Assessing Frailty in Elderly Patients

One of the key issues in the treating elderly patients with heart failure is the assessment and management of frailty—this may not be news to gerontologists, but it's an issue many cardiologists don’t hear much about, according to Dalane W. Kitzman, MD, who presented during the “Aging and Heart Failure: Bench to Bedside” symposium Monday at the HFSA 14th Annual Scientific Sessions.

The elderly population is increasing worldwide, and the rates of morbidity and mortality resulting from cardiovascular disease in this population—along with the related costs—are on the rise, said Kitzman. The challenge for physicians with heart failure, one of the most debilitating disorders in the elderly, “is to expand life expectancy while improving the act of life.”

And that means assessing frailty, a condition that can lead to both mobility and cognitive impairment. The three measures used to measure frailty are physical function status, cognitive status, and nutritional status, according to Kitzman, who described the short physical performance battery test often used to assess physical function. The test involves a timed 4-meter walk, timed standing balance, and a chair rise.

“It’s deceiving. You might think, what can you learn from a patient from such short, simple tests?” asked Kitzman. “But these components are powerful predictors of death,” particularly when paired with a weighted summary score.

The assessment (which can be downloaded here) is fast and easy to administrate, requires no specialized equipment or space, is supported by data from large studies, is highly predictive of key outcomes, and can even be shortened or broken down into individual components, according to Kitzman. Of its four components, the one that is the strongest predictor of outcomes is the 4-mile walk.

In another presentation, Michael W. Rich, MD, discussed pharmacotherapy in the elderly, a topic that is growing in interest among cardiologists. The average age of heart failure (HF) patients in the US is 75; however, the median age of patients in HF trials is around 60-65.

This is a major issue, he said, as “major changes occur in heart failure patients between their 60s and their 70s that impact the prognosis of the disease and the response to therapy. We can’t pressure that the results seen in younger patients in trials necessarily apply to older patients.”

The data on those older than 75-80, who comprise a large percentage of HF patients, is significantly lacking, said Rich, along with pharmacologic data on nursing home patients with multiple comorbid illnesses, women and minorities.