The overall goal of this procedure is to demonstrate a rapid, easily performed battery of tests to identify frailty in HIV infected individuals. This is accomplished by screening patients beforehand and selecting those at risk for frailty. The second step is to determine if patients are cognitively impaired using a mini cog test.
If further testing is appropriate, the patient is then administered several tests to identify frailty. Once identified treatments to address those components that contribute to frailty are discussed with the patient. Ultimately, the appropriate treatment may ameliorate or reverse frailty in HIV infected patients.
We first had the idea for this method when we realized that many of our HIV patients were struggling with frailty and we needed a method of measuring it. One of the advantages of the method we adopt is it's clearly measurable and it's been validated in the literature. Ms.Hillary Reese will be demonstrating the procedure.
Ms.Hillary Reese is a graduate student in the division of Infectious Diseases. She completed her study in our Peterson's clinic. Begin the assessment by weighing the patient and assessing for weight loss.
Someone who is frail may have unintentional weight loss of greater than or equal to 10 pounds in the prior year. Measure the patient's height and record their body mass index. Patients entering care with a CD four cell count of less than 200 complaining of unintentional weight loss, severe neuropathy, or who are not compliant with HIV therapy are candidates for frailty testing.
Explain the tests and obtain the patient's verbal consent to undergo tests for frailty or weakness. Next, perform a mini cog test. If the patient appears confused or apathetic, ask the patient to remember three unrelated words and then say the words out loud.
Next, instruct the patient to draw the face of a clock. After the patient puts the numbers on the clock face, ask him or her to draw the hands to read a specific time. After this, ask the patient to repeat the three previously stated words.
Give one point for each recalled word. Patients recalling none of the three words are classified as cognitively impaired. While patients recalling all three words are classified as cognitively intact.
Patients with intermediate word recall of one to two words are classified based on the clock draw test. If the patient fails the mini cog, the clinician should examine further for causes of confusion or delirium testing for frailty would not be appropriate at this time. Begin the frailty testing by timing the patient's walk for slowness.
Someone who is frail has a decreased walking time as defined by a timed 15 foot walk test using a dynamometer. With the value adjusted for gender and body mass index. Determine if the patient has decreased grip strength indicating weakness.
The Minnesota Leisure Time activity questionnaire is then used to determine if the patient has a low physical activity level. This questionnaire asks about activities like daily living, sports, and hobbies. Next, determine if the patient chose evidence of exhaustion.
This is self-reported by answering questions from the Center for Epidemiologic Studies Depression scale based on the patient's answers, determine if the patient exhibits depressive symptoms. Finally, if frailty is identified, discuss treatment options for the components that contribute to frailty in the patient of the 100 outpatient HIV one infected persons tested for clinical markers of frailty. 81, were not frail, and 19 were frail at their initial assessment.
As seen here, the younger patients had a greater incidence of frailty, and this was associated with lower CD four cell counts. When seven frail patients were measured for frailty six months after their initial assessment, two that had refused therapy were dead. Four were no longer frail and only one patient remained frail.
This demonstrates that frailty can be ameliorated if addressed properly. These results show that the longer patients take antiretroviral therapy, the less incidence of frailty there is in that population. These findings support the recent emphasis of starting HIV patients on antiretroviral drugs early in the course of disease.
Once mastered, the procedure can take about 15 minutes to complete. After watching this video, you'll have a better understanding of how to rapidly measure frailty in HIV patients. Don't forget to record the results.
Place them in the medical record for future reference in comparison.
