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Can you pass the frailty test?

A Dynamometer
How strong is your grip?

How well you're going to fare after surgery can now be predicted by a simple 10-minute test. It's the result of a study on frailty carried out by Johns Hopkins researchers on 594 patients who were 65 years old or older. The goal is to help doctors anticipate potential surgical problems before they happen and increase the odds for a good recovery.

Here's how it works. Patients are given a score based on how many frailty criteria they met. People who meet four or more of the criteria are considered frail. Those who have just two or three of the indicators are considered intermediately frail. You are considered NON frail if you meet only one or fewer of the five criteria.

The need for a test like this is actually surprisingly important, because up until now doctors have had to rely on tests that are limited to specific issues. For example, some doctors use the Lee Cardiac Index that looks at the likelihood of cardiovascular complications. That's great if you have heart problems, but doesn't help the surgeon if you have other medical issues.

Some surgeons judge a patient's capacity to withstand chest surgery by their ability to walk up a single flight of stairs. Physicians may also use the American Society of Anesthesiologists (ASA) score; which is based on subjective observations of a patients overall health. Unfortunately those tests and others commonly used tend to leave gaps and may not be accurate if the doctor isn't very familiar with the patient.

Researchers found that patients identified as frail were 2.5 times more likely to suffer a postoperative complication than non-frail individuals. Frail people were also 1.5 times more likely to spend extra time in the hospital and 20 times as likely to be discharged to a nursing home or assisted living facility after previously living at home.

A frailty test is especially important for people considering elective surgery. If you don't pass and are considered frail, why risk having the procedure? Instead, you should put together a plan to get in better shape before letting surgery continue.

Here are the five questions doctors used to help determine frailty.

1. Has the patient lost 10 pounds or more in the past year unintentionally?

2. What kind of grip strength does the patient have? (Answer is arrived at by having patient squeeze a hand-held dynamometer, and then adjusting the number based on body mass index and gender.)

a. The criteria for MALE weakness is below.

i. BMI at 24 or below and grip strength of 29 kg or below.

ii. BMI from 24.1 to 26 and grip strength of 30 kg or below.

iii. BMI from 26.1 to 28 and grip strength of 31 kg or below.

iv. BMI above 28 and grip strength of 32 kg or below.

b. The criteria for FEMALE weakness is below.

i. BMI at 23 or below and grip strength of 17 kg or below.

ii. BMI from 23.1 to 26 and grip strength of 17.3 kg or below.

iii. BMI from 26.1 to 29 and grip strength of 18 kg or below.

iv. BMI above 29 and grip strength of 21 kg or below.

3. How quickly does the patient become tired and how motivated is the patient?

a. Question – "I felt that everything I did was an effort."

b. Question – "I could not get going."

Answer each question with how often in the last week you felt that way. If either statement is met with a 2 or 3 then they meet the criteria for exhaustion.

0 = Rarely or none of the time – less than 1 day.

1 = Some or a little of the time – 1-2 days.

2 = A moderate amount of time – 3-4 days.

3 = Most of the time.

4. Over the previous two weeks, how much activity has the patient engaged in?

Patients physical activities are rated using the short version of the Minnesota Leisure Time Activities Questionnaire, and included frequency and duration. Weekly tasks are converted to kilocalories of expenditure.

Men who burn less than 3,830 calories per week and women who burn less than 2,700 calories per week are classified as having low physical activity.

5. Walking at a normal pace, how fast can the patient cover 15 feet?

a. Men who are 173 centimeters and under (about 5 feet 8 inches) have to walk 15 feet in under 7 seconds.

b. Men who are taller than 173 centimeters have to walk 15 feet in under 6 seconds.

c. Women who are 159 centimeters and under (about 5 feet 2 inches) have to walk 15 feet in under 7 seconds.

d. Women who are taller than 159 centimeters have to walk 15 feet in under 6 seconds.

Researchers noted that the frailty test, "strengthened the predictive ability of other commonly used" tests that attempt to determine risks facing surgical candidates.

While the results of the study are very encouraging, there are a couple drawbacks we should note. The study did not look at the patients' quality of life. In some cases, even if a patient is frail, surgery may be recommended because without it the quality of life for the patient is so poor. Also the patients were only tracked for 30 days, so it's unknown if the results would continue to hold up over time.

Now that you know, can you pass the frailty test?

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4/14/2013