Assessment of Frailty and Fall Risk
Bimba Wickramarachchi
University of Ruhuna
Content �
Introduction to Frailty �Definition �A multidimensional geriatric syndrome characterized by vulnerability to stressors�Prevalence: 10–25% in community-dwelling older adults�Relevance: Predictor of disability, hospitalization, institutionalization, and mortality���
Pathophysiology of Frailty�-Dysregulation of multiple physiological systems�-Sarcopenia and reduced reserve capacity�-Chronic inflammation (“inflammaging”)�-Neuroendocrine dysregulation�-Interaction with multimorbidity
Importance of Frailty Assessment �- Identifies at-risk older adults�- Guides clinical decision-making (medications, interventions, rehabilitation)�- Prevents adverse outcomes (falls, hospitalization, institutionalization)�- Supports resource allocation in community and hospital care
Fried Frailty Phenotype (FFP)��Five criteria: weight loss, exhaustion, weakness, slowness, low physical activity�Frail: ≥3 criteria; Pre-frail: 1–2 criteria
Clinical Frailty Scale (CFS)��-Visual, judgment-based scale (1 = Very fit, 9 = Terminally ill)��-Widely used in acute care and ICU settings��-Quick bedside tool
Frailty Index (FI)�Based on deficit accumulation�Number of deficits ÷ total considered = FI score�Highly predictive of outcomes but time-consuming��Tilburg & Groningen Frailty Indicators�Multidomain: physical, psychological, social�Self-reported questionnaire�Useful in community settings
Case Scenario 1�Mrs. K, 78 years�History: Hypertension, diabetes, weight loss (4kg/6mo), tiredness, walking speed reduced�Apply Fried Frailty Criteria → classify frail/pre-frail�Discuss implications for community nursing interventions
Case Scenario 2�Mr. S, 83 years�Post-hospital discharge, living alone, multiple medications, reduced social contacts�Apply Clinical Frailty Scale & TFI�Care planning: fall prevention, social support, medication review
Challenges in Frailty Assessment�Cultural and contextual variations�Self-reported vs. performance-based measures�Resource limitations in low- and middle-income countries�Integration into routine practice
Recent Advances & Research��- Biomarkers of frailty (IL-6, CRP, albumin)�- Digital health tools & AI in frailty detection�- Wearable devices for gait speed, physical activity�- Personalized interventions
Summary �- Frailty is common, multifactorial, and reversible in early stages�- Multiple tools available – tool choice depends on setting and purpose�- Frailty assessment should be linked with CGA for best outcomes�- Early detection = better quality of life and reduced healthcare burden
Mobility Assessment��Physical performance tests�- Timed Up and Go (TUG)<12 sec = normal; ≥12 sec = fall risk�- Gait Speed<0.8 m/s = poor prognosis, frailty indicator�- Short Physical Performance Battery (SPPB)�- Combines gait speed, chair stands, balance tests6-Minute Walk Test�- Endurance measure
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Case Scenario
Mrs. R, 80 years, Lives alone, history of osteoarthritis & hypertension
Reports difficulty climbing stairs and unsteadiness when walking outside
Assessment: TUG test = 15 seconds
Gait speed = 0.7 m/s
Needs to push up with arms for chair stand test
Interpretation: High risk for falls, reduced lower limb strength, needs intervention
Falls Risk Assessment��Falls in Older Adults�Epidemiology – 1 in 3 adults >65 years fall annually, leading cause of injury-related hospitalization and loss of independence�Consequences - fractures, fear of falling, institutionalization, mortality�Need for assessment - Early detection reduces risk and guides prevention
Risk Factors for Falls��Intrinsic: Age-related changes, sarcopenia, vision impairment, cognitive decline�Chronic diseases (stroke, diabetes, arthritis, Parkinson’s)�Medications (polypharmacy, sedatives, antihypertensives)�Extrinsic: Environmental hazards (poor lighting, loose rugs, stairs)�Inappropriate footwear, lack of assistive devices�Behavioral: Risk-taking, reduced activity due to fear of falling
Falls Risk Assessment Tools��Morse Fall Scale - Assesses history, gait, mental status, IV therapy, and mobility�Hendrich II Fall Risk Model - Includes confusion, depression, incontinence, medications, gait�STRATIFY Tool - Predicts falls in hospital settings�Timed Up and Go (TUG) test - Quick physical performance screen�Berg Balance Scale – comprehensive functional assessment
��Case Scenario��Mr. P, 82 years lives with spouse, history of hypertension and diabetes. Reports 2 falls in the past 6 months (one with a minor fracture)�Current medications: antihypertensives, sedative at night�Assessment Findings:TUG = 17 sec (slow), Mild vision impairment (cataract), Polypharmacy (≥5 medications)�Home check: loose rugs, poor lighting in hallway�Interpretation: High fall risk due to multiple intrinsic + extrinsic factors
��References��Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381(9868), 752–762. ��British Geriatrics Society (BGS). (2014). Fit for Frailty: Consensus best practice guidance for the care of older people living with frailty in community and outpatient settings. BGS and Royal College of General Practitioners.��American Geriatrics Society (AGS). (2019). Clinical Practice Guideline for the Prevention of Falls in Older Persons. Journal of the American Geriatrics Society, 67(1), 1–46. National Institute for Health and Care Excellence (NICE). (2023).� �Falls in older people: Assessing risk and prevention. NICE Guideline NG210.�����
Thank you