الفهرس 
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Abstract
frailty and geriatric syndromes are common geriatric disorders
Frailty is a common ageing problem. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status.
The term geriatric syndromes (GS) has been used to describe common conditions in elderly, although not characterized as diseases, but they can lead to disability and death. GS were announced by Bernard Isaacs (1969), who called them ‘Giants of Geriatric Medicine’ and included cognitive incapacity, postural instability, immobility, urinary incontinence and iatrogenesis (poly-pharmacy).
If frailty and geriatric syndromes were recognized early, preventative measures can be initiated to reduce part of the burden notably by decreasing the risk of hospitalization and institutionalization and improving the quality of life (QOL) of elderly patients.
The previous researches demonstrate a high frequency of frailty in the elderly worldwide. It was also stated that GS are highly prevalent in older adults, especially the frail elderly. And there is a greater chance of the elderly becoming frail as the number of geriatric syndromes accumulates. Frail elders also have an increased risk of developing other geriatric syndromes. Knowing this dynamic can assist in interventions to prevent the development of geriatric syndromes that may lead elderly persons to an increased risk of frailty.
According to the current level of evidence, frailty, geriatric syndromes and their interrelation has been little investigated in Egypt.
This study aimed to investigate the relation between frailty and geriatric syndromes, and the frequency of these conditions in the elderly attending the primary health care centers in Hadaeq El Qobba – Cairo.
A cross-sectional study was performed in two Primary Health care centers (PHCs) in Hadaeq El Qobba –Cairo during the period from August 2020 to November 2020. The study included 264 elderly participants aged 60 and older. Two days in every week was randomly chosen then all participants fulfilling inclusion criteria were included.
Study tools included questionnaire and examination. An interview questionnaire included; Socio-demographic questionnaire for baseline data, medical history, frailty assessment was done using fried phenotype, assessment of geriatric syndromes (cognitive impairement, postural instability, immobility, urinary incontinence, polypharmacy), nutritional assessment was done using MNA and to scan for depression 5-items Geriatric depression scale was used. Examination was including; basic anthropometric measures (body weight and knee height) and hearing assessment was done via whisper test.
Estimated height was calculated using the equation: EH = 64.19 + [2.02 x KH (cm)] - [0.04 x age (years)]. Body Mass index was calculated using the equation (BMI) = (weight (kg)/ (height (m))2. Data was coded, entered, and analyzed using SPSS version 23 (Statistical Package for Social Sciences)
The study sample included 264 elderly participants, 34.5% males and 65.5% females with mean ± SD age 63.66 ± 2.53. Based on Fried phenotype criteria, Frailty was present in (62%) of study participants, whereas (30%) were considered as prefrail and (8%) as robust. Weakness and exhaustion were the most frequent reported symptoms (81.4%) and (75%) respectively. As regard geriatric syndromes, the prevalence of polypharmacy (PP), postural instability, urinary incontinence, cognitive impairment, and immobility were (79.2%, 12.9%, 11.4%, 8.3% and 5.3% respectively). Using MNA scale, the prevalence of malnutrition was 28% while 50.8% of the participants were at risk of malnutrition. The frequency of hearing impairment was 30.7% using whisper test, while 40.9% were at risk of depression using the 5 items GDS. Frailty was highly prevalent in older age, low educational level, retired elderly, in participants with chronic diseases, with hypertension, with diabetes, with hearing impairment. The relations between frailty and (polypharmacy (PP), urinary incontinence, immobility, postural instability and cognitive impairment) are highly significant (P value = <0.001, 0.013, 0.011, <0.001, 0.043 respectively) and risk of being frail increased significantly as the number of geriatric syndromes increased.
Conclusion
• Frailty and geriatric syndromes (polypharmacy (PP), postural instability, urinary incontinence, cognitive impairment, immobility) are highly prevalent among elderly.
• Weakness and exhaustion were the most frequent reported symptoms among frail and prefrail elderly.
• Polypharmacy is the most frequent geriatric syndrome among elderly followed by postural instability, urinary incontinence, cognitive impairment and immobility respectively.
• There is a significant relationship between frailty and geriatric syndromes. Moreover the risk of being frail increased significantly as the number of geriatric syndromes increased.
Recommendations
1. It’s important to screen the elderly for both frailty and geriatric syndromes for early detection and intervention and the frequency of screening should increase with advancing in age.
2. It is also important to start prevention at younger age by preventing the risk factors of frailty and geriatric syndromes.
3. Health education should be directed to elderly and their care givers about the healthy nutrition of elderly
4. Screening of malnutrition among the elderly to prevent the highly prevalent malnutrition among them.
5. It’s also important to encourage sticking to mediterrenian diet hence prevent frailty.
6. A comprehensive medication review and risk assessment should be done for each elder before prescribing any new medication to prevent the highly prevalent polypharmacy and to prevent replication of any medication.
7. It’s recommended to encourage retired elderly to share in a suitable physical activity to prevent the high susceptibility to frailty that increase after retirement due to sedentary life.
8. It’s also recommended to enhance life style modifications and to encourage younger adult to share in physical activities to prevent early occurrence of frailty.
9. Increase training of general physicians of primary health centers to perform better screening for these geriatric syndromes and providing curative and rehabilitative services for them.
10. Telemedicine is recommended to be used in health education for frailty, healthy nutrition and geriatric syndromes.
11. It’s recommended to obtimize normal level of vit D due to its reported relationship with frailty.