Article

Asia-Pacific Clinical Practice Guidelines for the Management of Frailty

Nutrition & Disease Management

07.11.2019

4 min read

Frailty is characterized by a ‘reduced strength and physiologic malfunctioning that increases an individual’s susceptibility to increased dependency, vulnerability, and death’, making it a major public health problem in the geriatric population
Due to the lack of guidelines in the treatment of frailty, a group of experts has recently consolidated and developed a set of evidence-based, multidisciplinary Clinical Practice Guidelines (CPGs) for the identification and management of frailty for health practitioners in the Asia-Pacific region

The recommendations provided herein are intended for use by healthcare providers in their managements of older adults with frailty in the Asia Pacific region.

Seven key recommendation areas:

Strongly recommend	1. Use of a validated measurement tool to identify frailty, such as using the Comprehensive Geriatric Assessment (CGA) Routine screening should be done in adults aged 70 years and older, as well as those who had unintentional weight loss (>5%) in the previous year
2. Referral of older adults with frailty to a progress, individualized physical activity program with a resistance training components Resistance exercises mimicking daily activities should be encouraged, and higher intensity training appear to have more benefits Balance exercises are also recommended together with resistance training once a patient is able to stand The program should be supervised and individually tailored
3. Reduction of any inappropriate/superfluous medications Frailty development has been linked with polypharmacy, therefore medications prescribed to frail older people should be reviewed regularly
Conditionally recommend	4. Screening for reversible causes of fatigue in persons with frailty Some research has indicated screening and targeted interventions for fatigue can improve outcomes in this group Treatable causes of fatigue include sleep apnea, anemia, hypothyroidism and vitamin B12 deficiency
5. Screening,for reversible causes and consideration for protein and caloric supplementation in older adults with frailty who exhibit unintentional weight loss Potentially reversible causes include illness, dementia, medications, and swallowing problems Food fortification (energy dense meals) is the frontline recommendation, with supplements for complementary consideration Supplementation with Essential Amino Acids (EAAs) is suggested Recommended daily protein intake for older adults by expert groups varies from 0.9 g/kg body weight (BW) per day, up to 1.5 g/kg BW/d for those with malnutrition. To note, renal function should be monitored when supplementing with high levels of protein
6. Prescription of vitamin D for older adults who are deficient in vitamin D Sun exposure is important, while vitamin D supplementation remains controversial
No recommendation	7. Provision of an individualized support and education plan for older adults with frailty

Strongly recommend

1. Use of a validated measurement tool to identify frailty, such as using the Comprehensive Geriatric Assessment (CGA)

Routine screening should be done in adults aged 70 years and older, as well as those who had unintentional weight loss (>5%) in the previous year

2. Referral of older adults with frailty to a progress, individualized physical activity program with a resistance training components

Resistance exercises mimicking daily activities should be encouraged, and higher intensity training appear to have more benefits
Balance exercises are also recommended together with resistance training once a patient is able to stand
The program should be supervised and individually tailored

3. Reduction of any inappropriate/superfluous medications

Frailty development has been linked with polypharmacy, therefore medications prescribed to frail older people should be reviewed regularly

Conditionally recommend

4. Screening for reversible causes of fatigue in persons with frailty

Some research has indicated screening and targeted interventions for fatigue can improve outcomes in this group
Treatable causes of fatigue include sleep apnea, anemia, hypothyroidism and vitamin B12 deficiency

5. Screening,for reversible causes and consideration for protein and caloric supplementation in older adults with frailty who exhibit unintentional weight loss

Potentially reversible causes include illness, dementia, medications, and swallowing problems
Food fortification (energy dense meals) is the frontline recommendation, with supplements for complementary consideration
Supplementation with Essential Amino Acids (EAAs) is suggested
Recommended daily protein intake for older adults by expert groups varies from 0.9 g/kg body weight (BW) per day, up to 1.5 g/kg BW/d for those with malnutrition. To note, renal function should be monitored when supplementing with high levels of protein

6. Prescription of vitamin D for older adults who are deficient in vitamin D

Sun exposure is important, while vitamin D supplementation remains controversial

No recommendation

7. Provision of an individualized support and education plan for older adults with frailty

Important note:

Health practitioners should select the most appropriate interventions outlined in this CPGs, which are consistent with patient’s frailty stage, preference and feasibility

Reference

Dent E, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. JAMDA. 2017;18:564-675.
Link to full publication: http://www.jamda.com/article/S1525-8610(17)30241-4/fulltext

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