Frailty and Malnutrition

Frailty Background

  • Syndrome of physiological decline in late life, characterized by exhaustion, weakness, weight loss, low gait speed, and decreased physical activity leading to marked vulnerability to adverse health outcomes

Management

  • Screen for and treat depression.
  • Prevention of/extra support after stressors (consider HiRISE clinic referral if elective surgery planned)
  • Adapt interventions to the individual based on comprehensive geriatric assessmentincorporating de-escalations of care for patients with more advanced frailty
  • Exercise programs with additional physical and occupational therapy input if indicated.
  • Referral to Nutrition if concern for malnutrition (see below)
    • Malnutrition (Needs to meet two or more of following criteria):
    • Insufficient calorie intake
    • Weight loss
    • Loss of muscle mass
    • Loss of subcutaneous fat
    • Localized fluid accumulation that may mask weight loss
    • Diminished functional status as measured in handgrip strength
    • Reversible causes of malnutrition:
      • Food security (poverty), dental status (dentition, gum health), dietary restrictions, food-related functional status (shop, prepare meals, feed self), depression, dementia, alcoholism, swallowing ability

Evaluation

  • Assess for depression
  • Screening with Mini Nutritional Assessment (good sensitivity and specificity)
    • Order: CBC, CMP, TSH
    • Screen for Common Nutritional deficiencies: B12, folate, vitamin D
    • Consider CT C/A/P in severe or unexplained weight loss
      • Refeeding: K, Phos, Mg BID until stable and no longer having to replete
    • Refer to Nutritionist

Management

  • Manage reversible causes of malnutrition as above
  • Medications: consider Remeron (7.5 mg nightly). Avoid Megace (NNH = 23 for death)
  • Liberalize dietary restrictions
  • Nutritional Supplementation
  • Address what matters most (long, short term goals)
  • See Palliative Care section for resources on code status, goals of care discussions
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