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Measuring health is important for many reasons. It can help doctors and scientists understand the risk of medical problems and develop prevention strategies that can improve patient care. Monitoring health status can also help economists understand financial outcomes and help policymakers identify the likelihood of people needing caregiver assistance or retiring early, life events that can have implications for programs such as Social Security, Medicare, and Medicaid.
Further, measuring health is essential for assessing the return on U.S. health care spending which is large—close to one fifth of U.S. gross domestic product—and growing. In the United States, people usually take surveys that allow assessment of physical well-being.
Self-assessments of health can help forecast life expectancy and functional ability, and whether a person may require medical care at some point in the future. However, in some cases, a better measure of health than self-assessments might be necessary….Continue reading….
By: Karen Jacobs
Source: The Economics of Aging and the Frailty Index – Federal Reserve Bank of Atlanta
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Critics:
Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults. Frailty is a condition associated with ageing, and it has been recognized for centuries. It is a marker of a more widespread syndrome of frailty, with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss.
As a frequent clinical syndrome in the elderly, various health risks are linked to health deterioration and frailty in older age, such as falls, disability, hospitalization, and mortality. Generally, frailty refers to older adults who lose independence. It also links to the experiences of losing dignity due to social and emotional isolation risk. Frailty has been identified as a risk factor for the development of dementia.
As a population ages, a central focus of geriatricians and public health practitioners is to understand, and then beneficially intervene on, the factors and processes that put elders at such risk, especially the increased vulnerability to stressors (e.g. extremes of heat and cold, infection, injury, or even changes in medication) that characterizes many older adults.
Sarcopenia is the degenerative loss of skeletal muscle mass, quality, and strength associated with aging. The rate of muscle loss is dependent on exercise level, co-morbidities, nutrition and other factors. Sarcopenia can lead to reduction in functional status and cause significant disability from increased weakness.
The muscle loss is related to changes in muscle synthesis signalling pathways although is incompletely understood. The cellular mechanisms are distinct from other types of muscle atrophy such as cachexia, in which muscle is degraded through cytokine-mediated degradation although both conditions may co-exist.
Osteoporosis is an age-related disease of bone that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DXA; the term “established osteoporosis” includes the presence of a fragility fracture.
Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis. It may also develop in men. Osteoporosis may also occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP).
Given its influence in the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life. It has been suggested that the causes of frailty are multifactorial involving dysregulation across many physiological systems. A proinflammatory state, sarcopenia, anemia, relative deficiencies in anabolic hormones (androgens and growth hormone).
Excess exposure to catabolic hormones (cortisol), insulin resistance, glucose levels, compromised altered immune function, micronutrient deficiencies and oxidative stress, are each individually associated with a higher likelihood of frailty. Additional findings show that the risk of frailty increases with an increased number of abnormal bodily systems. This finding shows that interventions that target multiple systems may yield greater results in prevention and treatment of frailty than interventions that target only one system.
Associations between specific disease states are also associated with and frailty have also been observed, including cardiovascular disease, diabetes mellitus, chronic kidney disease and other diseases in which inflammation is prominent. It is possible that clinically measurable disease states can manifest themselves or be captured prior to the onset of frailty. No single disease state is necessary and sufficient for the pathogenesis of frailty, since many individuals with chronic diseases are not frail.
Therefore, rather than being dependent on the presence of measurable diseases, frailty is an expression of a critical mass of physiologic impairments. Frailty has been identified as a risk factor for the development of dementia. Recent work on frailty has sought to characterize both the underlying changes in the body and the manifestations that make frailty recognizable. It is well-agreed upon that declines in physiologic reserves and resilience is the essence of being frail.
Similarly, scientists agree that the risk of frailty increases with age and with the incidence of diseases. Beyond that, there is now strong evidence to support the theory that the development of frailty involves declines in energy production, energy utilization and repair systems in the body, resulting in declines in the function of many different physiological systems.
This decline in multiple systems affects the normal complex adaptive behavior that is essential to health and eventually results in frailty typically manifesting as a syndrome of a constellation of weakness, slowness, reduced activity, low energy and unintended weight loss. When most severe, i.e. when 3 or more of these manifestations are present, the individual is at a high risk of death.
The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. Generally speaking, the empirical assessment of geriatric frailty in individuals seeks ultimately to capture this or related features, though distinct approaches to such assessment have been developed in the literature (see de Vries et al., 2011 for a comprehensive review).
Two most widely used approaches, different in their nature and scopes,are discussed below. Other approaches follow. A popular approach to the assessment of geriatric frailty encompasses the assessment of five dimensions that are hypothesized to reflect systems whose impaired regulation underlies the syndrome. These five dimensions are:
- unintentional weight loss,
- exhaustion,
- muscle weakness,
- slowness while walking, and
- low levels of activity.
These five dimensions form specific criteria indicating adverse functioning, which are implemented using a combination of self-reported and performance-based measures. Those who meet at least three of the criteria are defined as “frail”, while those not matching any of the five criteria are defined as “robust”.
Additional work on the construct is done by Bandeen-Roche et al. (2006), though some of the exact criteria and measures differ (see Table 1 in the paper for this contrast). Other studies in the literature have also adopted the general approach of Linda P. Fried et al. (2001).
Another notable approach to the assessment of geriatric frailty (if not also to some degree its conceptualization) is that of Rockwood and Mitnitski (2007) in which frailty is viewed in terms of the number of health “deficits” that are manifest in the individual, leading to a continuous measure of frailty (see Rockwood, Andrew, and Mitnitski, 2007, for a contrast of the two approaches). This approach was developed by Dr. Rockwood and colleagues at Dalhousie University.
A model consisting of four domains of frailty was proposed in response to an article in the BMJ. This conceptualisation could be viewed as blending the phenotypic and index models. Researchers tested this model for signal in routinely collected hospital data, and then used this signal in the development of a frailty model, finding even predictive capability across 3 outcomes of care.
In the care home setting, one study indicated that not all four domains of frailty were routinely assessed in residents, giving evidence to suggest that frailty may still primarily be viewed only in terms of physical health.
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