Diabetes and Frailty
Frailty is an age-related condition characterized by a decline in the reserve capacity of multiple physiological systems, which leads to geriatric syndromes, disability, and mortality. Frailty is often observed among diabetic patients. In the clinical pra
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Diabetes and Frailty Mitsutaka Yakabe and Sumito Ogawa
Abstract Frailty is an age-related condition characterized by a decline in the reserve capacity of multiple physiological systems, which leads to geriatric syndromes, disability, and mortality. Frailty is often observed among diabetic patients. In the clinical practice for frail diabetic elderly, glycemic control should be personalized in order to minimize the risk of severe hypoglycemia and hyperglycemia. Other interventions for frailty with diabetes include nutrition, exercise, and avoiding polypharmacy. Keywords Frailty • Fatigue • Falls • Geriatric syndrome
12.1 Introduction Worldwide population aging is accelerating, and the most problematic expression of population aging is the clinical condition of frailty. Frailty develops as a consequence of age-related decline in multiple physiological systems, which results in a vulnerability to sudden health status changes triggered by relatively minor stressor events [1]. In this chapter, we describe the relationship between frailty and diabetes and the management of frailty with diabetes.
12.2 Definition of Frailty Frailty is a dynamic, age-related condition characterized by a decline in the reserve capacity of multiple physiological systems [1]. When exposed to an apparently small stress, such as a new drug, minor illness, or minor surgery, a healthy elderly can almost entirely recover in a relatively short time. In a frail elderly, however, resistance to stressors is decreased. Therefore, the stress results in a striking and M. Yakabe • S. Ogawa (*) Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Bunkyo-ku, Tokyo, Japan e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2018 S.-i. Yamagishi (ed.), Diabetes and Aging-related Complications, https://doi.org/10.1007/978-981-10-4376-5_12
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disproportionate change in health state—i.e., from independent to dependent, mobile to immobile, postural stability to proneness to falling, or lucid to delirious— and the person’s functional ability might not recover to the previous level even after the stress was removed. Frailty is supposed to be one of geriatric syndromes. It leads to increased risk of adverse health outcomes, such as low mobility, falls, functional decline, hospitalization, and death. The world is aging rapidly, and the number of frail elderly will lead to increased cost of healthcare and social security [2].
12.3 Clinical Presentations of Frailty 12.3.1 Fatigue In older adults, fatigue is common and associated with functional deficits and survival. A simple question whether the patient “feels tired most of the time” could identify older adults with a higher risk of mortality [3].
12.3.2 Falls Balance and gait impairment are major features of frailty and are important risk factors for falls. Spontaneous falls occur in severe frailty and are typically repeated, associated with fear of further falls that makes the patient less mobile [1].
12.3.3
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