Octogenarians are the fastest-growing age group in North America.
The number 80 does not always reflect true age as elderly people have a range of mental and physical abilities that varies from robust to frail.
Some 80-year-olds sit quietly in nursing homes, while others run marathons.
Increasing numbers of these individuals are now considered for, or will ask for, highly complex technological care: cardiac surgery, artificial ventilation in intensive care units and dialysis, to give a few examples.
Can we tell who will benefit and who will come to harm? But first, what is frailty?
Frailty is a state of health that makes people vulnerable to illness and injury because they lack the strength to withstand physical and emotional stress.
After becoming ill or injured, they possess a diminished ability to fight back to health. As people age, many lose muscle mass and bone strength. They may feel less stable on their feet and begin to move more slowly.
They may find shopping and housework more difficult. As their ability to think and remember decreases, they may find it harder to keep track of the details of their daily lives.
Research has identified factors that increase a person’s risk of becoming frail: increasing age, obesity, low physical activity, inadequate nutrition, depression, smoking, multiple chronic health problems and repeated episodes of acute illness, being among them.
Contributing social factors include isolation, lack of financial resources, and lack of mental stimulation.
When a frail person is injured or sick, he or she is slow to recover and may never regain previous health levels. As more health problems develop over time, the person requires more help with the tasks of daily living, like cooking, shopping and banking.
Eventually, he or she may need help with personal care, such as bathing or dressing.
In such patients, aggressive medical treatments can often do more harm than good.
During hospitalization or following medical procedures, frail patients may suffer delirium, functional decline or other complications.
Delirium is a state of confusion that, once triggered, often does not fully resolve itself in frail, older people. Functional decline is the loss of the ability to perform tasks the person could previously perform.
The outcome may be dependency on others. It may mean admision to a long-term care institution. These are significant developments in an older person’s life. They may be scarier than death.
Frail patients and their families need to understand the degree of frailty and the risk of the complications noted above. Only then can they make informed treatment decisions.
One avenue is to obtain a complete status evaluation through comprehensive assessment of physical, mental and social health, mobility and the ability to function independently.
The information gathered can then be shared with the patient, family and health-care professionals so all are on the same page concerning the degree of frailty and risk of complications.
This information empowers everyone involved in making the right decision at the right time.
This is what we are implementing at Health Sciences North.
Dr. Peter Zalan is president of the medical staff at Health Sciences North.
