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what is the definition of frailty?
- clinical syndrome in which three or more of following criteria are present?
- unintentional weight loss
- self reported exhaustion
- weakness (grip strength)
- slow walking speed
- low physical activity
frailty, independently predicted over 3 years leads to...
- worsening mobility
what are the pathophysiological mechanisms of frailty
- cellular level - cumulative oxidative damage
- system dysregulation - inflammation, hormonal dysregulation, activation of blood clotting pathways, metabolic abnormalities
- system impairment - sarcopenia, neurocognition
what are moderating factors of fragility?
- lifestyle factors - health behaviours, socioeconomic status
how is frailty managed?
- geriatric assessment
- physiotherapy and exercise
- nutrition assessment and intervention
how is exercise beneficial in treating frailty?
beneficial to increase gait speed, improve balance, and improve performance in ADLs in frail older adults
what is recommend exercise intervention for frailty?
- multicomponent training intervention
- long duration >5 months
- performed 3 times per week
- 30-45 mins per session
what is the definition for frailty fractures?
fractures resulting from a fall from a standing height or less, or presenting in the absence of obvious trauma
where are common fractures? who do they affect?
- up to one half of women
- one third of men over 50
- hip, spine, wrist
after hip # what is % of mortality?
25% die within 12 months, 50% do not regain original mobility
before mobilising older spines what should you consideR?
only about 30% of vertebral fractures are diagnosed in clinical practice
how can osteoporosis be avoided?
- adequate dietary calcium
- adequate vitamin D status
- limit alcohol to 2 drinks per day
- no smoking
what is management of osteoporosis to prevent the first fracture
- maintain/improve bone
- prevent falls
- nutrition and vitamin D
- physical activity and exercise
- drug therapy
how is vitamin D important?
- important for bone and muscle
- muscle weakness may be associated with vitamin D deficiency
- low serum vit D levels associated with decreased muscle strength, changes in gait, difficulties in rising from a chair, inability to ascend stairs and diffuse muscle pain
what are the principles of exercise to maximise bone health
- rapid short bursts of high intensity/high impact exercise
- exercise in short burst with rests better then long continuous bouts of exercise
- novel forces - change directions, different height jumps more stimulating then repetitive force
if a person has had a fracture, what precautions should you take
- avoid twisting and jarring activities
- consider level of high impact activities
- avoid heavy lifting
- avoid sudden abrupt movements
what the three best things for bone health
How are fragility fractures defined?
Where do they most commonly occur?
What are important strategies to prevent fractures in people with osteoporosis?
What should be features of an exercise programme aimed to build bone?
what is functional decline?
- a decrement in physical and / or cognitive functioning
- decrease in reserve capacity - reconditioning
- cumulative - bedrest, immobility, inactivity
how do physios work with functional decline?
- check strength
- spatial organisation
what are physiotherapist's recommendations for functional decline?
- assess/screen falls and fracture risk, mobility and functional status
- develop plan to encourage activity throughout the day, minimise bed rest, exercise, and retrain ADL
what are other issues to consider with functional decline?
- skin integrity
- management of adequate nutrition, hydration and mobility