Being Mindful of Frailty in MSK Practice
A member of our MSK team recently attended a frailty event that looked at a number of workstreams around this topic. This member of the team was reminded how frailty affects MSK conditions, and vice versa, and also about the responsibility of clinicians in being on the front foot in its identification. This clinician is not a frailty expert; however, they took away some clinical thoughts for MSK practice, which we thought worth sharing.
Frailty, although associated with older persons, could effectively be part of any patient’s presentation, when they are associated with vulnerability to adverse events. Ageing is associated with a loss of physiological reserves, whilst identifying frailty may be linked to being clinically aware of those with increased risk of complications, morbidity and mortality.
Sarcopenia, for example, is a key component of frailty, and as part of an MSK presentation may be highly relevant in terms of recovery, and injury prevention.
Many long-term MSK conditions can easily lead to functional decline and as we manage more patients with multiple long-term conditions, the risk of frailty can predict outcomes and complications, such as an increased falls risk.
Frailty can be defined through a phenotype model which emerges from factors such as chronic disease and MSK changes, leading to inactivity, energy expenditure and poor nutrition. This has been cited to lead to five key criteria for clinical and research settings such as loss of muscle mass, poor endurance, slowness and reduced activity (Fried et al 2001).
The other model cited is the accumulation model which considers components which allow an individual to live in the community and deficits that compromise that. These could be biomedical factors, psycho-social, socio-economic and community support.
MSK clinicians can easily look at a knee, hip and even biomechanically at an individual, but possibly not weigh up the whole of the factors to gain an appreciation of the potential for frailty, and how this will affect outcomes of all interventions.
Perhaps using a simple scale, such as the Rockwood Scale, might be something to add into MSK assessment when appropriate.
The MSK team at AECC University College will certainly be looking at this more in the future.
References
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in Older Adults: Evidence for a Phenotype. J Gerontol A Biol Sci Med Sci.
2001;56:M146-M57. Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D.B., McDowell, I. and Mitnitski, A., 2005. A global clinical measure of fitness and frailty in elderly people. Cmaj, 173(5), pp.489-495.
