8 - Frailty and Palliative Care Flashcards
What is the definition of fraility?
“A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death.”
Can be prevented or reversed
What are some signs of fraility and who should we assess for fraility?
- Unintentional weight loss (10 lbs in past year)
- Self-reported exhaustion
- Weakness (grip strength)
- Slow walking speed
- Low physical activity
What are some clinical consequences of fraility?
- deconditioning
- falls
- hypostatic pneumonia
- thromboembolism
- constipation
- increased risk of dying during a hospital stay
- higher risk for adverse event
What tool can be used to measure frailty?
Rockwood Clinical Frailty Scale
Helps you decide what the patient was at before and gives an aim to get back to
What are the parts of the Comprehensive Geriatric Assessment?
- Non-specific presentations: still may be serious
- Multiple comorbidities
- Functional decline and altered homeostasis: altered drug handling
- Differential challenge
This tool addresses all of the above
Why do we measure frailty?
Can help us predict how a patient is going to respond to certain stressors
How will a patients’ frailty score affect their management plan?
Helps to tailor managment plan to the individual so patient centred
Why are problem lists useful?
Geriatric syndromes e.g delirium, can be due to a number of comordities the patient may have so having a list can help you solve all of the possible causes to resolve the syndrome
What are the key objectives of palliative care?
- Holistic care rather than just symptom control
- Alleviation of suffering, which maybe physical, psychological, emotional, social or spiritual for a person with a far advanced progressive life-threatening disease which is incurable and where the prognosis is limited
- Aim to help family as well as patient
What are some challenges in achieving a ‘good death’?
- Lack of training in palliative care for undergraduates
- Coming to terms with one’s own mortality
- The need for spiritual care and recognition of the concept of ‘total pain’
- Unfamiliarity with death as a natural part of the normal life cycle as it is taboo
- The place of death
- Recognising the point at which curative treatment is futile
- Getting ‘stuck’ in one of the psychological stages of dying
- Lack of a healing contract
A good death involves a ‘healing contract’, what is this?
What are the stages of Anicipatory Grief that occur to a patient and their family at the end of their life?
Stages don’t have to be in order!
What is spiritual pain that happens when a patient is dying?
When a patient has conflicts they need to resolve and let go of or they need to say goodbye to certain people, if these do not happen then the patient can experience physical pain so as doctor want to help them facilitate these things
What can be done for the informal carer (e.g spouse or sibling) of a dying patient?
- Respite care
- Grief counselling before and after death
- Ensure they don’t feel guilty after death and assure they did a good job
What is the definition of euthanasia and what is the UKs stance on this topic?
- Some argue a request for euthanasia means inadequate palliative care
- ‘Passive euthanasia’ is allowed in the UK under certain circumstances, e.g withdrawal of life support when in patient’s best interest, but active is illegal (NHS website)
- Can get 14 years imprisonment
What are some aspects that may define a good death?
IMPORTANT CARD
Morphine and Opiates are good for painfree death
What are some arguments for and against euthanasia?
What is the reSPECT tool?
- National guidance on CPR decisions
- shared decisions, made for the benefit of the person to try to ensure that future decisions about their care are in their best interests
- Should be reviewed if the patient moves from one care setting to another, if the patient or relatives request a review or if the patients condition changes
What can hospices offer to patients with end stage heart failure?
- Terminal when they have a life expectancy of less than 6 months
- Pain and Symptom control for wherever the patient lives
- Emotional and spiritual assistance for patient and family
- Coordinated care at every level
- Financial asssitance for family
- Respite care
- Bereavement services
- Help with difficult decisions
Why are hospices good for patients with end stage COPD?
