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?
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Age as only a demographic
variable for adjustment?
What really happens along
with aging?
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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
Frailty is not just the same as ageing
By GINA KOLATA
Published: October 5, 2006
Frailty Syndrome
increased vulnerability to disease
Decrease reserves
Frailty = (Dependency x vulnerability x
co-morbidity)
+
(Environmental x Social factors)
apparently MINOR
insult
disease or disability
Adverse outcomes
Common pathway of terminal aging
Martinez Martin, et al. Rev Esp Geriatr Gerontol 2007;42:357-60
Frailty
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 predicts mortality of older adults
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3 out of 5 conditions
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No cognitive elements
slow walking speed
poor hand grip
exhaustion
weight loss
low physical activities
Outcome
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fall
disability
hospitalization
death
Fried LP, et al. J Gerontol 2001; 56A:M1–M11
Frailty Index and CSHA Clinical Frailty Scale
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70項臨床缺損評估, 包括
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當下罹病狀況與嚴重度
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執行日常生活功能 (ADL) 的能力
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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
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Weakness
Slowness
Poor endurance /
sarcopenia
Weight loss (Nutrition)
Physical inactivity
Multidimensional
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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.
The Trajectory of Gait Speed Preceding Mild
Cognitive Impairment
Burrachio T, et al. Arch Neurol 2010;67:980-6
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
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
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Critchley M. The neurology of old age. Lancet 1931;1:1221–30
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
Rogers & Evans. Exerc Sport Sci Rev 1 993;21:65-102
6% decline in muscle mass per decade
from age 30-70
Fleg& Lakatta. J Appl Physiol 1988;65:47-51
1.4 –2.5% decline in muscle mass per
year after age of 60
Frontera,et al. J Appl Physiol 2000;88:1321-6
Consequences of sarcopenia
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
GOODPASTER BH et al J Gerontol Med Sci 2006; 61A: 1059-64
Sarcopenia, obesity and mortality
Sarcopenia plays a stronger
role than obesity in all-cause
mortality in the elderly
Cesari,et al. J Gerontol Med Sci 2009;64A:377-84
How to define sarcopenia
Cruz-Jentoft AJ et al. Age Ageing. 2010 Jul;39(4):412-23.
Asian Working Group for Sarcopenia
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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, Taiwan
b The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong,
China
c Department of Preventive and Social Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
d Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
e Geriatric Medicine Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
f Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
g Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Thailand
h Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, I-Land, Taiwan
i Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South
Korea
j Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
k Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
l Department of Comprehensive Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu,
Japan
mResearch Institute, National Center for Geriatrics and Gerontology, Obu, Japan
n Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
o Department of Family Medicine, National Cheng Kung University Hospital and College of Medicine,
Tainan, Taiwan
臨床上的重要性
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老年人口激增, 潛在性肌少症與衰弱族群增加
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可預期的功能退化
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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
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早期發現  預防晚期的共病症及併發症
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Sarcopenia & Frailty 是可以預防改善的！
Potential therapeutic approaches
Assessment and Management
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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
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Early mobilization: bed is BAD
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Comprehensive rehabilitation
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"Hospital at home" schemes
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"Case management" by community matrons
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Assessment by a specialist geriatrician and/or a
multidisciplinary team
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Develop an overall plan for treatment and longterm follow-up
Treat contributing causes
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Drug treatment
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Vitamin D deficiency should be recognized and
treated in the elderly
Surgical treatment
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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
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Preventing falls and osteoporosis
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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
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劉力幗, MD
Aging and Health Research Center, National
Yang Ming University, Taipei, Taiwan
Center for Geriatrics and Gerontology, Taipei
Veterans General Hospital, Taipei, Taiwan
email: lkliu@vghtpe.gov.tw