Building Competency in Diabetes Education THE ESSENTIALS

4-38 | CHAPTER 4

Measuring Frailty

Frailty is a widely used term associated with aging that denotes a multidimensional syndrome that gives rise to increased vulnerability (3,83).

Research has shown that frailty is a better predictor of complications and death in older patients with diabetes as compared to chronological age or multiple comorbidities (83,84). There are numerous ways to measure frailty, including the index developed by Rockwood and colleagues in the Canadian Study for Health and Aging (85) and the frailty phenotype instrument developed by Fried and colleagues in the Cardiovascular Health Study (86). It is suggested that these instruments should be used in a complimentary fashion in order to identify the full multidimensional range of factors which determine “frailty” (87,88). The Clinical Frailty Scale is a validated nine-point frailty scale used to stage the older adult from 1 Being “Very Fit” to 9 being “Terminally Ill"(84,88), and is well articulated in the 2018 Guidelines chapter discussing diabetes in older people. The Phenotype Frailty Model assesses five functional aspects of aging with the following criteria and uses a six-point Likert scale for determining the level of frailty. Criteria for staging in the Phenotype Frailty Model: 1. Weight loss, unintentional, of ≥10 pounds in prior year or, at follow - up, of ≥5% of body weight in prior year (by direct measurement of weight). 2. Weakness: Grip strength in the lowest 20% at baseline, adjusted for gender and body mass index. 3. Poor endurance and energy: As indicated by self-report of exhaustion. Self-reported exhaustion, identified by two questions from the CES–D scale, is associated with stage of exercise reached in graded exercise testing, as an indicator of V̇O 2 max, and is predictive of cardiovascular disease. 4. Slowness: The slowest 20% of the population was defined at baseline, based on time to walk 15 feet, adjusting for gender and standing height. 5. Low physical activity level: A weighted score of kilocalories expended per week was calculated at baseline, based on each participant's report. The lowest quintile of physical activity was identified for each gender (86).