In This Decade of Healthy Aging, Making the Most of Physical Reserve
Throughout the two-hour assessment, the geriatrician did not use the word “frailty”. Instead, he told 75-year-old Roy that his responsibility is to guide his patients into practices intended to “preserve their reserves” – their physiological reserves – to modify their risk of developing other conditions and the deficits currently impacting their reserve.
Then the physician proceeded to unpack the “deficits” of polypharmacy, falling, chronic pain, and poorly controlled diabetes. He deftly explained how these deficits were depleting Roy’s reserves, the risks they were creating, potential goals, and the social and medical services available to accomplish these goals together.
Since standardized tests likely would have felt demeaning to Roy, a highly educated and high-functioning man, the physician-guided the conversation to elicit the information needed to present options consistent with Roy’s medical needs, social circumstances, and capacity to change. Roy came to understand one concept of frailty–balancing assets with deficits– and how the change would be important if the physiological reserves he clearly demonstrated were to be optimized and preserved for as long as possible.
Assets: Characteristics that help maintain independence and function.
Deficits: Characteristics that threaten self-sufficiency, function, and cognition.
Maintaining the balance is a goal for aging well.
In our usual clinical practice, where time is of the essence and decisions often more urgent, it is beneficial to screen for frailty or measure it on a continuum to provide options that have the potential to ameliorate frailty, prevent adverse outcomes, and inform decision-making. Tools are now more available for assessing frailty in every setting where adults with multiple chronic illnesses reside. It is incumbent on us, as clinicians, to consider the value of considering frailty and its impact on the care we provide for our patients.
The World Health Organization (WHO) has designated 2020 – 2030 the ‘Decade of Healthy Aging’ to support action to enable well-being in older age and ensure everyone can fully participate in society. We will be doing our part as we allow frailty to inform the care we provide and the options we present to our patients and their families. We will help them make the most of their physiological reserve.
Please contact us at contact our team today for information on comprehensive frailty assessment and clinical decision support across the continuum of care.