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Recognising frailty - frailty syndromes

Sometimes frailty means that individuals can present with what appears to be a straightforward symptom masking a more serious or complex underlying medical problem. This gives rise to the concept of ‘frailty syndromes’ (previously known as the geriatric giants).

Broadly there are 5 frailty syndromes and encountering one of these should raise suspicion that the individual concerned has frailty. However, it is possible to have any of these problems without frailty and sometimes there can be a very straightforward explanation for the problem. Nonetheless, frailty can mean, for example, that myocardial infarction, stroke, pneumonia or even spinal cord compression due to infection could all manifest themselves in a patient with frailty as a sudden change in mobility. Likewise a fall could indicate serious underlying illness and it will not be possible to make this decision without reviewing the patient (see section 4.2.3 - Management of a patient in an urgent situation).

Frailty syndromes

  1. Falls (e.g. collapse, legs gave way, ‘found lying on floor’).
  2. Immobility (e.g. sudden change in mobility, ‘gone off legs’ ‘stuck in toilet’).
  3. Delirium (e.g. acute confusion, ’muddledness’, sudden worsening of confusion in someone with previous dementia or known memory loss).
  4. Incontinence (e.g. change in continence – new onset or worsening of urine or faecal incontinence).
  5. Susceptibility to side effects of medication (e.g. confusion with codeine, hypotension with antidepressants).

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