Clinical Frailty and Multimorbidity

Question 1

Frailty is a a syndrome of physiological decline in late life, leading to an increased vulnerability to poor resolution of homeostasis after a stressor event. Are frail patients able to respond to stressors as well as non-frail patients?

Answer 1

• no

Question 2

Morbidity relates to having a disease or condition. How many many diseases/conditions is defined as multimorbidity?

1 - >2
2 - >3
3 - >4
4 - >5

Answer 2

1 - >2

Disability:
impairments, activity limitations, and participation restrictions caused by interaction between person’s body and features of society

Question 3

Do all people who have multi-morbidities have frailty?

Answer 3

• no

Question 4

What % of patients with multi-morbidities have frailty?

1 - 2.1%
2 - 9.2%
3 - 21.5%
4 - 35.5%

Answer 4

3 - 21.5%

Question 5

By 2034 what number of over 65yo will have multimorbidity?

1 - 1/20
2 - 1/10
3 - 1/5
4 - 2/3

Answer 5

4 - 2/3
- these multimorbidity patients currently use:
- 50% GP appointments
- 55% of hospital admissions
- 80% of prescriptions
- 3% of over 65yo have a degree of frailty
- Increasing to 50% of over 80yo

Question 6

The phenotype model of frailty was 1st described by Fried (2001). He stated that there are a number of presentations that make-up a phenotype of frailty. How many of the following would be needed to satisfy the phenotype model of frailty according to Fried?

• unintentional weight loss
• exhaustion
• muscle weakness
• slowness while walking
• low levels of activity

1 - >2
2 - >3
3 - >4
4 - >5

Answer 6

2 - >3

• > 2 was defined as pre-frailty

Question 7

The cumulative deficit model includes a range of different clinical factors and assigns a score. This score is the ratio of the number of deficits a person may experience and the total number of considered deficits based on which of the following?

1 - Symptoms
2 - Signs
3 - Diagnoses
4 - all of the above

Answer 7

4 - all of the above

Question 8

What tool do GPs used in an attempt to identify patients who are at risk of frailty?

1 - CURB-65 score
2 - Wellness score
3 - Electronic Frailty Index (eFI)
4 - Modified Glasgow score

Answer 8

3 - Electronic Frailty Index (eFI)
- GPs able to review patients online

Question 9

GPs use the Electronic Frailty Index (eFI). Which of the following is this model NOT able to predict?

1 - falls
2 - nursing home admission
3 - hospitalisation
4 - mortality

Answer 9

1 - falls

Question 10

The rockwood score is a designed to allow an objective assessment of frailty in the clinical environment. It is a hybrid of which 2 models?

1 - Cumulative Deficit Model
2 - Phenotype Model
3 - Genetics model of ageing
4 - Wellness model

Answer 10

1 - Cumulative Deficit Model
2 - Phenotype Model

Question 11

In the rockwood score, does a high or low score indicate greater frailty?

Answer 11

• higher score

Question 12

What is the purpose of the Clinical Frailty Scale App?

1 - for use by frontline staff
2 - allow staff to undertake clinical frailty scoring with patients in real time
3 - assesses patients from severely frail to non-frail and identifies level of frailty
4 - provides recommendations on management of patients
5 - all of the above

Answer 12

5 - all of the above
- able to reliably predicts survival rates after all cause ED attendance

Question 13

Clinical teams need to be able to identify patients who are frail. This can be achieved by identifying patients with a frailty syndrome. Which of the following is NOT a frailty syndrome:

1 - Patients with Parkinsons
2 - Fallers
3 - Patients with delirium
4 - Patients with immobility
5 - Patients with incontinence
6 - Patients with polypharmacy / drug side effects
7 - Care home residents or those with large care packages

Answer 13

1 - Patients with Parkinsons

Question 14

In patients with severe frailty, they are four times more at an increased risk of all of the following, EXCEPT which one?

1 - Hospital admission
2 - Requiring a care package
3 - Care home placement
4 - Death

Answer 14

2 - Requiring a care package
- even non-severe frailty patients are at increased risk of needing a care package

Question 15

In patients admitted who are admitted to hospital with Frailty there is an increased incidence of all of the following EXCEPT which one?

1 - Falls
2 - Hospital associated infections
3 - Hospital acquired delirium
4 - Fractures
5 - Pressure damage
6 - Incorrect diagnosis
7 - Adverse drug reactions
8 - Mortality
9 - Length of stay

Answer 15

4 - Fractures
- unless it is as a direct result of a fall

Question 16

Following a Complete a Comprehensive Geriatric Assessment we should do which of the following EXCEPT which one?

1 - Treat co-morbidities
2 - Review polypharmacy and de-prescribe if appropriate
3 - Ensure vitamin D is checked an adequately replaced
4 - Advice on exercise and nutrition
5 - Initiate advanced care planning discussions
6 - all of the above

Answer 16

6 - all of the above
- where possible and appropriate give preventative advice (exercise and nutrition) and look into disease modifying treatments such as anti-inflammatory / hormonal therapies

Question 17

We can use tools such as the Electronic Frailty Index (eFI) to identify those at risk of frailty, but which of the following are benefits of identifying patients who are at risk of frailty?

1 - patients managed based on functional status and not chronological age
2 - identify and prevent those in the community at greater risk of hospital admission, care home placement
3 - identify patients admitted to hospital/care homes who will benefit from specialist geriatric service (Medicine – acute frailty services, Surgery – perioperative medicine (including elective surgery and Orthopaedics - Orthogeriatrics)
4 - all of the above

Answer 17

4 - all of the above