss low physical activities

Outcome fall disability hospitalization death

Fried LP, et al. J Gerontol 2001; 56A:M1–M11

Frailty Index and CSHA Clinical Frailty Scale 70 項臨床缺損評估 , 包括

當下罹病狀況與嚴重度 執行日常生活功能 (ADL) 的能力 臨床生理及神經學檢查結果

Rockwood, a seven point scale based on 70 points in Frailty Index

Rockwood K, et al. CMAJ. 2005;173(5):489–95.

Bauer JM, et al. Exp Gerontol. 2008.

Two main phenotypes

Physical characteristics Multidimensional

Weakness Slowness Poor endurance /

sarcopenia Weight loss (Nutrition) Physical inactivity

Socio-demographic Biomedical Functional Cognitive components Mood disorders

Factors associated with entry into frailty

Mental health impairment may precede the development of frailty?

Stundenski S, et al. JAMA 2011l;305:50-8.

Burrachio T, et al. Arch Neurol 2010;67:980-6

The Trajectory of Gait Speed Preceding Mild Cognitive Impairment

Aging is a complex dynamic process

Sarcopenia as a fundamental component of frailty

Bauer J.M., et al. Exp Gerontol, 2008. 43(7): p. 674-8.

The history of sarcopenia is as old as the aging of man

Critchley M. The neurology of old age. Lancet 1931;1:1221–30

loss of certain fiber types in skeletal muscle over time (muscle biopsies): even after the first few decades of life

decline in world weight-lifting records between 30 and 60 years of age

loss of muscle strength and power, as early as 35 y/o

Age-related changes of body composition

Senescence and Sarcopenia

Aging and skeletal muscle

There is probably no decline in structure and function more dramatic than the decline in lean body mass or muscle mass over life

40% loss in muscle mass from 20-70 years of age

6% decline in muscle mass per decade from age 30-70

1.4 –2.5% decline in muscle mass per year after age of 60

Rogers & Evans. Exerc Sport Sci Rev 1 993;21:65-102

Fleg& Lakatta. J Appl Physiol 1988;65:47-51

Frontera,et al. J Appl Physiol 2000;88:1321-6

Consequences of sarcopenia

GOODPASTER BH et al J Gerontol Med Sci 2006; 61A: 1059-64

Age-associated loss of skeletal muscle, postulated to be a

major factor in the strength decline with aging. Moreover,

sarcopenia is related to (1) functional impairment, (2)

disability, (3) falls, and (4) lost of independence

Sarcopenia, obesity and mortality

Cesari,et al. J Gerontol Med Sci 2009;64A:377-84

Sarcopenia plays a stronger role than obesity in all-cause mortality in the elderly

Cruz-Jentoft AJ et al. Age Ageing. 2010 Jul;39(4):412-23.

How to define sarcopenia

Asian Working Group for Sarcopenia

Experts from Japan, Korea, China, Hong Kong, Taiwan, Thailand, Malaysia meeting in Taipei and obtained certain consensus

a Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwanb The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, Chinac Department of Preventive and Social Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailandd Department of Medicine, University of Malaya, Kuala Lumpur, Malaysiae Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwanf Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwang Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Thailandh Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, I-Land, Taiwani Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South Koreaj Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailandk Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwanl Department of Comprehensive Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, JapanmResearch Institute, National Center for Geriatrics and Gerontology, Obu, Japann Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Koreao Department of Family Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwanp Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Health, Beijing, Chinaq Department of Geriatric Medicine, University of Tokyo, Tokyo, Japanr Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

臨床上的重要性 老年人口激增 , 潛在性肌少症與衰弱族群增加 可預期的功能退化 明顯影響老年族群的～ 用藥治療、用藥反應 、罹病率、死亡率 & 生活品

質 早期發現 預防晚期的共病症及併發症 Sarcopenia & Frailty 是可以預防改善的！

Potential therapeutic approaches

Assessment and Management 身體狀況評估 , 治療可能導致失能的各種身體狀況：包括疾病控制 , pain control

用藥：包括 polypharmacy 評估溝通 Communication Cognition & Mood Function ：包括 ADL & IADL, assess

interference of symptoms with activities of daily living

Nutritional support, supplement Environment, Social support

Assessment and Management

Early mobilization: bed is BAD Comprehensive rehabilitation "Hospital at home" schemes "Case management" by community matrons Assessment by a specialist geriatrician and/or a

multidisciplinary team Develop an overall plan for treatment and long-

term follow-up

Treat contributing causes

Drug treatment Vitamin D deficiency should be recognized and

treated in the elderly

Surgical treatment Age alone is not a contra-indication for surgery. Operations such as joint replacement, cataract

surgery and surgery for prostatic hypertrophy are frequently performed on the elderly to reduce disability.

預防孱弱與失能

跌倒預防

健康促進 Preventing falls and osteoporosis

Healthy diet and lifestyle, including smoking cessation

Annual influenza immunization常規視力檢查、聽力測驗、大腸癌篩檢、乳房攝影、子宮頸癌篩檢

劉力幗 , MD

Aging and Health Research Center, National Yang Ming University, Taipei, TaiwanCenter for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan email: lkliu@vghtpe.gov.tw