From the Guidelines
Frailty syndrome in an older person can lead to death through a sequence of events that may include:
Key Events Leading to Death
- Progressive decline in physical function and mobility, leading to increased risk of falls, pressure ulcers, and infections 1.
- Malnutrition and dehydration due to decreased appetite, swallowing difficulties, or inability to prepare meals, which can be exacerbated by conditions such as anorexia of aging 1.
- Immobility and decreased muscle mass, leading to increased risk of deep vein thrombosis, pulmonary embolism, and pneumonia 1.
- Decreased immune function, making the person more susceptible to infections, such as urinary tract infections, pneumonia, or sepsis 1.
- Organ dysfunction, including kidney failure, heart failure, or respiratory failure, which can be exacerbated by underlying medical conditions, such as diabetes, hypertension, or chronic obstructive pulmonary disease 1.
Sequence of Events Leading to Death
The sequence of events leading to death may be reflected on a death certificate as follows:
- Immediate cause of death: Sepsis or pneumonia
- Intermediate cause of death: Immobility and decreased immune function due to frailty syndrome
- Underlying cause of death: Frailty syndrome, with contributing conditions such as malnutrition, dehydration, and organ dysfunction.
It is essential to note that the death certificate should accurately reflect the sequence of events leading to death, with frailty syndrome as the underlying cause, to raise awareness of the importance of addressing frailty in older adults 1.
Importance of Accurate Death Certificate
Accurate documentation of frailty syndrome as the underlying cause of death can inform healthcare policy and practice, and facilitate the development of future evidence-based clinical practice guidelines 1.
Geriatric Syndromes and Considerations
Geriatric syndromes, such as frailty, sarcopenia, malnutrition, mobility impairment, and polypharmacy, can have a significant impact on the management of older adults with peripheral artery disease 1.
Shared Decision-Making
Identification of these geriatric syndromes in older adults with peripheral artery disease can be a catalyst for shared decision-making to evaluate the use of endovascular, surgical, or hybrid revascularization procedures to balance the risk of complications or loss of independence against the potential for improved quality of life and palliation of symptoms with a limited life span 1.
From the Research
Frailty Syndrome and Mortality
The frailty syndrome in older persons can lead to death due to the decline in functional reserve and alterations in diverse physiological systems, including:
- Lower energy metabolism
- Decreased skeletal muscle mass and quality
- Altered hormonal and inflammatory functions 2 This altered network leads to an extreme vulnerability for disease, functional dependency, hospitalization, and death.
Sequence of Events
The sequence of events leading to death in frail older persons may involve:
- A decline in physical function, including muscle weakness, fatigue, and decreased mobility 3, 4
- Increased risk of falls, disability, hospitalizations, and mortality 5
- A transitional state in the dynamic progression from robustness to functional decline, characterized by a decrease in total physiological reserves 4
- The accumulation of deficits in multiple physiological systems, leading to increased vulnerability for adverse health outcomes 6
Key Components of Frailty Syndrome
The key components of frailty syndrome include:
- Decreased reserve in skeletal muscle functioning, characterized by a loss in muscle mass and strength (sarcopenia) 2
- Weight loss, muscle weakness/fatigue, low physical activity, and slow walking speed 3
- Loss of endurance, decreased balance and mobility, slowed performance, relative inactivity, and potentially, decreased cognitive function 4
Clinical Applications
The clinical applications of frailty syndrome include: