Defining Frailty: What Does it Really Mean?

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When I went to the hospital last week for a series of appointments related to my upcoming knee replacement surgery, I was asked if I would be willing to participate in a study being conducted by researchers at the Geisel Medical School at Dartmouth College (that's the one named after the Dr. Seuss creator).

The research is an attempt to determine a "frailty index" for people 65 and older who are having elective surgery.

I thought about the question for about two seconds and replied: "I'm a blogger who writes about caregiving, dementia and other problems related to the elderly. How can I not participate in such a research study?"

So I was duly read the rules, regulations, disclaimers, etc. necessary to enroll someone in a research study. One of the disclaimers was that I understood there would be no compensation for my participation. Darn!

The researcher assured me it wouldn't take more than ten minutes of my time. She was almost right about that.

The first part of the study involved a brief, very brief, mental acuity test. I had to draw a clock and repeat three words. Passed that with flying colors – surprise, surprise!

Next was a strength test. She handed me a gadget with a meter on it and asked me to squeeze as hard as possible. I did this three times. My score was in the average range. A little surprise there – given my difficulty opening cans, bottles and boxes, I would have thought I was far below average. How do those poor people who scored below average manage to survive?

The third part of the research involved mental attitude—depression, anxiety, etc. I was asked questions related to any depression or anxiety I might have had over the past few weeks.

Well- duh? I have volunteered my body to have a very difficult elective surgery and they want to know if I have any anxiety or depression.

Yes!

I am concerned that I won't be able to perform the required exercises in a manner that will get me back to good as new. I won't be able to drive for six weeks – who's going to get the groceries and take me to my therapy sessions since Charlie no longer drives? I will need antibiotics every time I go to the dentist for the rest of my life. I will need heavy-duty pain meds for some time.

Of course I am depressed!

I am concerned about how my Charlie will cope with me being hospitalized for 3–15 days, depending on whether or not I need rehab care. He gets confused if I'm away from him for an hour, and they want to know if I am anxious?

Yes!

My score on that part was similar to other people undergoing elective surgery. We are all anxious and depressed.

The research group to date numbers 162 participants.They're hoping to coerce 1,000 to participate in order to obtain a good reference point. So far, of the 162, only two people scored high (or was it low) in the frailty index – meaning they are frailer than most people in their age group.

Supposedly, the frailty index is a predictor of morbidity, outcome, chance of wound infection, other infections, and mortality. In other words – the frailer you are going into surgery, the more likely you are to have problems during or after surgery.

Does it take a study to figure that out? I'm glad I was not number three in that frail group, or I might be expected to die or lose my leg from having chosen elective surgery. If any of those events do occur, given that I performed well on the test, how will that affect their study?

Apparently the study was prompted by a large Canadian study on people who had emergency surgery.

I'm not sure how you do a frailty test on people who have emergency surgery. Do they say – wait – we can't take your appendix out until you take this test? And then, do they tell you will die if we don't take it out, but you might die if we do because you're frail?

Or, do they give people the test after emergency surgery – provided they survived the procedure?

I'm not sure what that all means, but I hope it means something to somebody. It may be that they will, at some point, tell people who perform poorly on the test that they might not want to have elective surgery.

I'm just glad the research is not funded by government grants. Seemed pretty useless to me.

I'm not sure what the point is to this story. Maybe it's that we senior citizens should take a frailty test before we decide to have a knee replaced, a face lift, or cataract surgery.

What do you think?

By the way, "I do not like green eggs and ham."

Marlis describes herself as a “Gramma who loves technology and has a lot to say.” She blogs about whatever catches her interest: food, books, family and more. For AgingCare.com, she writes about the issues facing the elderly and her experiences caring for her husband, Charlie, who suffers from dementia.

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4 Comments

My mom said something interesting to me years ago: "If you keep your heart healthy, they'll replace your parts." She was right -- at 85 they agreed to replace her hip. She's still hummin' and kickin'. It's a fact. Doctors have known for years what the risk factors are and won't touch you for elective surgery if they think they'll lose a patient. No study necessary.
I agree that as you get older, things don't work so well, people we love die or move or are also not well enough to visit it is...DEPRESSING. As you said - DUH. I think for most of those things, if you were NOT somewhat blue or depressed, at least for a time, you would need to have your actual sanity questioned! Seeing the glass half full (for example, "I wish I didn't have to have this stupid surgery but thank God I have good doctors") seems like the best you can do going in to something that you aren't exactly looking forward to, don't know for sure a head of time what the outcome will be and knowing you will probably have a significant amount of pain with (at least at first) is doing really well.
Interesting article. I had two total knee replacements, both in 2011, 5 months apart at ages 65 & 66. Although those were fairly difficult, I'm very happy I had them done. The hardest part was taking care of my frail 66 year old husband with advanced dementia (young onset) at the same time. Honestly, it made the TKR's seem easy in comparison, especially in retrospect. I told myself that getting up and taking care of him was actually good therapy for my knees. Two years afterwards, I am thrilled with the outcome of the TKRs and can only say "go for it".