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Frailty, Fall and Functional Assessment

Functional Assessment

Fall Assessment
  • 21.6 % percent of world population will be geriatrics by 2050. This is up from 12.2 % in 1950. 
  • 30% > 65 fall each year 
  • 5-10 % fall cause serous injury
  • Hip Fracture if present increases mortality of > 20-30% 
  • Risk assessment
    • Intrinsic
      • Sarcopenia / Frailty (decreased muscle mass and strength)
      • Impaired sensorium (vision, proprioception) 
      • Multiple morbidity
    • Extrinsic
      • Vitamin D deficiency
      • House hazards
      • Polypharmacy
  • Evaluation
    • Clinical Evaluaiton
      • History 
      • Physical
        • Vision, Cognition, Gait and Balance, Lowe limb joints, neurological
        • Timed get up and go test 
          • Taking 14 sec or longer for 10 feet or 3 meters is associated with high risk for fall 
      • Medication Review 
      • Labs (as indicated) 
  • Complications
    • Fractures and Injuries 
    • Decline in functional status 
    • Fear of falling 
    • Increased Mortality 
  • Obtain fall management algorithm fro Dr. Negrea's presentation 

  • 250 Million $ per year for checking Vitamin D level. Cost effectiveness of it compared to avoidance of complication? Will the diagnose of lab deficiency improve the compliance? 
Frailty :
  • Definition: State of Increased Vulnerability to poor resolution of homeostasis after stressor event, which increases risk of adverse outcome (including Fall, Delirium, Disability)
  • Pathophysiology: Reduced physiological reserve of Multiple Organ System along with decreased Physical Activity and Nutritional Status
  • Frailty Model:
    • 5 Phenotypical Model Indicators of Frailty
      • Weight loss
      • Self reported exhaustion
      • Low energy expenditure
      • Slow gait speed
      • Weak grip strength
    • Cumulative Deficit Model
Frality in elderly people Lancet 2013 
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