frailty - british hiv association · frailty model 2: accumulated deficit “incremental...

NIHR CLAHRC Northwest London

Collaboration for Leadership in Applied Health Research and Care

Northwest London

The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London

is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London

Frailty

BHIVA


Collaboration for Leadership in Applied Health Research and Care

Northwest London

The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London

is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with North West London

Frailty and HIV

Dr John Soong


Declarations

• Royal College of Physicians London

Fellowship Award hosted NIHR CLAHRC for

NWL

• Chelsea & Westminster Joint Research

Committee Fellowship Award


Content

• Population ageing and frailty

• Frailty definition and measurement

• HIV and frailty

• How to treat frailty


Frailty Definitions and purposes

Frailty

Nutrition

• MUST

Anxiety

Depression

• GDS

Confusion / delirium

• CAM

• AMT

(In)continence

Co-morbidity

• CHARLTON

Mobility & Falls risk

• BERG

• STRATIFY

Level of functioning:

FAM iADL bADL FIM

Level of social support:

Lives alone

Friends & Family Carers

Medicines Optimisation

Polypharmacy Reconciliation Rationalization

Acute Diagnosis

Physiological Aggregated

Track and Trigger System

FRILTY


FRAILTY


Frailty Model 1: Phenotype

“bio-gerontological observation of physical

weakness”

1)Unintentional weight loss

2)Exhaustion

3)Weakness

4)Slowness

5)Low levels of activity

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence

for a phenotype. Journals of Gerontology Series A Biological Sciences & Medical Sciences. 2001;56(3).


Frailty Model 2: Accumulated Deficit

“incremental aggregation of loss”

All Deficit

Rockwood K, Howlett SE, MacKnight C, Beattie BL, Bergman H, Hebert R, et al. Prevalence, attributes, and outcomes of fitness and frailty in

community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 59. United States2004. p.

1310-7.


PROS

• Validated for long term

mortality

– 1-5 year mortality

– Functional decline

– Institutionalization

• Physiologically Credible

– Mouse models

– Anthropometrics

– Biomarkers

CONS

• Validated mainly on

Community Dwelling

adults (though

increasing evidence for

hospital population)

• No absolute consensus

on measurement

– Diverse independent

variables

– Research based

measurement techniques

with little clinical

acceptability

Frailty Models


Frailty and HIV


Frailty and HIV

• Does HIV cause frailty?

NIHR CLAHRC Northwest London Evidence for intervention:

Ageing & Longevity


Evidence for interventions: Frailty in Acute Care


Perioperative Medicine and Frailty


QI: Contextual implementation


Summary

• Frailty is prevalent, associated with ageing but non-fully

elucidated pathophysiological pathways may result in

presentation in younger cohorts e.g. HIV

• Measurement of frailty should lead to appropriate

multidisciplinary interventions which are holistic

frailty - british hiv association · frailty model 2: accumulated deficit “incremental...

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