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Bologna 22 March 2016Biomedical versus BioPsychosocialModel of FrailtyMarcello Maggio MD PhDDepartment of Clinical and Experimental MedicineUniversity of ParmaGeriatric-Rehabilitation DepartmentUniversity-Hospital Trust of Parma
OutlineThe evolution of the biological/physical model offrailty and its pitfalls.The additional value of biopsychosocial model in thedetection of frailty.From bench to bedside: 1 clinical case showing themultidomain components of frailty.
Trajectories of physical function in older subjectsPhysical ”Frail and pre-frailReversibleADL-MobilityDisability65Age (years)100DisableADL-Mobility Dependence
From Certification of Disability to Assessment of FrailtyVery expensive with poor quality of life
Current Approach of Social-Health SystemExpensive with poor qualityof life for subjects andcaregiverHOSPITALIZATIONDISABILITY’wide mesh fishnetFRAILTYNarrow mesh fishnet
O- ychological,social.(Gobbensetal,2010)Vulnerability
The progress of Biomedical Model of tedObjectiveassessmentGait SpeedSPPBHand gripstrengthFerrucci L, Guralnik JM. Practice of Geriatrics Chapter 21. 2007
SPPB and diagnosis of physical frailtyShort Physical Performance Battery can be used to detect physical frailty (cut off 9)(Da Câmara 2013)It is composed by three testsBalance5 Chair Stand4m WalkEach test has a score: from 0 to 4 pointsMaximum Score 12 points (subject fully performant)
Frailty as altered response to stressors and resiliencyInfectionSurgerySeeman TE et al Endocrine Reviews 1994:233-261Frail
The Multidomain Model of frailtyPsychologicalPhysicalPhysicalSocialFrom Cappola AR, Maggio M, Ferrucci L. J Gerontol A Biol Sci Med Sci. 2008;63(7):696-7
EDMONTON FRAIL SCALE
The Story based on physical frailtySubject 94 years old living alone in an apartment located at3 floor without elevator appointed in February 2016 for avisit at Frailty Lab of the University-Hospital of ParmaSymptomSPPB 9Referred Inhability to complete 400meter walking distance between hishouse and newsstand withoutstopping three times (fatigue) since10 daysHeart Failure and moderate aorticstenosisIs it all physical/biological Frailty matter?
The Complete StorySubject 94 years old living alone in an apartment located at3 floor without elevator appointed in February 2016 for avisit at Frailty Lab of the University-Hospital of ParmaSymptomInhability to complete 400 meterwalking distance between his houseand newsstand without stoppingthree times (fatigue)Deterioration ofsymptomsconcomitant to sondeparture for fewmonthsmicronutrientsdeficiencies includingiron, potassium andmagnesiumsleepinessfalllonelinessHeart Failure decompensation and aortic stenosisIt is not physical/biological Frailty matter
Frailty as altered response to stressors and resiliencyHeart failuredecompensationLonelinessSon TemporaryDepartureSeeman TE et al Endocrine Reviews 1994:233-261Frail
TargetBeyond tentiateDiuretictherapyFluid restrictionSocial SupportFalls and FracturespreventionAbility to complete 400 meterwalking distance between his houseand newsstand without stoppingthree times (fatigue)MonitoringICT?
Avoid the Involution of theConcept of ment”(TavaniC.,1978)SOCIO- pic and ClinicalPhysical CHOSOCIALMultidomain ysical,psychological,social.(Gobbensetal,2010).
Take Home MessagesThe biological/physical model of frailty made significantprogress during the last decades making possible theelevation from socio-anthropological condition to ageriatric syndrome.The “vulnerability” is not completely captured by thebiological perspective and the biopsychosocial modeladds important value in both assessment and target ofintervention during frailty.The operationalization of biopsychosocial model isrequired in order to avoid the involution of concept offrailty.
BADLIADL95/1007/8Auto- ‐sufficientAuto- - dividualDEFRA ndMentalFa guePiYsburghFa NUTRITIONALSTATEBODYWEIGHTBMIMNA- - sEQ- ‐5Dver.3L621222–Score0,701Mul ipharmacotherapy
Short Physical Performance Battery can be used to detect physical frailty (cut off 9) (Da Câmara 2013) It is composed by three tests Each test has a score: from 0 to 4 points Maximum Score 12 points (subject fully performant) Balance 5 Chair Stand 4m Walk SPPB and diagnosis of physical frailty
