Blog and Commentary

JS is a 72 year-old caregiver to her 75 year-old husband with advanced heart failure.  She usually brings him in to clinic every 3 months.  In April, she was able to conduct a telemedicine visit with the heart failure clinic. She said her grand-daughter had face-timed with her from out of state and talked her through using the computer to connect to the electronic record, but she had to search for her glasses to read the weight chart to the provider, as she could not scan and upload it. And she got flustered manipulating the camera to show his degree of edema. She requested refills but, she expressed a sincere fear of going to the pharmacy to pick-up the medications, where there may be sick people.  JS is not alone in the adaptations she is making or the stress she feels from having to do so.  Even formerly routine activities of daily living like grocery shopping feel oddly intense, full of new rules and routines. This is not normal time; this is pandemic time, and the impacts on health are likely to be significant even in those who never get COVID-19.  Continue Reading

This post explores Dr. Ravi Varadhan’s motivations for writing “A Socratic Inquiry Into the Nature of Frailty,” published in the Journal of the American Geriatrics Society in 2019. Continue Reading

Please note: this post serves an addendum to the previous blog, Accelerated Frailty and COVID-19.  Colleagues from Johns Hopkins University recently published an important paper (Bullen et al., 2020) the demonstrated that COVID-19 can infect brain cells  The study points out that neurons also have the ACE 2 receptor on their surface, necessary to transfer COVID-19 into a cell.  These findings provide a potentially important explanation for some of the more common brain-related symptoms of COVID-19 infections that we see in frail, older adults.  Continue Reading

Over the past two months, I’ve worked on several occasions as the attending physician on a non-ICU COVID unit at Hopkins Bayview where I treated several older adult patients.  Although many of them had some level of COVID-related pneumonia, many others presented to the hospital in unexpected ways.  One of the more common ‘alternative’ presentations that I observed was one that looks like accelerated frailty with none of the other common signs or symptoms of COVID.  The following clinical presentation represents an amalgam of several patients who presented in this way, and a few thoughts on how COVID infections could provide researchers and clinicians alike important insights into frailty, its etiologies and its potential treatments.  Continue Reading

Consider the following hypothetical scenario from the experiences of an emergency medicine physician: An 84-year-old man is transferred to the emergency department (ED) from a skilled nursing facility (SNF) following three days of mild shortness of breath and non-productive cough. His past medical history includes mild dementia, COPD on home oxygen (4 liters per minute), and atrial fibrillation on anticoagulation and hypertension. The emergency medicine providers have no advanced care directives from the patient’s SNF. On arrival, the patient is awake and alert with a slight increase in work of breathing. The patient’s triage vital signs show a slightly elevated temperature, respiratory rate and heart rate which together with oxygen readings are consistent with a likely respiratory infection; blood pressure of 115/80 is within the range considered normal. His pulmonary exam demonstrates bilateral wheezing. In the Spring of 2020, the above patient commonly presents to the emergency department (ED) where a concern for COVID-19 is at the top of the list of possible problems. Continue Reading

Welcome to the Frailty Science blog!    Whether you are a researcher, clinician, student, policy maker, advocate, older adult, or caregiver—we hope you will find something interesting or useful on the site. We aim to provide a gateway to information for those seeking to learn more about frailty, vulnerability and resiliency in older adults. We hope you will enjoy checking in for the latest frailty-related findings, evidence-based reporting on research and clinical topics, best-practice recommendations from national and international organizations, and guidance on frailty assessment instruments. Continue Reading